Inspection on 06/09/06 for Elm Tree Close

This inspection was carried out on 6th September 2006.

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 29/07/08

Elm Tree Close 22/08/07

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Elm Tree Close Elm Tree Avenue Frinton On Sea Essex CO13 0AX Lead Inspector Kathryn Moss Key Unannounced Inspection 6th September 2006 09:45 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.V311190.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.V311190.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 Mrs Brenda Ann Garrett Care Home 40 Category(ies) of Dementia - over 65 years of age (16), Old age, registration, with number not falling within any other category (40) of places Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Persons of either sex, aged 65 years and over, who require care by reason of old age only (not to exceed 40 persons) Persons of either sex, aged 65 years and over, who require care by reason of dementia (not to exceed 16 persons) The total number of service users accommodated in the home must not exceed 40 persons The registered provider must review staffing levels (care and ancillary) in consultation with the Commission, within six months of dementia registration, to ensure that staffing levels are sufficient to meet the needs and number of service users in the home 7th March 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 and the home is divided into five separate units, joined by connecting corridors. Each unit has a lounge and dining area, and all service users are accommodated in single bedrooms with ensuite bathrooms. A separate central area is used as a day centre, and is run independent of the residential home, although some events are shared with the home (e.g. outside entertainment). The home is registered to provide residential care for 40 Older People (over the age of 65), and provides 24-hour personal care and support. It has appropriate aids and equipment (e.g. mobile hoist, assisted bathing facilities, hand rails, etc.) to assist residents with limited mobility. There are currently a few existing service users at Elm Tree Close who have developed dementia since coming to live in the home, but the home is not registered to admit people with dementia. The home is owned by Southend Care. The registered manager is Mrs Brenda Garrett. The current scale of charges notified to the CSCI on the inspection is between £367.15 and £400 per week, with additional charges for personal items (toiletries, hairdresser, newspapers, chiropody, etc.). The home’s statement of purpose is displayed in the hallway of the home. Elm Tree Close DS0000017811.V311190.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 inspection that took place on the 6th September 2006, and lasting eight hours. On the day of the inspection there were 35 residents living at the home. The inspection process included: • • • • discussions with the manager, 7 staff, and 6 residents; feedback questionnaires received from two relatives; viewing of communal areas, a sample of bedrooms and bathrooms, and the laundry; and inspection of a sample of records and policies. This report also draws on other information received by the CSCI or submitted by the provider over the previous year (e.g. feedback from healthcare professionals, complaints, notifications of deaths and incidents in the home, reports on monthly visits by the registered provider, etc.). 25 standards were inspected, and 5 requirements (4 of which were repeat requirements) and 15 recommendations have been made. What the service does well: What has improved since the last inspection? Activities in the home had shown significant development since the last inspection. An activities co-ordinator had been appointed, and staff and residents were very positive about this. Additionally, during the year a number of social events had taken place with other local Southend Care Homes, with groups of residents from each home visiting the other homes for events such Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 6 as a Barbecue and a strawberry tea. Residents spoken to had clearly enjoyed the opportunity to go out on these trips. Quality Assurance processes had also been developed since the last inspection. The provider had implemented a number of new Quality Monitoring checklists in the home, and these provided a more comprehensive and focused means of monitoring the service and of identifying areas for improvement. This is commendable. 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. Elm Tree Close DS0000017811.V311190.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.V311190.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 4 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has information available to enable prospective residents to make an informed choice about living in the home. Residents’ needs are assessed prior to admission, to ensure the home can meet their needs. EVIDENCE: A revised Statement of Purpose had been submitted by the home earlier in the year, and a Service User Guide was submitted last year. These were not reviewed on this inspection, but it was noted that a copy of the Statement of Purpose was displayed in the hallway. A file inspected for a newly admitted resident contained a care management assessment and also a pre-admission assessment carried out by Southend Care’s placement co-ordinator, which included an assessment of mental health needs (the person suffered with dementia). The placement co-ordinator also Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 9 carries out post-admission interviews with new residents to check how they are finding the home. All residents spoken during the inspection were positive about the staff at Elm Tree Close, and felt that they had the skills to meet their needs. Relatives who provided feedback were also satisfied with the overall care provided. The home provides appropriate facilities to meet the needs of the people it aims to accommodate. Earlier in the year the home’s conditions of registration were amended to enable it to care for up to 16 people suffering with dementia, and it was good to see that most staff had attended an initial dementia care training course at that time, and a few were now completing a distance learning dementia course. For a person who suffered with dementia and got disorientated in time and place, especially when wandering around the home, it was suggested that the home needs to consider ways of improving the environment to meet the needs of people who may get disorientated (e.g. improved signage, colour schemes, recognisable ‘landmarks’, etc.). Elm Tree Close DS0000017811.V311190.