CARE HOMES FOR OLDER PEOPLE
Elm Tree Close Elm Tree Avenue Frinton On Sea Essex CO13 0AX Lead Inspector
Vicky Dutton Unannounced Inspection 22nd August 2007 07:50 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 Tree Close DS0000017811.V348870.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 Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Elm Tree Close Address Elm Tree Avenue Frinton On Sea Essex CO13 0AX 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) 01255 677747 01255 679926 Southend Care Limited Manager post vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only Persons of either sex, aged 65 years and over, who require care by reason of dementia The total number of service users accommodated in the home must not exceed 40 persons 6th September 2006. Date of last inspection Brief Description of the Service: Elm Tree Close is a purpose built home for older people, situated in a residential area of Frinton, close to the town centre. Accommodation is all on one level. The home is divided into five separate units referred to as bungalows, which are joined by connecting corridors. Each bungalow has a lounge and dining area. All residents are accommodated in single bedrooms with en suite areas. The home also has two large communal areas, one of which is available to residents and used for activities. The home is registered to provide care and accommodation for up to forty older people who may also have care needs associated with dementia. The home has appropriate aids and equipment (e.g. mobile hoist, assisted bathing facilities, hand rails, etc.) available to assist residents with limited mobility. The home is owned and managed by Southend Care. The current scale of charges notified to the CSCI on the inspection is between £374.50 and £409.44 per week, with additional charges for personal items (toiletries, hairdresser, newspapers, chiropody, etc.). The home has a Statement of Purpose and Service Users Guide available. Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was an unannounced ‘key’ site visit. The visit took place over an eight hour period. At this inspection all the key standards were considered. The home’s compliance with requirements made at the previous inspection was assessed. At the site visit a tour of the premises took place, care records, staff records, medication records and other documentation were selected and various elements of these assessed. Time was spent talking to, observing and interacting with residents at the home, and talking to staff. Prior to the site visit the home had completed and sent in to CSCI their Annual Quality Assurance Assessment (AQAA). This outlined how the home feel they are performing against the National Minimum Standards, how they can evidence this, and their plans for improvement. Prior to this site visit a selection of surveys with addressed return envelopes had been sent to the home for distribution to residents, relatives involved professionals and staff. A further supply of relatives and staff surveys were left at the home on the day of the site visit. At the site visit a notice was displayed advising people that an inspection was taking place, and with an open invitation to speak with the inspector at any time. The views expressed at the site visit and in survey responses have been incorporated into this report. The inspector was assisted at the site visit by the manager and other members of the staff team. Feedback on findings provided throughout the inspection process. The opportunity for discussion or clarification was given. The inspector would like to thank the manager, staff team, residents, relatives and visiting professionals for their help throughout the inspection process. What the service does well:
In discussion and on surveys residents and visitors gave generally positive feedback about Elm Tree Close, and felt that the home provided a good level of care. One said ‘I am very happy with all the care my relative receives. The staff are always extremely helpful and cheerful.’ A resident said ‘what more could I want, I could not live anywhere better.’ During the site visit staff were kind and caring in their approach to residents in the home. Before people move into the home they are given good information and have a comprehensive assessment of their needs completed. Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 6 The home provides a spacious and homely environment for residents to live in, and their visitors are always made welcome. The home has good strategies in place to make sure that residents and relatives can say what they think about the service. Peoples’ concerns are listened to. What has improved since the last inspection? What they could do better:
A new care planning format has been introduced that will give staff and residents a simpler and clearer picture of individual care needs, and provide supporting documentation. The home need to make sure that these care plans are adequately completed and maintained so that residents can be sure that they will receive appropriate care to meet their assessed needs. Since the previous inspection the home has become registered to accommodate people who have care needs associated with dementia. To ensure that this specialist care is managed and delivered effectively the home need to consider the following: • If staffing levels/deployment are adequate to provide residents with holistic care that encompasses their physical, emotional and occupational needs. • Health and safety in the home needs to be reviewed to make sure that the environment is safe for people who have dementia. Some areas of the home need redecoration, and some furnishings need replacement, so that residents live in a pleasant and well maintained home. Plans should be in place so that these matters are addressed in a planned way within reasonable timescales. When staff start work at the home they need to be given information and training so that they can care properly for residents, or carry out other duties that they are employed to do in a safe and effective manner. To achieve this
Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 7 the home needs to review their induction programme so that it is carried out consistently and meets current standards as set out by the Skills for Care organisation. 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. The summary of this inspection report can be made available in other formats on request. Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 8 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 Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People considering moving into the home can be sure that their needs will be assessed to make sure that the home is suitable for them. They will be given information about the home and encouraged to visit before moving in. EVIDENCE: Southend Care employs a placement co-ordinator who undertakes preadmission assessments for prospective residents for all the homes managed by Southend Care. The placement co-ordinator happened to be at the home during the site visit, and the process of admissions was discussed. The prospective resident and/or their families are encouraged to visit the home before moving in, and information about the home is given to them. Both CSCI survey responses and surveys by the home showed that people felt that they had received a good level of information about the home before moving in.
Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 10 The file of one new resident viewed showed that the pre-admission assessment undertaken was very detailed. In addition there was information available from Social Services. The assessment material had been used to for an initial care plan for the resident. The admissions process was also discussed with the manager. In being responsible for the home the manager should, for best practice, have some input into the pre-admission process. This should confirm that they are able to meet prospective residents assessed needs in consideration of the needs of the existing resident group, current dependency levels and any staffing constraints. Intermediate care is not provided at Elm Tree Close. Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 11 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. 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 available evidence including a visit to this service. Residents cannot be sure that the care they receive will be based on robust care planning, or that it will encompass all of their assessed care needs. EVIDENCE: Residents who were able to express an opinion felt that their care needs were generally met by staff at the home. Staff spoken with had an understanding of residents’ needs. Residents are allocated ‘key workers.’ The home have recently reviewed their key working system and hope that this will enhance resident care. The home has recently introduced a new care planning system. A number of care plans were viewed during the site visit. The new format has the potential to form a good basis for delivering care to residents. However work is needed to make sure that care plans reflect residents’ current needs, cover all of residents assessed needs and provide a sufficient level of detail for staff giving the care and assisting residents. One resident’s needs had changed
Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 12 significantly, but this was not reflected in their care plan. For example they had a catheter in place, but this was not mentioned in the care plan, they were no longer mobile, but the care plan indicated that they were. For another resident, a note from a family member indicated that their relative wore two hearing aids, which they needed reminding/encouragement to wear. The care plan just said ‘wears hearing aid.’ Sometimes assessed health issues such as depression, asthma, and the potential to bruise easily were not mentioned in care plans. The manager explained that care plans were still a work in progress. They had been completed by staff, and management were in the process of going through each one to produce a properly typed up and detailed document for each resident. An example of one was seen that provided a good level of detail and instruction/information for staff. The initial care plan for a recently admitted resident had also been well completed and was in place in a timely manner. Files viewed and discussion with staff showed that residents have access to good health care, and that the home makes appropriate referrals to respond to residents’ changing needs. Files viewed showed that assessments had been undertaken by the falls prevention team. Records showed district nursing, chiropody and community psychiatric team input. A senior member of staff said that residents have six monthly oral health check ups, and that an optician visits the home on a regular basis. The home undertakes nutritional assessments for residents, and maintains good nutritional records. However for one resident where nutrition and ‘concerns about diet’ had been identified, the nutritional assessment had not been completed. Staff training records sampled showed that some staff had undertaken training in relevant health care issues such as incontinence and pressure area care. Medication at the home is mostly managed through a monitored dosage system (blister packs.) At this site visit medication was viewed on bungalow five. Good records were maintained, and the system appeared well managed. A number of residents are prescribed items to be taken/used as and when required (PRN.) For best practice and resident care, protocols need to be developed to detail when, why, how much and how often these items should be used. A tour of the premises showed that creams (sometimes unlabeled) are stored in many bedrooms/en suite areas. In view of the fact that the home is now registered to provide dementia care, this needs to be assessed to see if alternative storage facilities are required. On two of the units it was noticed that the locks were broken on the medication storage cupboards. Although the cupboards were still secured they need to be repaired. Evidence was seen to show that staff that administer medication have received appropriate training. During the day staff were noted to treat residents respectfully, and ensure that their privacy was maintained. Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 13 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. 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 available evidence including a visit to this service. Residents can expect to have some opportunities for activity and occupation, but these may not be based on their individual needs and preferences. Residents will always be able to enjoy having visitors, and have good food provided by the home. EVIDENCE: Elm Tree close does not have a planned programme of activity. A four week activity programme was on display around the home, but this was old and the inspector was told that it was not being used. The home no longer employs an activity co-ordinator. Staff do what they can to provide activity and stimulation for residents, and organise different activities on an ad hoc basis. The manager reported that one member of staff had completed a course on activities, and another member of staff said that they were attending this course in September. Residents who were able to express an opinion felt that there were ‘usually’ or ‘sometimes’ activities available that they could take part in. A relative felt that ‘there were lots of activities going on, which residents and family can join in if they wish.’ On the day of the site visit some residents were taken to the home’s large communal area to take part in a sing-along, during
Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 14 which an overseas member of staff was observed singing a song in their own language. Since the previous inspection the home has been registered to provide care for people who have dementia. One resident was assessed as having dementia and suffering from depression. The section of care plan headed Likes, Dislikes, Social Activities and Hobbies. Was blank with just the comment that ‘……has no preferences.’ During the site visit this resident was transferred into a wheelchair and taken to the sing-along without being asked if they wanted to go, or any audible explanation being given. Another resident was quite short with people, and was left sitting in a wheelchair at a dining table. Staff did not ask them if they wished to attend, but the member of staff said that the resident in question did not like any activities. The resident chatted away very happily on a one to one basis with the inspector and confirmed that they just did not like group activities. The new care plan format includes a section called ‘Residents Recreational Record.’ This included space to record the activity attended and the outcome. As such it could provide a useful tool in assessing what is enjoyed or not enjoyed by residents who cannot easily express their views or preferences. For one resident most entries on this sheet were ’relaxed in lounge.’ These observations suggest that the home has work to do in properly assessing and meeting peoples individual activity/occupational/stimulation needs, particularly those who have dementia. Observations on the day of the site visit showed that the routines at the home are flexible and that residents can make choices in their daily lives. Residents stayed in bed when they wished, and went where they wanted to go in the building. The home does organise communal events, and residents have recently enjoyed a barbeque party. Equipment for activities was seen to be available on individual bungalows. Church services are held at the home for residents to attend if they wish. Visiting at the home is open and residents are able to enjoy having visitors at any time. During the site visit visitors came and went. Information on advocacy was available in the home, and referral forms are kept by the home. Residents’ bedrooms showed that they are able to bring in personal possessions and items of furniture. Residents spoken with said that they enjoyed the food at the home. Lunch on the day of the site visit looked appetising and was plentiful. Menus viewed showed that residents are offered choices at each meal, and that teatime menus have now been adapted to provide a greater range of foods and choice. Where residents needed assistance with eating staff did this in a sensitive manner. It was noted that the place mats in use in a number of bungalows were in a poor condition. The catering staff spoken with at the site visit were very experienced and said that they had undertaken training in the nutritional needs of older people. Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 15 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. 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 available evidence including a visit to this service. People can be sure that any concerns they raise will be listened to. Residents can be confident that they will be cared for in a way that protects them from abuse as staff have been trained and understand this area. EVIDENCE: The home has a clear complaints process in place that was on display for residents and visitors. The manager was advised that this should be updated to include the contact details of the Local Authority. The homes complaints record showed that the home are good at recording and concerns or issues raised with them, and record all comments and concerns raised by residents or families. This is good practice. The two most recently recorded concerns however did not have the action or outcomes clearly recorded to complete the process. CSCI is aware of two complaints made about the service. These have been dealt with by the home and registered provider. The manager confirmed that many staff at the home have completed training in safeguarding adults. It was reported that approximately eight staff have still to complete this and that further training is planned for December. In the meantime the manager ensures that this topic is discussed and that information is available. One incident occurred at the home that should have been reported under Safeguarding Adults procedures. (Formerly known as
Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 16 POVA) This did not happen and the home started to conduct an internal investigation before they were advised by CSCI to follow proper procedure and report the incident to the POVA team at the Local Authority. The incident was around a resident’s behaviour towards another resident, and has now been resolved. Staff spoken with had an understanding of what abuse was, and what they would do if they suspected that abuse of any kind had occurred. No staff at the home have undertaken training in managing challenging behaviour. The manager felt that this had been covered to a degree in the dementia training undertaken by staff. Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 24, 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a generally pleasant environment, which could however be improved by a planned programme of re-decoration and renewal. EVIDENCE: As part of the site visit a tour of the premises was undertaken. Generally Elm Tree Close provides a pleasant and homely environment for residents. Some areas however would benefit from redecoration, carpets need to be replaced in a number of areas and furnishings are becoming shabby and would benefit from replacement in many residents bedrooms. The manager thought that there were plans in hand to improve the premises but was not sure of the detail of this. A maintenance person is employed so that minor repairs can be dealt with promptly. The home consists of five different ‘bungalows.’ Each of these has direct access to a pleasant outdoor space. The home has spacious corridor areas that link the bungalows and provide further seating areas. The
Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 18 home has two large communal areas, but one of these is used primarily for storage. On the day of the site visit the hairdresser was using this area. Each bungalow has a bathroom with an assisted bath and a separate shower room. On some bungalows these areas were cluttered as there was insufficient storage space available. Bathrooms had been made homely by the use of pictures and mirrors. Some bathrooms had shelving used for storage of items such as disposable gloves. Now that the home is registered to provide dementia care other storage solutions may need to be considered to make sure that residents are kept safe. The home is now registered to provide dementia care. Some orientation signage has started to be developed, but this is currently limited to one bungalow and does not provide directional signage around the home. All bedrooms viewed were homely and personalised with individual residents own possessions. Residents spoken with were happy with their rooms. Two residents bedrooms were noted to have vinyl rather than carpet as a floor covering. The manager thought that this probably dated from previous residents, and was not sure if residents currently occupying the rooms had been offered the choice to have carpet refitted. The poor condition of furnishings in many bedrooms has already been mentioned. In some rooms low tables were being used turned up on their ends to provide bedside tables. All bedrooms have an en suite area, in many instances these were cluttered by the need to store supplies of continence aids, which are delivered on a two monthly basis. Call points were available in each room but these were not always fitted with cords to facilitate them being easily used by residents. On the day of the site visit the home appeared generally clean and odour control was satisfactory. The homes laundry area was suitable to meet the needs of the home. On the day of inspection two recently recruited domestic staff were on duty. One had not had training in infection control but felt that it was ‘common sense.’ The other working in the laundry had piled up soiled linen on the floor. Toilet brushes around the home were mostly in a poor condition, dirty and had been stored without their container lids being replaced. Although information on infection control and laundry hygiene was on display in the home’s staff area the issues identified show that staff may need to gain a greater understanding of infection control issues and practice. Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 19 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. 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 available evidence including a visit to this service. Residents can be sure that staff working at the home will be friendly and approachable, but cannot be sure that they will always be readily available to meet their needs. EVIDENCE: Since the previous inspection the home has become registered to provide dementia care. There has been no subsequent increase in staffing levels to support the potentially higher level of residents’ dependency. The manager thought that 50 to 60 (possibly higher) of residents at the home had dementia to some level. The manager felt that current staffing levels were sufficient to meet the needs of residents and said that if it additional staff were needed to meet a specific need then this would happen, an example of this was given. During the morning at the home there are eight staff on duty, one of which is a shift leader and during the afternoon and evening there are seven staff on duty including a shift leader. The manager’s hours are supernumerary to this. Rotas viewed for the week during which the site visit took place showed that these levels were being maintained. Feedback from residents and some staff was that there were insufficient staff at the home. In particular they felt that the bungalow described as ‘high needs’ should always have two staff in attendance. One resident said that ‘the staff are very good but there are not enough of them.’ On surveys people reported that there were ‘usually’ staff available to meet their needs. The manager reported that the home currently
Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 20 have vacancies for four full time carers and two full time domestic staff. To cover the home’s rotas, many staff are working excessive hours, which is not good practice. On the rota viewed one member of staff was working in excess of 70 hours and another 68 hours. Agency staff are also used at the home to cover shortfalls. At the moment there are two domestic staff on duty each day and a laundry person on duty on four days each week. No domestic/laundry cover is provided during the evening. No administrative staff are provided at the home. During the site visit the inspector’s observation was that at certain times there were no staff available in individual bungalows to offer residents proper support and supervision. During the morning in one bungalow residents were sitting at the dining room table for some time with no staff around. One said ‘will staff be here soon to give us a cup of tea.’ During the early part of the afternoon in four out of the five bungalows visited no staff were available for a period of time. In the living areas of the bungalows only one call point (with no cord) is available. This is not situated in a place that would allow residents to easily summon assistance if needed. This was also raised by a relative who said ‘a call bell in the lounge would be helpful for residents.’ When no staff were around, in one bungalow the TV had gone off, in another one resident who had returned from hospital that morning after a fall during the night had removed the dressing from their head wound and was wandering around. In the same bungalow a resident was sitting at the table coughing up a drink. However the manager did attend quickly and got staff to deal with these needs. When call bells were tested staff also responded promptly and pleasantly. Later in the afternoon a resident climbing out of a recliner chair with initially no staff around was quickly attended to, the staff member was then doing ‘paperwork’ interacting with one resident while others with dementia were unengaged and wandering around. During the day some good interactions between staff and residents were observed. However as observed/experienced by the inspector and commented on by some staff, not all staff at the home have good communication or language skills which can make things difficult. The manager felt that this was an improving picture, and that overseas staff were improving in their ability to communicate effectively with residents and colleagues. Out of 29 staff it was reported that 12 staff hold a National Vocational Qualification (NVQ) at level two or above, or equivalent qualification from their country of origin that has been verified by NARIC (an organisation that verifies overseas qualifications and equates them to British equivalents.) A further six staff are working towards an NVQ. The home has yet to achieve the recommended target of 50 of care staff being trained to NVQ level 2 or above. The files of four recently recruited staff were viewed to see if recruitment procedures in place protect residents living at the home. Generally it was
Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 21 possible to see that care had been taken to carry out appropriate checks such as taking up references and undertaking POVA first and Criminal Records Bureau (CRB) checks. Interview processes were identified and equal opportunities taken into consideration. However it was seen that CRB checks are often not in place before members of staff take up their employment. For the two most recent staff working as domestic staff POVA first checks had been obtained but no CRB checks were in place and the staff concerned were working unsupervised. This is not best practice. One member of staff who had much previous experience had no evidence of previous qualifications on file. The home has four different induction formats in place for carrying out an induction programme with staff. These were not completed to a consistent level on the files viewed. For one member of staff who commenced work in May 2007 only one of these formats was reasonably completed, others were blank or only partially completed. For another member of staff, also commenced in May 2007 all four formats had been well completed. The home has not yet commenced an induction programme that is identifiably in line with Skills for Care Standards. The manager said that information on this had just arrived. Staff felt that they were offered a good level of training. All staff are issued with a ‘Schedule for In Service Training’ book which identifies training undertaken. The manager estimated that about eight staff at the home have still to complete training in dementia care. Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 22 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know that the home will be managed in their best interests and that they will have the opportunity to express their views on the service. EVIDENCE: Since the previous inspection a new manager has been appointed at Elm Tree Close. They have a background and experience in care. It was reported that a suitable provider is being looked for so that they can commence their Registered Managers Award and NVQ level four in care. The manager has applied to CSCI for registration, and this process is almost complete. The manager has a proactive approach and is keen to promote a person centred approach to resident care. Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 23 The registered provider has strategies in place to monitor the quality of the service provided at Elm Tree Close. An annual quality audit is undertaken by an external provider. This includes sending out questionnaires to residents and relatives. Examples of these were seen. It was seen that from the results of surveys a report is complied to show the results and identify any areas for improvement. The manager said that this years surveys had just gone out. The home also does internal surveys as part of a self monitoring process. This is required by the main placing Local Authority as part of their contracts monitoring. The home also has other internal procedures that contribute to overall quality monitoring of the home. These include daily ‘floor walking’ and care plan auditing. As required by Regulations, a manager from the organisation visits the home each month to assess the quality of the service. The last report available in the home from these visits was dated April 2007. The manager said that subsequent visits had been carried out, but that the reports from these had not been received. The home holds some monies belonging to residents for safekeeping. Secure facilities are provided for this. Records and balances were sampled in relation to two residents and were satisfactory. The AQAA completed by the home and records sampled showed that systems and services within the home are monitored and maintained. Fire records were satisfactory, and it was seen that fire drills are undertaken on a very regular basis. It was however advised that the home check that their fire risk assessment complies with the current expectations of the fire service. Generally the home appeared to be managed in a safe and effective manner. However in view of the fact that the home is now registered to provide dementia care, health and safety management at the home needs to be reviewed to ensure that residents are cared for safely. For example disposable gloves being available in some areas, the cupboards containing hot water tanks on each bungalow being left open. Health and safety information was available in the home’s staff room, but in the laundry area there was no health and safety information/instructions available in relation to the home’s roller press. Staff records sampled, and staff spoken with indicated that staff training in core areas such as Health and safety, fire safety and moving and handling was satisfactory. The manager said that some new staff have still to undertake food hygiene training. Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 24 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X 2 X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 2 Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 25 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 So that residents receive care that is planned and carried out in a consistent manner, care planning at the home needs to improve. Care plans need to identify all residents assessed needs, and identify clear actions for staff as to how these needs are to be met. Care planning must include details of how residents’ personal care and health care needs, as well as social and emotional/mental health needs are to be met. Timescale for action 01/11/07 2. OP12 16(2)(n) Requirements relating to care planning have been repeated for the last six inspections. (Last timescale for compliance was 30/11/06). So that residents receive holistic 01/11/07 care the home must continue to develop appropriate opportunities activities and occupation in consultation with residents. In particular residents with dementia should have their needs properly assessed, appropriate occupation provided, and outcomes recorded.
DS0000017811.V348870.R01.S.doc Version 5.2 Page 26 Elm Tree Close 3. OP27 18 Appropriate care staffing levels must be maintained throughout the day, sufficient to meet residents’ needs. This refers to the issues raised in the body of the report, and the need to show how staffing levels have been reviewed in consideration of the home’s new registration for dementia. 01/11/07 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. Refer to Standard OP9 OP18 Good Practice Recommendations Protocols for the administration of medicines prescribed to be taken ‘as and when required’ should be developed. So that residents receive assistance in a safe and consistent manner, staff at the home should receive training in managing challenging behaviour. Management at the home should provide a clear programme of works to show that there is a process of refurbishment and renewal in place. The home should continue to improve the environment, and assist people who may get disorientated when navigating around the home by providing directional and orientation signage. The infection control issues highlighted in the report such as laundry practice should be addressed. The manager should ensure that staff do not work excessive hours, including too many long days per week, or successive long days, as this could put both staff and residents at risk. This is a repeat recommendation.
DS0000017811.V348870.R01.S.doc Version 5.2 Page 27 3. OP19 4. OP22 5. 6. OP26 OP27 Elm Tree Close 7. OP28 It is recommended that the registered person progress action to ensure that at least 50 of care staff have achieved NVQ level 2. This is a repeat recommendation. The registered person should ensure that Department of Health POVA guidance is followed in relation to arrangements for the supervision of new staff who start work before the receipt of a full CRB check. This is a repeat recommendation. It is recommended that the registered person revise the induction programme to ensure it reflects the new Common Induction Standards (Skills for Care). This is a repeat recommendation. Copies of reports undertaken under Regulation 26 should be maintained in the home. Health and safety at the home should be reviewed to ensure that the premises are safe as possible for residents who have dementia. 8. OP29 9. OP30 10. 11. OP33 OP38 Elm Tree Close DS0000017811.V348870.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection South Essex Local Office Kingswood House Baxter Avenue Southend on Sea Essex SS2 6BG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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