Inspection on 29/07/08 for Elm Tree Close

This inspection was carried out on 29th July 2008.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Elm Tree Close 22/08/07

Elm Tree Close 06/09/06

Elm Tree Close 07/03/06

Elm Tree Close 11/10/05

Elm Tree Close 03/03/05

Elm Tree Close 28/09/04

Elm Tree Close 18/03/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2009.

CARE HOMES FOR OLDER PEOPLE Elm Tree Close Elm Tree Avenue Frinton On Sea Essex CO13 0AX Lead Inspector Francesca Halliday Unannounced Inspection 29th July 2008 09:30 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.V369456.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.V369456.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 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.V369456.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 22nd August 2007 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 toilet and hand washbasin. The home also has two large communal areas. The home is registered to provide care and accommodation for up to forty older people and older people 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 weekly scale of charges at the time of inspection in July 2008 was between £384 and £450 per week, with additional charges for personal items (toiletries, hairdresser, newspapers, chiropody, etc.) and visits to the local day centre. Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means that people who use this service experience adequate quality outcomes. This key inspection was carried out on 29th July 2008 and completed on 30th July. The term “resident” is used throughout the report to refer to people who live in the home and the term “we” refers to the Commission for Social Care Inspection. The manager was present throughout the inspection and the operations manager for Southend Care was spoken with on 30th July. We spoke with four members of staff including the manager and we also had a chat with six residents. We spoke with four relatives who were visiting at the time of inspection. One relative responded to our survey. Information from the survey has been included within the report where appropriate. We also spoke with two members of the district nursing team who were visiting at the time of our inspection. We carried out a tour of the parts of the premises and sampled the records held in the home. We also looked at the annual quality assurance assessment (AQAA) completed by the manager. What the service does well: Residents and relatives told us that they were happy with the standards of care in the home. One resident told us “I’m quite happy here. It’s jolly good”. Another resident said “The staff are very nice and very good”. A relative told us “She’s quite happy and settled here and seems happy with the food. She’s well looked after, she wasn’t eating before admission but now she’s put on weight. The home suits her. Staff are always really friendly, helpful and welcoming. I’m impressed overall”. Another relative said “I’m happy with the standards, I’ve not had any concerns. The food is good and it’s well presented. They look after mother very well”. The home was clean with no unpleasant odours and the domestic staff took pride in their work. The majority of residents we spoke with were very happy with the standard of the food and the choices available. A relative told us that there was “a lovely atmosphere” in the hairdressing room and said that the hairdresser was “very nice with the residents”. Staff told us that the manager and the senior managers in the company were very supportive. Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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.V369456.R01.S.doc Version 5.2 Page 7 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.V369456.R01.S.doc Version 5.2 Page 8 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): Standards 1, 3, 5 (standard 6 is not applicable) Quality in this outcome area is good. Prospective residents can be confident that they will receive an assessment of their needs before making a decision about admission to the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a range of information for prospective residents and their representatives in the statement of purpose and service user guide. The service user guide was available in a larger print size. Residents and their relatives were encouraged to visit the home before making a decision about admission. Where possible a choice of room was offered. A review was held at the end of the four weeks’ trial period to ensure that the resident and their family were happy with the care and wanted to make this a permanent placement. The manager told us that the home did not pre-book regular respite but would offer a respite place if a bed was available. Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 9 The placement coordinator for Southend Care previously carried out the preadmission assessments. At the time of inspection the manager was carrying out the assessments. This was a positive move as it enabled him to assess the needs of the prospective resident in relation to the dependency and needs of the residents currently in the home. The three pre-admission assessments we looked at were of a good standard in relation to residents’ physical needs. However, the assessment form used did not contain sufficient information on residents’ mental health, which was particularly important for residents with dementia. Some previous mental health assessments were seen but they were very lengthy and needed to be adapted for use in the preadmission assessment. The home also used information provided by social services or health professionals to form part of the preadmission process. The manager confirmed that residents who had been admitted to hospital for any length of time would be assessed prior to readmission to the home. One complimentary letter seen thanked the staff for the “help and kindness” they had shown in helping a new resident settle into the home. Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 10 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): Standards 7, 8, 9, 10 Quality in this outcome area is adequate. Residents’ healthcare needs are generally met but their dignity is not always upheld. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents and relatives we spoke with told us that they were happy with the standards of care in the home. There was evidence that relatives provided information about residents if they could not do this for themselves. A family history and resident profile was completed wherever possible in order to provide staff with background information about residents. We examined the care documentation for three residents. The care plans did not always reflect residents’ current condition, abilities or needs in sufficient detail. They also contained limited information on residents’ interests, preferred routines, wishes and preferences. Residents and relatives told us that they were not involved in devising care plans and evaluating care. Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 11 The daily care records we sampled did not contain sufficient evidence that staff were monitoring residents’ healthcare needs on a daily basis. Some charts were being used, for example for elimination and food charts, however they were not being completed regularly. This may have been because staff were trying to complete them for all residents rather than targeting the residents who were at particular risk. The home had a range of risk assessments that identified the risk of residents developing pressure sores or malnutrition and residents’ needs for moving and handling. The home used a behaviour monitoring chart to record any challenging behaviour. However the chart did not provide sufficient evidence that staff were systematically monitoring residents’ mental health, their responses to changes in medication or any periods of challenging behaviour. Staff said that the hospital had told them that the most frequent reason for admission from Elm Tree Close was dehydration. They said that staff were now much more aware of the need to provide regular drinks to residents, particularly those with dementia who would not always ask staff for a drink themselves. During the inspection we observed staff giving out regular drinks to residents. However, one relative who responded to our survey told us “I believe encouragement should be given to residents to drink more frequently, fruit drinks should be available at all times. Those residents unable to help themselves should be given same”. The home was part of the local falls prevention scheme and completed a monthly falls register. The register included the circumstances of the fall, any injuries caused by the fall and the action taken when appropriate. The manager said that a member of the falls prevention team would visit and provide advice for residents who were at particular risk. Accidents were audited by the manager to ascertain whether there were any trends or factors that could be identified and addressed. Staff carried out a follow up check of residents 24 hours after an accident. Residents were not regularly monitored in the period following the accident but the manager said that this would be put in place following the inspection. Staff told us that the home had good support from two local GP practices and from the local district nursing team. One of the GPs carried out a weekly surgery at the home. The two members of the district nursing team told us that they were happy with standards in the home and considered that staff referred healthcare concerns to them appropriately. The manager told us that they also had support from the community psychiatric nurse when needed. Residents told us that they had regular visits from the chiropodist and had their eyes tested. Staff kept a record of all specialists visits to residents in the home, with information on any changes to treatment or care that might be required. Accidents were well recorded in the sample of records we looked at. Charts were used to record any bruises, wounds or sores that residents developed. None of the residents had pressure sores at the time of inspection. Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 12 The home had some pressure mats, which were used to alert staff if residents with dementia got out of bed at night and might be at risk if not supervised. The pads also alerted staff to residents who might wander into other residents’ rooms and disturb them at night. A risk assessment was always carried out before the mats were used and agreement was gained from relatives where appropriate. The manager said that they were hoping to purchase some more of the sensor mats. Staff were observed to treat residents in a respectful, friendly and caring manner. A resident told us that staff treated them respectfully and respected their privacy. However, there were some areas where staff could do more to protect residents’ dignity. One relative told us that staff did not promote continence or offer to take residents to the toilet at regular interval and that for some residents this was resulting in unnecessary incontinence and distress. According to the training records seen only one member of staff had received training in the promotion of continence. They also said that the residents were not always encouraged to mobilise and that this was increasing some residents’ dependency. We noticed that two residents needed assistance to clean their dirty nails. The medicine administration charts (MAR) were well completed. The home did not use homely remedies. The manager said that they never normally used