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Health and personal care needs were being met. However, care plans did not provide adequate information on the action required by staff to meet needs; this has been an ongoing issue that has not yet been addressed. Care was delivered in a way that respected residents’ privacy and dignity. Medication practices safeguarded residents. EVIDENCE: The files of three residents were inspected on this occasion. Care plans present were relevant to the individuals, but lacked any individual detail of the action required from staff to help the person to meet each need. It is important that care plans contain clear guidance on the action required by staff, particularly in relation to key personal care needs (e.g. in one case care plans for ‘inability to self-toilet’ and ‘inability to carry out personal cleansing’ contained no details of what support was required, or what the person could do for themselves). For a person who suffered with dementia, there were no care plans to address some core needs (e.g. support with toileting, personal Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 11 care, feeding, and managing challenging behaviour). Care plans had been reviewed monthly, but did not show any significant improvement in content since the last inspection. Residents spoken to were all positive about the support given to them at Elm Tree Close: they stated that staff gave them good support with their personal care, and felt that staff treated them with respect and dignity. One person confirmed that the home accessed medical advice for them when required, and confirmed that the district nurse regularly visited them to monitor their diabetes needs. Several staff had attended a diabetes workshop earlier in the year, and a senior carer spoken to showed good knowledge of this. Residents spoken to appeared well cared for, with clean and co-ordinated personal clothing, and well-groomed hair. The hairdresser was visiting the home on the day of the inspection, and residents were enjoying the having their hair done. Risk assessments showed any pressure area risks and also addressed moving and handling risks and risk of falls, although the care plans viewed lacked details of specific action to address risk of falls. One person whose file was viewed was at risk of developing pressure areas: whilst discussion with manager and staff confirmed that this person was receiving appropriate care, care plans lacked clear information on the pressure relief mattress and cushions in use. There were no unpleasant odours noticed around the home on the day of the inspection, suggesting good continence management. Other healthcare records were not specifically viewed on this occasion. The home has safe medication storage facilities on each unit, and additional central storage facilities (including a fridge and a controlled drugs cabinet). The home was monitoring the temperature of the storage facilities on the units: temperatures were close to 25°C and the home should therefore keep storage facilities under review to ensure they are appropriate for the medication. Regularly prescribed tablet medication was dispensed to the home in a monitored dosage system; most bottles of liquid medication viewed had been dated on opening. The Medication Administration Record (MAR) was printed by the pharmacist, and medication received by the home was recorded on the MAR. Where no new medication stock had been received, medication carried over from the previous month was clearly recorded. Records of medication were well maintained with no gaps seen; ‘as required’ medication was recorded in a consistent manner. Medication details entered by hand on the MAR were clearly recorded and signed by the person making the record. The home’s medication administration policy was not viewed on this occasion, but a copy of the company policy had been previously viewed and contained appropriate guidance. Staff medication training records were not specifically inspected on this occasion: the inspector was advised that staff attend a training session led by the pharmacist and internal training covering the home’s procedure and an assessment of competence, and that all staff administering medication had completed the competency assessment. Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 12 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 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has space and facilities that meet the social and recreational preferences of the residents, and provided a range of activities to meet residents’ needs. The home provides residents with choices in their daily lives, and encourages contact with family and friends. The home provides the residents with a varied and nutritious diet. EVIDENCE: A new part-time activities co-ordinator had been appointed since the last inspection, and staff and residents were very positive about this initiative. Activities were observed taking place on the day of the inspection (with residents seen making paper garlands in preparation for a forthcoming ‘Hawaiian’ party!). One carer felt that having someone organise activities in the Day Room enabled them to focus on any residents remaining in the units, where they said care staff would carry out other activities with residents. Residents spoken to were very positive about a number of social events that had taken place this year between the five local homes owned by the registered provider, including a trip to the seaside, a barbecue, and an Easter Bonnet and ‘pub lunch’ event. There had also been a recent barbecue at the Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 13 home. Residents had clearly enjoyed these events. Another person said that they loved the singing and dancing and that they liked to join in with all activities. Both relatives who provided feedback felt that the home provided appropriate day-to-day activities. Residents meetings were held in the home, and suggestions were acted on: for example, was good to see that as a result of a request by residents, the home was now regularly having a buffet tea in the day room, to enable residents from different bungalows to get together. The file of a resident who suffered from dementia and had been living in the home approximately six weeks was noted to have no social and family history completed. Staff are encouraged to record life history information as soon as possible after admission. Care plans to address ‘lack of recreation activities’ or ‘inability to engage in social interaction’ lacked information on the action required of staff to assist the person to occupy their time, engage in activities or receive stimulation. This needs to be addressed. Records of daily activities were not specifically reviewed on this occasion. Residents spoken to were positive about the meals at Elm Tree Close. One resident reported that they had eaten mince and vegetables for lunch and had enjoyed it. Another said that the main meals were good, but felt that there was too much ‘beans or spaghetti on toast’ type of meals at teatimes. A sample two-week menu submitted showed that a number of tea-time meals were duplicated over the two week period (e.g. scrambled eggs on toast, spaghetti on toast, bacon and tomatoes, sausage and tomatoes – all served twice), and the home should consult with residents and review whether teatime choices meet their needs and preferences. A resident confirmed that there were choices at each meal: this was confirmed by the menus seen, which showed a good range of main meals served within the home. Residents said that they had a good cook at the home, and relatives who completed feedback questionnaires felt that the meals provided to residents were of satisfactory variety and quality. Food stocks and kitchen issues were not inspected on this occasion. The visitors book demonstrated that friends and relatives were able to visit the home whenever they wished, and relatives providing feedback stated that they felt welcomed in the home by staff, could visit the resident in private, and were kept informed of any important matters affecting their relative. Residents spoken to were clear that they had choices in their daily life (e.g. meals, when to get up, what to do, etc.), and it was noticed that residents were free to wander around the home and to spend time where they chose. From bedrooms viewed it was evident that residents could bring personal possessions into the home with them, and it was good to hear that one resident had chosen the colour that their room was to be painted. Information on advocates, and access to personal files, was not discussed on this inspection. Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has appropriate procedures for responding to complaints or allegations, and has demonstrated that concerns are responded to. EVIDENCE: Elm Tree Close has a complaints procedure for residents, which is included in the statement of purpose and available to residents. The manager maintained a complaints record book: this showed regular entries of all types of concerns and complaints, showing good attention to identifying and addressing even minor concerns. There were several complaints raised about residents suffering with dementia wandering into other residents’ rooms: the manager was advised to monitor this, as it may indicate that higher levels of staffing are required to monitor this, now that the home is registered to care for people who suffer with dementia. Residents spoken to had no concerns about the home, and appeared confidant to speak to the manager if required. Relatives who provided feedback said they were not aware of the home’s complaints’ procedure, but said that they had not needed to make a complaint. The home’s Protection of Vulnerable Adults (POVA) policy was not viewed on this occasion, but has been previously seen and satisfactorily covered the procedure to follow in the event of suspicion of abuse. Records of training courses attended this year showed that two POVA workshops had been held in the home (led by an outside trainer), which 28 staff had attended. This Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 15 showed a good level of current training in this subject. Two concerns had been raised in the home since the last inspection: these had been appropriately responded to by the home, and had not been substantiated. Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 16 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, 20, 25 and 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 well-maintained environment, and have access to a range of comfortable communal facilities. Heating, lighting and water supplies were safely maintained. The home was clean and hygienic. EVIDENCE: There were no obvious areas of concern (re décor or safety) arising from a brief tour of the premises. Communal areas were warm, clean and tidy, and a sample of bedrooms viewed were in a satisfactory condition. Records of work carried out were not viewed on this inspection, but the manager reported that several bedrooms had been decorated recently, and another room was due to be done (where the resident had already chosen the colour). One of the newly decorated rooms was viewed, and was clean and fresh. The manager advised that the corridors were in need of decoration. Staff reported that if they noticed repairs that needed action, they advised the manager or maintenance Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 17 person and action was taken to address the concern. Both relatives providing feedback felt that the premises were usually clean, warm and well maintained. The home is centrally heated, naturally ventilated, and suitably lit. Action to fit radiator covers to unprotected hot radiators (to reduce risk of scalding) was in process at the time of the inspection, and it was noted that radiators in the corridors and lounge on one of the bungalows had already been covered. The manager was encouraged to ensure that this task is completed as soon as possible. There were systems in place to reduce risk of scalding from hot water, and hot water taps were checked regularly to ensure they remained close to 43°C to prevent risk of scalding. Unregulated hot taps (not accessed by residents) were checked regularly as an indicator as to whether central hot water was stored at over 60°C to prevent risk of Legionella. The home’s laundry room was away from areas where food was stored or prepared. It contained washing and drying machines, a sink for hand washing clothing, and a hand washbasin; a sluice sink was available in a separate adjacent sluice room. From discussion with the person doing the laundry, it appeared that sheets or other items soiled with body fluids were being washed on a 60°C wash cycle: machines only had hot-wash options of 60°C and 95°C, and this meant that items soiled with body fluids were not being washed at over 65°C (for at least 10 minutes) as infection control advice recommends. The manager was advised to seek advice on infection control practices with regard to linen that may be infected, and to ensure that all staff follow clear consistent practices regarding this. There was evidence that most staff had attended infection control training this year, which was good to see. The home was free from unpleasant odours. Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 18 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 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff have the skills to meet residents’ needs, but care staffing levels had not been consistently maintained due to short staffing. The home provides an appropriate range of training to give staff the skills to do their job, but not all staff had attended all core training. Recruitment practices generally met regulations, but not all pre-recruitment information was fully recorded. EVIDENCE: Staffing was discussed with the manager during the inspection. It was noted that ten carers had left since the last inspection: although four new carers had been recruited, the manager confirmed that the home was still short staffed and that it had been difficult staffing the home over the summer period. She stated that they had managed by using staff from other homes and some agency staff; the manager had been helping out when required, and advised that domestic staff had also been acting as ‘support carers’ at peak times, mainly doing meal serving and clearing, but also acting as a support for care staff when hoisting residents (the manager confirmed that domestic staff had received moving and handling training). The home aimed to maintain care staffing levels of eight staff in the morning, and seven in the afternoon: rotas for the two weeks prior to the inspection showed that this had not been consistently maintained, with some shifts one Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 19 or two care staff short. It was noted from rotas that domestic staff were being included in the ‘total’ care staffing levels because of their ‘support’ role: as they remain primarily domestic staff and do not replace the role of a carer the manager was advised that domestic staff should not be included in care staff numbers, but it was suggested that if any domestic staff work in a care capacity for a significant part of a shift, the rotas should reflect the specific hours in which they are working in a care capacity instead of carrying out domestic duties. Rotas showed that on most days there were several domestic staff on duty, although on the day of the inspection there was only one on duty, covering the laundry and priority domestic tasks. Another member of the domestic staff was working as a ‘care support’ on one of the units on the day of the inspection, and confirmed that they had received moving and handling training. From rotas provided it appeared that some care staff in the home had been working several long days each week (sometimes three or four long days a week), including some consecutive long days. Whilst staff are commended for their commitment to cover the home, the registered person must closely monitor this to ensure that the health and welfare of staff and residents is not put at risk. On some days it was noted that four or five staff were working a long day: staff on long days had a one hour lunch break, and when several staff were on a long day this meant that there were several hours of the day when the home was short staffed. Of the twenty-one care staff currently working at the home, five had achieved NVQ level 2; a senior carer