CARE HOMES FOR OLDER PEOPLE
Elm Royd Nursing Home Brighouse Wood Lane Brighouse West Yorkshire HD6 2AL Lead Inspector
Liz Cuddington Unannounced Inspection 23rd May 2006 10:15 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Elm Royd Nursing Home Address Brighouse Wood Lane Brighouse West Yorkshire HD6 2AL Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01484 714549 Philip Bennett (Elmroyd) Ltd Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Can provide accommodation and care for one service user under 65 years of age category physical disability (PD). Can provide 5 intermediate care places for older people over 65 years of age. 13th January 2006 Date of last inspection Brief Description of the Service: Elm Royd Nursing Home offers nursing care, personal care and accommodation for up to 45 people over 65 years of age. This includes 5 places registered for intermediate care as well as 1 place for an adult with a disability under 65 years of age. There are 31 single bedrooms, 22 of which have en suite facilities, and 7 twin bedrooms. The home is located in a residential area of Brighouse just a short distance from the town centre and near to the bus routes between Brighouse, Elland and Halifax. The current fees range from £323 - £500 per week. Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. In April 2006 the Commission for Social Care Inspection (CSCI) made some changes to the way in which care services are inspected. Care services are now judged against outcome groups. The inspection report is divided into separate sections for each outcome group, for example ‘Choice of Home’, ‘Health and Personal Care’. An overall judgement is made for each outcome group based on the findings of the inspection. The judgements reflect how well the service delivers these outcomes to the people who use the service. The judgement categories are “excellent”, “good”, “adequate” and “poor”. The judgements are recorded in the main body of this report. More detailed information about these changes is available on our website – www.csci.org.uk This unannounced visit was carried out by two inspectors on the first day and one inspector returned on a second day. There have been other visits to the home before this inspection to investigate a complaint. The complaint was about care practices and staffing levels and was partly upheld. The home has taken appropriate remedial action as a result of the complaint findings. An additional part of the complaint had already been resolved by the home. The methods we used to gather information included conversations with residents and staff, examining records, and touring the house. We also talked with residents’ relatives and visiting health care professionals and sent out questionnaires for residents to complete. Before the inspection the acting manager completed a pre-inspection questionnaire, which provided useful information about the home and the care services it provides. This purpose of this inspection was to assess a selection of the National Minimum Standards for Older People and to assess the home’s progress in meeting the requirements and recommendations from the last inspection. We looked at twenty-six of the thirty-eight standards. Seven requirements, three of which have been brought forward from the last inspection, and five good practice recommendations have been made following this inspection. This represents an improvement from the last inspection when seven requirements and twelve recommendations were made. While there have clearly been significant improvements since the last inspection, there are still a number of areas for improvement. The outcomes for residents in each outcome group were judged to be either “good” or “adequate”. For the home to achieve all “good” or “excellent” outcomes the programme of improvement will have to be sustained. I would like to thank everyone who lives and works at Elm Royd Nursing Home for their welcome and hospitality during the inspection. Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection?
The home has now developed new pre-admission records which are much more comprehensive, giving a clearer picture of residents needs. The intermediate care service has improved. There is now a dedicated staff team and residents have the use of an alternative lounge/dining room. The Primary Care Trust manager responsible for intermediate care in Calderdale, confirmed that the service has improved, although there is still scope for further development. In general, positive comments were made about the services provided by staff for the residents. One relative said the staff were more efficient, and she felt her mother’s care had improved. The staff appeared more confident in what they were doing.
Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 7 A new handrail had been fitted to the external steps, to provide assistance for people with poor mobility to gain easier access the home. The recruitment procedure has improved, but requires some further action to ensure staff employed at the home are suitable to work with vulnerable adults. A new system of working has been introduced. Senior care staff allocate a work sheet rota for care staff. This identifies their responsibilities whilst on duty. Care staff told me this was working well for the benefit of residents, as it was a more personal approach to providing care and support to residents. A number of staff said that recent changes introduced by the new management team were an improvement. They had been consulted about changes, and believed these had improved the quality of life for the residents. They were confident that the manager listens to their concerns and resolves them where possible. Care staff said that they are now having one to one supervision with their manager. The quality assurance system has been expanded and includes regular residents and relatives meetings as well as staff meetings. It is currently being further developed. The kitchen is cleaner and tidier than at the last inspection and the walls have been painted. A new dry goods storeroom has been created. What they could do better:
In the care plans that I saw there was limited information about each individual’s social interests. Wherever possible, the resident or their family should be involved in developing and reviewing the care plan and sign the plan to confirm their agreement. When the staff members who usually work with intermediate care residents are not available the ‘stand in’ staff need to be better briefed. The medication practice is still unsatisfactory. Nursing staff must be aware of, and use, safe methods for administering medicines. All clothes should be marked with the owner’s name to make sure they are returned to the right person after laundering. Tea is served at approximately 4pm, only three hours after lunch. Most of the residents said they were not hungry. The manager should consult with residents to consider introducing a later teatime. The practice of re-heating residents’ lunchtime meals to serve at teatime must stop. Environmental health guidelines should be introduced into the kitchen to reduce the risks to residents.
Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 8 A number of bathrooms and toilets had doors that did not lock. This could compromise the dignity of residents. The home’s recruitment procedure has improved, but requires further action to ensure staff employed at the home are suitable to work with vulnerable adults. Staff would benefit from training in Infection Control, so that they understand and implement practices to minimise the risk of cross infection. At the time of the inspection the home had not achieved the target of 50 of care staff with an NVQ qualification. The door to the manager’s office is still not always kept locked when the room is unoccupied. As this room houses confidential information it is essential that it is secure at all times. The door is also sometimes wedged open, constituting a potential fire hazard. The kitchen floor covering is worn and needs to be replaced and many of the cabinets are of domestic quality and unsuitable for a commercial kitchen. Some of the doors are broken and ill fitting and one was missing. The kitchen needs to be re-planned and refurbished. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to the service. Prospective residents’ needs are assessed to make sure they can be met before they are offered a place. The intermediate care service has improved. There is now a dedicated staff team and residents have the use of an alternative lounge/dining room. EVIDENCE: I looked at a number of residents files and the pre-admission documents covered most of the daily living information needed. There was limited information in these files about individual’s social interests. The home have now started to use a new pre-admission document and the completed one that I saw was much more comprehensive than the previous version. It gave a clearer picture of the person’s needs and meant that a better
Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 11 informed judgement could be made about whether or not the home would be able to meet the individual’s needs. The intermediate care service has improved since the last inspection. The upstairs lounge is now being used as both a lounge and dining room. There are dedicated members of staff who provide the regular care and support for this group of residents. Due to staff sickness on the day of the inspection, there were other staff members working with these residents. When this situation occurs the ‘stand in’ staff need to be better briefed, as they seemed to be unclear about their role. The Primary Care Trust manager responsible for intermediate care in Calderdale confirmed that the service has improved, although there is still scope for further development. More training is to be provided for the staff, in addition to the training they have already completed. Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to the service. The plans include the information and risk assessments needed to plan an individual’s care. Some, but not all, care plans show that they have been developed and agreed with the residents or their family. This process is ongoing. Residents have access to the health care services they need and records are kept. One area of medication practice is still unsatisfactory. Staff must be aware of, and use, safe methods for administering medicines. Residents are treated with respect by the staff at Elm Royd, although in one area there is still scope for improvement. EVIDENCE: I looked at a number of individual care plans. They contained a lot of valuable information on all aspects of care and showed that reviews are regularly
Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 13 carried out by the nursing staff. One plan I saw referred to the resident’s family being involved in the review process. It is important that, wherever possible, the resident or their family are involved in developing and reviewing the care plan and that they sign the plan to confirm their agreement. This is not happening yet. There was plenty of information showing that resident’s health care needs are being met. The care plans showed how people’s individual needs are attended to and that health care professionals, such as the tissue viability nurse, are involved in planning the specialist care. The plans contain nutritional screening and skin integrity assessments, as well as moving and handling plans and risk assessments. Wound and pressure care is well documented and demonstrates the treatment and progression of the area. Staff record in the daily reports what treatment has taken place each day. Staff giving personal care to residents who are nursed in bed, should include attention to oral care and encourage residents to take regular fluids. This would help reduce the potential risk of infection and dehydration. I was told that all the nursing staff are taking medicines administration training. A trainer is attending the home for this. The Medicines Administration Record charts that I looked at were accurate. At lunchtime on the first day of the inspection I observed two nurses, one on each floor of the home, removing medicines from the dispensing