covert, or hidden, medication unless this was agreed with the residents’ GP and family and there was no other preparation of the medicine that could be used. The MAR did not always have clear instructions for care staff on when to give “as required” medicines. Staff did not have a care plan giving clear guidance to staff on when to use sedatives and the actions to take to reduce challenging behaviour before any sedatives were used. Staff were monitoring the temperature of the drug trolleys. This was sometimes recorded at night and not at the hottest time of the day. The temperature of the drugs fridge was being recorded daily but action was not being taken when the temperature was occasionally outside the safe temperature of 2-8c. This could result in the medicines not being fit for use. The fridge needed defrosting at the time of inspection. The controlled drugs were stored correctly and the balances checked were correct. The home had a good system for monitoring the medicines that were not in the monitored dosage systems and the balances of the sample checked were correct. The manager said that two staff checked the MAR when handwritten additions were made, to reduce the possibility of errors occurring. The manager confirmed that all senior staff had received in-house training in administration and safeguarding of medicines. He told us that staff were observed over period of time and then had an assessment of competence from the operations manager, who had a nursing qualification. There was documentary evidence of this. Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 13 We saw a number of very complimentary letters praising staff for the terminal care they had provided to some residents and the support they had given to relatives. One relative said “She was made comfortable and happy during her last illness”, another said “Thank you for the support given during a very difficult time. Thank you for the wonderful care. Staff make a wonderful home and nothing is too much trouble”. Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 14 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): Standards 12, 13, 14, 15 Quality in this outcome area is good. Residents are offered a nutritious and varied diet but would benefit from further development of activities in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff said that a carer was responsible for activities each day, however, this was fitted in around care duties. The manager said that they hoped to appoint an activity coordinator to organise and encourage activities in the home. One member of staff we spoke with had a good understanding of the types of stimulation and activities suitable for residents at all stages of dementia. They told us that music sessions were very popular with residents and could help them communicate. However, a number of the activity records seen contained frequent statements such as “relaxed in lounge”. This did not give any indication that the residents were engaged in conversation or provided with any stimulation. It also demonstrated that some staff did not have an understanding of the importance of social activities and stimulation for residents with dementia. Two relatives we spoke with considered that there was a lack of stimulation and limited activities in the home. Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 15 Staff told us about some of the social activities that had taken place. These included having the evening meal in the garden with sandwiches, strawberry cream scones and Bucks Fizz, which staff said residents’ really enjoyed. The home also had a Chinese takeaway one evening and the manager said that they were also planning to have a fish and chips supper and a barbecue soon. The home had a coffee morning and bake sale and residents helped to make some cakes. An Easter egg hunt was arranged at Easter. Staff said that they were hoping to develop a sensory garden. Three residents went to the local day centre. One resident told us that they had attended church regularly in the past but were not aware of any services in the home. The manager said that the home previously had a religious service once a month and he said he was hoping to arrange for this to be restarted. The home used to have a session of seated exercise but the person who conducted the sessions was on maternity leave. The home did not have any member of staff trained to carry out seated exercises but the manager said that they tried to have a physical activity on a regular basis. The manager said that occasionally dogs were brought to the home as long as this had been agreed with him. The home was planning to get some rabbits to provide another source of interest for residents. The manager was hoping to improve links with the local community still further. Residents who could express an opinion told us that they went to bed and got up at a time that suited them and spent their day where they liked. All the relatives that we spoke with told us that they were always made to feel very welcome in the home. There was a communication log for recording important conversations with relatives. Staff spoken with realised how important it was to communicate well with relatives and support them. The menu was a four-week rotational menu. Choices were available and there was evidence that residents could have an alternative if they did not like what was on the menu. The manager told us that sometimes residents’ individual requests could be met by purchasing food they particularly wanted from the supermarket, which was close to the home. The manager told us that sandwiches were always available if residents wanted additional snacks outside set meal times. Kitchen staff talked to residents about their preferences. However, one relative told us that the resident they visited was regularly given foods that they did not like even though these dislikes had been mentioned to staff on a number of occasions (see section on complaints). The lunch we saw looked nutritious and residents in the dining room told us that the food was good. The majority of residents said that they liked the food. Although one resident told us that the menu was repetitive and that the food was “not like you have at home”. The environmental health officer had carried out a visit recently and there had been no requirements. Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 16 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): Standard 16, 18 Quality in this outcome area is adequate. Residents can now be confident that they will be protected from abuse but cannot be assured that their concerns will be promptly addressed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure. The procedure was available in the service user guide and was on display in the home. Residents and relatives we spoke with told us that they knew how to make a complaint and said that they would speak to the manager if they had any concerns. However, there was evidence that staff were not always documenting verbal concerns and complaints and when they were recorded they were not always dated. One relative said that they had told staff on a number of occasions that the resident they visited did not like particular foods, however, they were still being given them and so did not eat the meal or the part of it they did not like. Another relative who responded to our survey said that they had made “numerous complaints” about the condition that a resident’s room was left in and about items of clothing going missing but said that “the problems still remain”. This demonstrated the need for staff to document verbal concerns in order that appropriate action could be taken by the manager to prevent recurrent concerns becoming complaints and also to improve communication between staff. In the annual quality assurance assessment the manager acknowledged Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 17 that staff in the home could be better at avoiding and defusing potential concerns before they become complaints. The two large communal rooms were now being used for all residents in the home rather than the communal areas on each of the bungalows. One relative told us that they were pleased with the recent reorganisation and said that the “new system works well, there’s better supervision of residents”. However three relatives told us that they were not happy with the recent changes and one considered that the changes had aggravated residents’ challenging behaviour. They said that they had not been consulted about the change before they occurred. One resident said that staff “come and talk to you less now the dining room’s changed”. The manager said that the changes had been made as a result of a number of complaints by both residents and relatives, who said that staff were not supervising residents adequately on the individual bungalows. The manager did acknowledge that he had not fully consulted with residents and relatives before the changes were made. He said that he would discuss the changes with residents and relatives in order to establish what was best for individual residents and make changes if necessary. The home had policies on safeguarding vulnerable people and a policy on disclosure of abuse and bad practice. There had been four safeguarding referrals in the past year. These included allegations of poor care, development of pressure sores and poor moving and handling practices. The home did not follow their own policies when two of the safeguarding issues were identified and refer immediately to social services. A social worker who spoke to us considered that the home was having problems adjusting to the move from providing general care to providing dementia care. Staff said that a large number of residents with dementia had been admitted over a relatively short time before sufficient staff training had been provided. Staff spoken with said that standards in the home had improved since the safeguarding referrals, that there was now more staff training and that communication with the district nurses was much better. The district nursing team confirmed that communication with them had improved; they said that they had no current concerns about care in the home and confirmed that staff referred healthcare concerns to them appropriately. The home had introduced a form to identify the possible risks of abuse and actions to take to prevent abuse. Staff had received in-house training on safeguarding vulnerable adults and in addition half the staff had received external training. The manager told us that all staff had received a copy of the Essex County Council guidelines on safeguarding vulnerable adults. Staff we spoke with had a good understanding about the types of abuse that could occur and the actions to take if abuse or bad practice was suspected. We were shown a letter from Essex County Council adults safeguard unit. The letter confirmed that the home had made the necessary changes in the home and addressed all the safeguarding issues raised. One relative told us that the resident they visited “feels she’s safe in the home”. Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 18 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): Standards 19, 26 Quality in this outcome area is adequate. Lack of maintenance in a few parts of the home detract from the homely environment. Residents cannot be confident that good infection control procedures are always followed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home was all on one level and was divided into five eight-bedded areas known as bungalows. Each bungalow had its own bathroom and shower and communal lounge/dining room. Each of the bedrooms had an en-suite toilet and hand wash basin. The home was generally well maintained but some parts of the premises were in need of redecoration as the paintwork was chipped and a few sections of wallpaper were peeling. Some of the carpets seen were in poor condition. One resident’s room had a heavily stained carpet and another had numerous old cigarette burns on their carpet. The manager Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 19 said that they were planning to do some decoration and were getting a quote for new carpets in the areas where they were needed. The home had enclosed and secure gardens. Some parts of the gardens had attractive and colourful plantings. There were tables and chairs with parasols for residents to use outside and the fish in the pond could easily be seen from inside the home. The home was clean and had no unpleasant odours on the day of this unannounced inspection. The laundry room had a washing machines with a sluice cycle. However, staff were hand sluicing soiled linen and not using the red dissolvable bags. This could put staff and potentially residents at risk of cross infection. The home had a supply of protective equipment such as gloves and aprons. Residents’ bedrooms did not have a supply of liquid soap and paper hand towels. This would mean that staff could not carry out good infection control procedures when they gave personal care. One resident told us that their family took their clothes home to wash as a number of items had been lost. A relative told us that they were not happy about the loss of some of a resident’s clothes. The manager said that the laundry assistant now kept a list of any items of clothing that had been mislaid and regularly checked to see whether clothes had been put in another resident’s room by mistake. Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 20 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): Standards 27, 29, 29, 30 Quality in this outcome area is adequate. Residents’ well-being and safety are potentially compromised when care staff work excessively long shifts. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staffing levels at the time of this inspection were generally 8 care staff in the morning, 7 care staff in the late afternoon and evening and 3 care staff at night. The manager was supernumerary to these numbers. The home also had cleaning, laundry and kitchen staff. A relative told us that they were concerned at the “double shifts staff do, as they get so tired”. We looked at a sample of recent staff rotas. On some weeks a few staff were working extremely long hours, on occasions the period worked was in excess of 77 hours. Staff were sometimes working a mix of day and night duty in the same week. One carer worked 5 day duties and 4 night duties in the same week. Some shifts were 14.5 hours long. These hours put staff at risk of becoming overtired and not able to sustain their best working practice for such long periods, putting residents in the home at risk or at a disadvantage. The manager said that he did monitor staff tiredness and restrict staff hours if he noticed that the additional hours were affecting their standard of work. However, as he mainly worked from 8-5 he might not be aware of staff performance later in the evenings and at night. The manager said that they Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 21 used agency staff but sometimes could not get anyone to cover, so that staff provided the additional hours. Three staff records were seen and they showed that the home had sound recruitment procedures. The recruitment process included checks with the criminal records bureau and POVA list, obtaining two written references and the checking of applicants’ identification, however, identification was not always held on file in the home. The home used guidance questions at interview and kept a record, which is good practice. According to the annual quality assurance assessment that the manager completed, only a third of care staff had completed the national vocational qualification (NVQ) at level 2 or above. The home had yet to achieve the recommended target of 50 of care staff being trained to NVQ level 2 or above. The manager said that he hoped that more staff would be starting NVQ level 2 soon. The home had an induction for the home and also used the Skills for Care induction. The manager said that new staff were usually supernumerary for five days when they first started work in the home. The manager told us that he tried to arrange staff training to enable them to have the appropriate skills to meet the needs of the current residents. He was hoping to book some training in both catheter care and diabetes. The manager and one of the team leaders had received training in the Mental Capacity Act and the manager had also received training in deprivation of liberty. The manager told us that he was hoping to arrange further training in these topics for other staff. Some staff needed fire safety and infection control training and some care staff had not completed a food hygiene course. The majority of staff had completed a moving and handling course. One of the team leaders was a moving and handling trainer for the home. The home did not have sufficient staff with a first aid certificate to ensure that there was a member of staff with first aid training on every shift. None of the staff had received health and safety training. A number of staff had not received dementia care training but two further sessions in June and September 2007 were booked. A number of residents had intermittent challenging behaviour. The manager recognised the need for staff to have additional training in the prevention, reduction and management of challenging behaviour. A number of staff were due to commence a distance learning course on palliative care. Elm Tree Close DS0000017811.V369456.