was due to enrol on NVQ level 3, but there were no plans for other staff to start NVQ training in the near future. The provider has advised CSCI that some staff recruited from outside of the UK (currently seven staff) have qualifications equivalent to NVQ level 2 in care, but there is not yet evidence available to demonstrate this. Other training was evidenced on individual files (records not specifically inspected on this occasion) and it was recommended that the manager develop a central summary of staff training to enable her to more easily monitor levels of staff training and check when updates are due. A good range of training had been competed by staff this year, including training referred to elsewhere in this report (e.g. dementia care, POVA, infection control, etc.) plus some staff had attended workshops in management of constipation, continence and catheter care, diabetes and blood sugar monitoring, reminiscence, funeral service awareness and first aid. The manager had identified that food hygiene training was needed, and individual staff training profiles showed that a number of staff had not received recent fire awareness training. This needs to be addressed. The manager was due to attend a fire marshal training course, and expected this to include skills in cascading fire training to staff. The manager reported that the home had an induction workbook covering the five TOPSS induction units, which was still being given to new staff to complete (evidence seen). The manager was not specifically aware of the new Skills for Care ‘Common Induction Standards’ that have replaced the TOPSS induction, and was advised to look these up. Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 20 The files of two new staff members were viewed for evidence of the home’s recruitment process. Both contained completed application forms, which included names of referees, a statement of health, a declaration of criminal record, and an employment history. In both cases there was an unexplained gap in the employment history, and the manager was reminded that the regulations require a written explanation of any gaps in employment. Both files contained evidence of identification; only one contained a photo of the person. Both files contained two written references received before the carer started work. Both also contained a Criminal Records Bureau (CRB) check: although these had not been received before the carers started work, in both cases there was evidence of a POVAfirst check obtained before they started. The manager was reminded of the need to evidence supervision processes (in accordance with Department of Health guidelines) pending receipt of the full CRB check. Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 21 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 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The registered manager has appropriate experience to manage the home, and is working towards obtaining a relevant qualification. Quality assurance processes are in place to ensure that the home is run in the best interests of residents. Systems for looking after service user’s money safeguard their financial interests. Health and safety practices in the home protect residents and staff, although some staff had not attended all relevant training. EVIDENCE: The Manager reported that she has now started a combined NVQ level 4 in management and in care. Evidence seen showed that the manager had attended other relevant training, and that she was in the process of doing a distance learning dementia course. She reported that she received support Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 22 and supervision, and staff and residents spoken to during the inspection were very positive about the manager, finding her supportive and approachable. The manager reported that a survey of residents’ views was carried out earlier this year, and a report had been produced from this (evidence seen). This included some recommendations, and the manager intended to develop an action plan to address these. Other forms of quality assurance and monitoring in place within the home included: consultation with residents through residents’ meetings (minutes of recent meeting displayed on a notice board in each bungalow), records of monitoring visits on behalf of the registered provider (evidence of these seen bi-monthly); a monthly quality control audit form and a monthly management report, covering a comprehensive range of practices and issues in the home; a communication records showing regular contact with relatives; and monthly medication audit forms. Some of the monitoring forms had been introduced since the last inspection, and it was good to see the development in quality assurance monitoring processes in the home. Annual development plans were not discussed on this occasion. The home maintains secure facilities for the safekeeping of residents’ monies, and clear records of any money held for safekeeping and of any expenditure. A sample record viewed was clear and accurate (balanced with cash held), with entries double-signed by staff and evidence that the records and cash held were audited monthly. The manager acts as agent for six residents’ benefits, and a few residents have additional money held for safe-keeping in a non-interest residents’ account (records not viewed on this occasion). Health and Safety policies and procedures were not viewed on this inspection. Staff training showed good evidence of training in moving and handling and infection control, but further action was needed with regard to fire safety and food hygiene. Records evidenced the current servicing of equipment and utilities, showing that the home maintained facilities well. There was also evidence of checks carried out internally on fire alarms, fire equipment