packaging, transferring them to individual pots and carrying these across the home to the residents. This practice is unsafe and must cease. The rack of blister packs containing the lunchtime medicines is small and can easily be carried intact to the residents, if the nurse does not wish to move the medicines trolley. Any liquid medicines must also be taken to the resident in the bottle and the dose poured immediately before offering it to the resident. The staff were seen to treat the residents respectfully and maintain their dignity. I saw one member of staff escort a resident to the bathroom to apply some cream in private, even though the resident would have allowed the cream to be applied in the communal area of the home where he was sitting. In the laundry I was shown a large number of residents’ clothes, which were not labelled. All clothes should be marked with the owner’s name to make sure they are returned to the right person after laundering. If this is not possible, then a different system needs to be developed to make sure all clothing is returned to the right person. After lunch three residents were taken into the lounge and left in the middle of the room in their wheelchairs, instead of being assisted to armchairs. When I
Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 14 asked why this had occurred a member of staff said it was because they were short staffed. It is not acceptable that residents are left ‘parked’ in the lounge for long periods. Residents should be assisted into their armchairs as soon as they enter the lounge. Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to the service. Residents are able to choose how and where they spend their day. There is a lack of suitable social activities for all of the residents. Residents are supported and enabled to maintain contact with family, friends and the local community. The home has open visiting arrangements and residents know they can entertain family and friends in their own room or in the communal areas of the home. Information about independent advocates is readily available. The meals are satisfactory and meet the dietary needs of the residents. Staff are trained to help those residents who need help when eating and are sensitive in their approach. EVIDENCE: During conversations with a number of residents, they confirmed that the home does not currently provide a weekly programme of social activities. Their comments included “nothing happens here” and “ I am bored, it is a long day.”
Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 16 Another service user said he enjoyed chatting to the staff, and a good rapport was observed between them. Before this inspection a care assistant had been spending two days a week focusing on activities for residents. There were good records showing what had been done, and who had enjoyed the one to one and small group activities. This is no longer available, and the only social stimulation appeared to come from a television in the upstairs lounge that no one was watching. Music is now played in one area of the downstairs lounge. The residents would benefit from regular social activities to enable their days to be more fulfilled. In one resident’s room the family had put up signs and pictures, showing how the service user likes to spend her day. I spoke with a number of visitors. Generally, positive comments were made about the services provided by staff for residents. One relative said the staff were more efficient, and she felt her mother’s care had improved. It was commented that the home had lost some of its homely touch, but staff appeared more confident in what they were doing. I was concerned that one visitor, who had been at the home for most of the day, was not offered refreshments. On the second day of the inspection a refreshment table had been set up with a flask of hot water and everything needed for visitors to make themselves hot drinks. One person, visiting for the first time, knew the manager’s name and felt confident to contact him if he had any concerns about his relative’s care. Information about independent advocates was displayed in the main downstairs corridor. This enables residents to have independent support and advice from someone external to the home. Residents can eat their meals in one of two dining rooms, or in their own rooms. One resident was enjoying a full English breakfast when I first visited the dining rooms. He said he looked forward to it every morning. Another resident had chosen toast and tea. The residents were not hurried to finish their breakfast, and were provided with assistance from staff when necessary. There was a choice of mid-day meal, but most residents could not remember what they had chosen. The manager should consider introducing daily menu boards into both dining rooms. This would remind residents what was available on the day. The cook serves meals from the kitchen. The portion sizes varied depending on the individual appetites of the residents. One resident said he could have second helpings if he wished. Another resident did comment that the meals could be better.
Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 17 The dietary needs of diabetics were well met, as the cook uses a sugar substitute in all home baking. The pureed food, served to residents who need a soft diet, was well presented. Staff were seen providing appropriate and discreet support to residents who needed assistance to eat their meals. The manager must make sure that all the intermediate care residents are aware of mealtimes. One person was not aware that the lunchtime meal had been served and it was a visitor who brought this to the staff’s attention. Tea is served at approximately 4pm. This is only three hours after lunch. Most of the residents I spoke with said they were not hungry. The manager should consult with residents to consider introducing a later teatime. Supper drinks are served at 7pm. The fresh vegetables were of good quality but better storage facilities, away from the heat of the kitchen, would help to better preserve their quality and nutritional value. Generally, the kitchen was cleaner than at previous inspections. An area under the kitchen sink required attention, as it was very dirty. The home does not have a hot trolley to transport food from the kitchen to the upstairs dining room. The staff and manager said one was on order. On the day of the inspection one resident’s lunchtime meal was to be reheated and served at teatime. This is a potentially unsafe practice and must stop. Environmental health guidelines should be introduced into the kitchen to reduce the risks to residents. Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 18 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to the service. The home has a complaints procedure that is available within the home to residents and relatives. Any complaints received are dealt with in a timely manner and in accordance with the home’s policies and procedures. There are suitable policies and procedures for dealing with any allegations of neglect or abuse and staff are aware of how to express any concerns they may have. EVIDENCE: I looked at the complaints file. This, and other information I have seen, shows that the home deals with any complaints in a timely and thorough manner. Where needed, changes are made to practices in the home as a result of complaints’ investigations. The home has suitable policies and procedures for the protection of the people who live at Elm Royd. Staff are aware of how to use the ‘whistle blowing’ policy and procedure if they have suspicions of neglect or abuse. Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 24 & 26 Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to the service. The home has a well-maintained environment and provides the adaptations and equipment needed to meet the care needs of the residents. It is a pleasant and safe home with rooms that meet the National Minimum Standards. The home was clean, tidy and generally free from odour. A number of bathrooms and toilets had doors that did not lock. This could compromise the dignity of residents. EVIDENCE: There was evidence of a refurbishment programme and decorations were ongoing in a resident’s room. By the second day of the inspection this work had been completed and the resident had moved in. The resident said she was
Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 20 highly delighted with her new room and had chosen the colour scheme and décor herself. The practice of wedging open the office door continues. This puts people at risk if a fire were to occur in this room. Documentation confirmed that fire safety equipment and fire drills are carried out on a regular basis. A new handrail has been fitted to the external steps, to provide assistance for people with poor mobility to gain easier access the home. There were a plenty of rubber gloves and disposable aprons for use by staff, when providing personal care to residents. One domestic was on duty. She was new to the post, and because she had not received training in safe moving and handling, and safe use of chemicals hazardous to health, some of her work practices were unsafe. She was advised not to leave cleaning chemicals unattended, as a service user may be caused harm by coming into contact with them. The home was clean and tidy, and generally free from odour. However, one inspector noticed an unpleasant odour on the corridor near the downstairs lounge. It had gone by the second day of the inspection. A carpet in one bedroom required attention, as it was taped down and presented a tripping hazard to people using the room. A number of bathrooms and communal toilets were without locks, or had locks that did not work. This compromises the dignity of people using these facilities. Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using the available evidence, including a visit to the service. The numbers and skill mix of staff is sufficient to meet the residents’ needs. The staff are clear about their role and what is expected of them. The home’s recruitment procedure has improved, but requires further action to ensure staff employed at the home are suitable to work with vulnerable adults. There is some staff training, but there is still a lot to be done to make sure that the staff have all the necessary skills and knowledge to meet residents’ needs. EVIDENCE: The staff rotas were reviewed. The numbers and skill mix of staff on duty appeared to meet the needs of residents. The residents said that the staff are caring and understand how to assist them. The home had a number of vacancies for residents. Staffing levels will need to be reviewed when the home is at full capacity, to ensure the needs of residents can be met. A new system of working has been introduced. Senior care staff allocate a work sheet rota for care staff. This identifies their responsibilities whilst on duty. Care staff told me this was working well and for the benefit of residents, as it was a more personal approach to providing care and support.
Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 22 Four staff recruitment files were looked at. All four demonstrated the home had undertaken a thorough recruitment process. However, not all of the files showed evidence that the providers had undertaken the specific checks needed to ensure that the new staff were suitable to work with vulnerable people. This includes Criminal Records Bureau and Protection of Vulnerable Adults register checks. A nurse’s file showed that she is registered with the Nursing and Midwifery Council. This confirms her right to work as a nurse. There was evidence of a work permit allowing her to work at the home. Application forms and references, plus interview notes, and a copy of a contract of employment were all on file. Staff training records were not easy to review. They were mixed with old certificates and not in any order. There was evidence of recent moving and handling training in January 2006 attended by most staff. Staff said they had attended training on health and safety, adult protection, pressure area care and diabetes. Staff would benefit from training in Infection Control, so that they fully understand and implement practices to minimise the risk of cross infection. Some of the care staff have achieved an NVQ qualification. One carer said she was getting lots of help from her assessor, who also worked at the home. At the time of the inspection the home had not achieved the target of 50 of care staff with an NVQ qualification. Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 23 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 37 & 38 Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to the service. The acting manager has the necessary qualifications and experience to manage the home effectively. There are quality assurance systems in place and these are being developed further. Residents’ monies are handled correctly and accurate records are kept. Care staff receive one to one supervision, providing them with opportunities to further develop their skills and knowledge. Confidential information is not always securely stored. Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 24 EVIDENCE: A number of staff said that recent changes introduced by the new management team were an improvement. They had been consulted about changes, and believed these had improved the quality of life for the residents. They were confident that the manager listens to their concerns and resolves them where possible. One staff member said, “I now work for a clued up management team, and that has improved standards to residents.” Regular residents and relatives meetings, and staff team meetings, are now being held. Internal quality audits are being carried out. Other quality assurance systems are in place, but the questionnaires sent out to residents’ families were not completed by many people. The quality assurance system is currently being further developed. Care staff confirmed that they had one to one supervision with their manager. They understood and valued the purpose of these sessions, which is to help them improve and develop their skills and knowledge as effective carers. The door to the manager’s office is still not always kept locked when the room is unoccupied. As this room houses confidential information it is essential that it is secure at all times, in accordance with the Data Protection Act 1998. The door was also being wedged open when the room was occupied. To enable the door to be kept open when the room is in use a magnetic device, connected to the fire alarm system, could be fitted. Some maintenance records were looked at. These included servicing of equipment and adaptations used in the home, to ensure they were safe. All the documents were up to date. The home is making progress with implementing the recommendations of the Fire Safety Officer’s report and a recent Environmental Health Officer’s report. The cook and the kitchen assistant on duty did not have food hygiene certificates. Hot food temperatures were not being recorded on each occasion. The kitchen is cleaner and tidier than at the last inspection and the walls have been painted. A new dry goods storeroom has been created, which is a great improvement on the previous, very limited, storage facilities. The kitchen staff can now properly control their stocks, and I saw evidence of good stock rotation. The kitchen floor covering is old and worn and needs to be replaced. The standard of the kitchen units is poor and many of the cabinets are of domestic
Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 25 quality and unsuitable for a commercial kitchen. Some of the doors are broken and ill fitting and one was missing. The kitchen needs to be re-planned and refurbished. Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 X 3 X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 3 2 2 Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement All individual care plans must show evidence, wherever possible, that the service user or their representative has agreed the plan. Brought forward from last inspection. Original timescale: 31/03/06 The administration of medications must be carried out in accordance with the guidance from the Royal Pharmaceutical Society. Brought forward from last inspection. Original timescale: 30/09/05 The home must provide stimulating activities, in accordance with the residents wishes. All staff files must show evidence that all pre-employment safety checks, i.e. CRB & POVA checks, have been completed. Staff must have the appropriate training and skills to carry out their role. All confidential information must be stored securely in accordance
DS0000061813.V290005.R01.S.doc Timescale for action 30/11/06 2. OP9 13(2) 31/07/06 3. OP12 16(2)(m) 31/07/06 4. OP29 5. 6. OP30 OP37 19(1)(b) (i) & Schedule 2 18(1)(c) (i) 17(1)(b)& Sch3(3)(i) 31/07/06 31/10/06 31/07/06 Elm Royd Nursing Home Version 5.2 Page 28 with the Data Protection Act 1998. Brought forward from last inspection. Original timescale: 30/09/05 7. OP38 16(2)(g) The worn and broken kitchen cabinets must be replaced. 31/10/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. Refer to Standard OP6 OP10 OP10 OP28 OP33 OP38 OP38 Good Practice Recommendations The intermediate care staff team should be fully trained to support the rehabilitation work of the visiting healthcare professionals. Residents’ clothing should be labelled to make sure laundry is returned correctly and that residents are wearing their own clothes at all times. To ensure privacy, toilets and bathrooms used by service users should have suitable locks fitted. The home should have a minimum of 50 of the care staff who have completed NVQ 2 in care. The quality assurance systems would benefit from further development. Hot food temperatures should be recorded. The kitchen flooring should be replaced. Elm Royd Nursing Home DS0000061813.V290005.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection Brighouse Area Office Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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