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): Standards 31, 33, 35, 38 Quality in this outcome area is good. Residents know that the home is managed in their best interests and they have the opportunity to express their views on the service. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager had been appointed to the post in September 2007 but was still not registered with the commission. He held national vocational qualification (NVQ) at level 3 and was undertaking the registered manager’s award at NVQ level 4. Staff told us that the manager and the operations manager were “very supportive” and that the manager sometimes helped them out if they were short staffed. Staff said that these was “always someone to call on for support or advice”. A relative described the manager as “very approachable, most Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 23 helpful”. The company arranged for independent quality audits with surveys of residents (and their relatives where appropriate) to be carried out. Three audits had been carried out in the last two years and indicated that the overall satisfaction level at Elm Tree Close had increased. The operations manager carried out regular visits to monitor the quality of services and care in the home. The home held a small amount of money for residents’ daily expenses. The money was held securely, receipts were kept and a double signature system was used. The balances of two residents’ monies were checked and they were both correct. Monthly audits of the system were carried out. The home had good systems in place to ensure that equipment was maintained and serviced and in safe condition for residents to use. The manager told us that there were systems in place for monitoring the temperature of the hot water from outlets used by residents. A fire risk assessment had been completed. Elm Tree Close DS0000017811.V369456.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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 1 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Elm Tree Close DS0000017811.V369456.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 Residents must have care plans that reflect their current needs and abilities and give clear guidance for staff on how their care should be delivered. Residents and relatives where appropriate must be involved in drawing up the care plans, so that the plans reflect their individual wishes, interests, preferences and priorities. This requirement had a previous timescale of 01/11/07 that was not met. Care plans must also provide guidance to staff on when to use sedatives and the actions to take to reduce challenging behaviour before any sedatives are used. Residents’ with dementia must have their mental health needs monitored on a regular basis and this should include their responses to changes in medication or any periods of challenging behaviour. Staff must ensure that they respect residents’ dignity. This DS0000017811.V369456.R01.S.doc Timescale for action 01/11/08 2. OP8 12(1)(a) 01/09/08 3. OP10 12(4)(a) 29/07/08 Page 26 Elm Tree Close Version 5.2 particularly refers to assisting residents with care that they cannot do for themselves such as taking them to the toilet regularly to maintain their continence, assisting them to remain mobile and cleaning their nails. 4. OP16 22 Staff must ensure that all residents’ and relatives’ verbal concerns and complaints are documented in order that communication between staff can be improved and concerns can be addressed before they become more serious complaints. 29/07/08 5. OP26 13(3) 01/09/08 The manager must ensure that staff have the appropriate equipment to enable them to carry out good infection control procedures and reduce the risk of cross infection. This refers to the use of dissolvable bags for handling soiled laundry and the supply of liquid soap and paper hand towels in all areas that staff carry out personal care. 01/11/08 There must be sufficient numbers of people available to work in the home so that staff do not have to work so many hours and do day and night shifts in the same week, as this potentially compromises the wellbeing and safety of residents as well as their own health and safety. This requirement had a previous timescale of 01/11/07 that was not met. Staff must be given the training to enable them to care safely and appropriately for residents. DS0000017811.V369456.R01.S.doc 6. OP27 18 7. OP30 18 01/03/09 Elm Tree Close Version 5.2 Page 27 This refers to first aid training for senior staff, training in health and safety, infection control, food hygiene, fire safety and care related training such as the promotion of continence and the management of challenging behaviour. 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 OP3 OP9 Good Practice Recommendations The preadmission assessment should be developed to include a mental health assessment. Protocols for the administration of medicines prescribed to be taken ‘as and when required’ should be developed so that staff have guidance on when to administer these medicines to residents. The home should consider appointing a designated activity coordinator with responsibility for coordinating and arranging activities on a daily basis, in order to improve the quality of life for residents. The décor and furnishings in the home should be maintained in a good condition in order to provide a pleasant environment for residents to live in. A minimum of 50 of care staff should achieve NVQ level 2 in order that a sufficient number of staff have the knowledge and skills to care for residents appropriately. 3. OP12 4. OP19 5. OP28 Elm Tree Close DS0000017811.V369456.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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