and emergency lighting: records over the last six months were intermittent, and the manager explained that this was because the maintenance person had left. A new person was now in post and evidence was seen that fire equipment had been recently checked. Hot water taps were also checked regularly to ensure they remained close to 43°C to prevent risk of scalding, and included checks on some unregulated taps to check that central hot water was stored at over 60°C to prevent risk of Legionella. A health and safety checklist was completed in the home each month, covering most aspects of safety and repairs. Risk assessments viewed included a general risk assessment on hazards/working practices in the home, which had been updated to provide fuller detail. There were also separate (individual) risk assessments for specific issues (e.g. unguarded radiators), including activities. There was no risk assessment covering the use and storage of chemicals in the home. Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 23 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 3 X N/a 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 X X X X 3 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.V311190.R01.S.doc Version 5.2 Page 24 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 The registered person must ensure that care plans describe the action required by staff to meet each individual need. This must include personal care and health care needs, as well as social and emotional/mental health needs. This is a repeat requirement for the sixth time (last timescale 30/04/06). The manager must ensure that appropriate care staffing levels are maintained throughout the day, sufficient to meet residents’ needs. This includes periods of the day when staff working long days are taking a break. This is a repeat requirement (last timescale (31.3.06). The registered person must ensure that all records required by regulation are obtained and kept on file for all care staff recruited by the home. This is in respect of a written explanation of any gaps in employment history, and photos. DS0000017811.V311190.R01.S.doc Timescale for action 30/11/06 2. OP27 18 31/10/06 3. OP29 19 31/10/06 Elm Tree Close Version 5.2 Page 25 4. OP38 13 & 18 This is a repeat requirement in relation to written explanation of gaps in employment history (last timescale 31.3.06). The registered person must ensure that staff (care and ancillary) receive appropriate training in all areas of health and safety. This is particularly with respect to food hygiene training and fire safety. This is a repeat requirement in relation to food hygiene training (last timescale 30.6.06). The registered provider must ensure that records are maintained in the home to evidence that monitoring visits on behalf of the registered provider are carried out at least once a month (i.e. Regulation 26 visits). (ref also NMS 37) 31/12/06 5. OP33 26 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 Refer to Standard OP4 OP7 Good Practice Recommendations The home should consider ways of improving the environment to assist people who may get disorientated when navigating around the home. (ref also NMS 22). Care plans to address residents’ need for activity/occupation and stimulation should include information on the action required of staff to assist the person to occupy their time, engage in activities or receive stimulation. (ref also NMS 12) Care plans relating to the action required where there is a risk of pressure areas should clearly describe any pressure relief equipment in use. This is a repeat recommendation. DS0000017811.V311190.R01.S.doc Version 5.2 Page 26 3 OP8 Elm Tree Close 4 5 6 OP15 OP16 OP26 7 OP27 8 OP27 9 10 11 OP28 OP28 OP29 12 13 14 OP30 OP30 OP38 15 OP38 It is recommended that the home reviews the range of food provided at tea-times, in consultation with residents. It is recommended that the relatives of new residents are made aware of the home’s complaints procedure. It is recommended that the registered person seek advice (e.g. from the Health Protection Agency) regarding washing clothing soiled with body fluids at temperatures of less than 65°C. This is a repeat recommendation. 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. The registered person should ensure that sufficient domestic staff are consistently on duty each day to ensure that the home is maintained in a clean and hygienic state. (ref also NMS 26). 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. If staff have alternative qualifications that are equivalent to NVQ level two in care or above, evidence to demonstrate this should be maintained in the home. 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). It is recommended that a central summary of staff training be maintained in the home, to facilitate the monitoring of staff training. The registered person should ensure that risk assessments on safe working practices in the home address potential risks, and any action taken to address these, in relation to the safe storage and use of chemicals in the home. The registered person should ensure that evidence of regular health and safety checks on equipment and facilities are consistently maintained. This is particularly with reference to checks on fire alarms and equipment, and ensuring systems in place for the maintenance of checks when the responsible staff member is absent. Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Colchester Local Office 1st Floor, Fairfax House Causton Road Colchester Essex CO1 1RJ National Enquiry Line: 0845 015 0120 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. Extracts may not be used or reproduced without the express permission of CSCI Elm Tree Close DS0000017811.V311190.R01.S.doc Version 5.2 Page 28 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!