Inspection on 17/05/07 for Elm Tree Court

This inspection was carried out on 17th May 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elm Tree Court 12/10/05

Elm Tree Court 14/06/05

Elm Tree Court 17/02/05

Elm Tree Court 09/09/04

Elm Tree Court 09/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Elm Tree Court 344 Preston Road Hull East Yorkshire HU9 5HH Lead Inspector Beverley Hill Key Unannounced Inspection 17th May 2007 09:00 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 Court DS0000000846.V334556.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 Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm Tree Court Address 344 Preston Road Hull East Yorkshire HU9 5HH 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) 01482 788447 01482 788448 administrator.elmtreecourt@hica-uk Humberside Independent Care Association Limited Ida Sieglinda Smith Care Home 72 Category(ies) of Dementia - over 65 years of age (72), Old age, registration, with number not falling within any other category (72) of places Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Elm Tree Court to provide personal care for one named service user who is under the age of 60 years. Refer to Application Number V33161. 12th October 2005 Date of last inspection Brief Description of the Service: Elm Tree Court is a purpose built care home located on the eastern outskirts of Kingston upon Hull in a mainly residential area and close to shops, a health surgery, a post office, public houses, churches and leisure facilities. Main bus routes into the City Centre stop just outside the home and there are ample car parking facilities within the grounds. It is owned By Humberside Independent Care Association Ltd (HICA), which is a not for profit organisation. The home provides personal care and accommodation for a maximum of seventy-two older people, some of whom may have memory impairment. The facilities are all on the ground floor and the home is structured into three separate bungalows: Willows, Sycamore and Hawthorne. Each bungalow has twenty-four single bedrooms, however two of the bungalows have the facility to join together two bedrooms to make them shared accommodation. Each bungalow has two separate lounges, a serving area and dining room, which leads onto a further lounge, a bathroom, a shower room and individual toilets. Each bungalow has access to an individual enclosed courtyard where service users can walk in safety. A further courtyard area is the central core of the home and an internal ‘street’ surrounds this. Located on the street are a small shop, hairdressers’ salon and seating. Photographs of old Hull and other memorabilia decorate the walls. The main building also comprises of an entrance and reception area, administration offices, a visitors room, the kitchen and the laundry room. The home has a community feel to it and the individual bungalows are homely and well presented. According to information received from the home the weekly fees are between £327.50 and £440. There is a top up system of £10 for a basic room and £20 for an en-suite room. Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As the home is large with seventy-two service users the visit took place over two days. Throughout the days the inspector spoke to several service users to gain a picture of what life was like for people who lived at Elm Tree Court. The inspector also had discussions with the registered manager, care staff, catering staff, the administrator and two relatives. The inspector looked at assessments of need made before people were admitted to the home, and the home’s care plans to see how those needs were met while they were living there. Also examined were medication practices, activities provided, nutrition, complaints management, staffing levels, staff training, induction and supervision, how the home monitored the quality of the service it provided and how the home was managed overall. The inspector also checked with service users to make sure that privacy and dignity was maintained, that people could make choices about aspects of their lives and that the home ensured they were protected and safe in a clean environment. The inspector also observed the way staff spoke to service users and supported them and checked out with them their understanding of how to maintain privacy, dignity, independence and choice. Prior to the visit to the home the inspector had sent out a selection of surveys to service users, some family members, a selection of staff members and professional visitors to the home. Those returned were checked and comments used throughout the report. There were very positive comments about the home in general and the care provided by the staff team. What the service does well: The home provides good information to people about the services it provides so they can make a choice as to whether the home is suitable for their needs. They also complete assessments of peoples needs and obtain assessments done by care management to help them decide whether needs can be met in the home. The home provides a very pleasant environment for people to live and work in. It had a friendly and homely feel with separate bungalows and different areas for people to sit. The home was clean with no unpleasant odours. One relative stated, ‘it’s always clean and tidy, if there is an occasional odour the staff sort it’. Visitors were welcomed at any time of the day and this was confirmed in discussions with people the inspector met on the day. Replies from relatives Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 6 surveys also confirmed this and that the staff made sure they were kept informed of important issues affected their loved ones, ‘staff are approachable and contact is prompt if there are changes in his condition’. The home was well managed and the staff team showed genuine affection for the people they supported. They had a low staff turnover, which means that there is consistency of care and staff get to know the people who live there very well. One survey from a person who lived at the home stated, ‘the staff are lovely, friendly and help you as much as you can’. Relatives stated, ‘they make the individual feel that they are a much valued person’, ‘staff are first class’. A staff members stated, ‘residents are listened to and involved’. There were plenty of activities provided for people and staff ensured they were given choices about their lives. Staff members enjoyed working at the home and in discussions with them showed good understanding of how to make sure people remained as independent as possible. The induction and training provided in the home gave staff the opportunity to develop their skills and knowledge. Surveys received from staff commented positively on the home and their work, ‘it’s a fantastic place to work’, ‘the morale is very good’, ‘we have good teamwork’, ‘the training is very good and it’s a supportive environment’ and ‘it’s nice to get thanks from relatives’. Staff members feel they are supported and well supervised by management. Staff managed medication well and any complaints were looked at straight away and sorted out. People who lived at the home stated they liked the meals and drinks provided. Service users had plenty to eat and they always had choices at each meal with fresh fruit and vegetables. The home had been awarded part 1 and part 2 of the Local Authority Quality Development Scheme for ensuring care plans and a quality monitoring system was in place. The home has good policies and procedures and staff are aware of how to protect people from harm. What has improved since the last inspection? What they could do better: Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 7 The home completes assessments prior to admission. Staff members need to make sure they formally write to service users or their representatives following assessment stating that the home can meet their needs. The home produces care plans that state how peoples’ needs are to be met by staff. These need to make sure they include the full range of needs and what staff must do to minimise any risks that have been identified. It’s important that staff members have clear guidance in how to support people or care could be missed. The way the home completes checks on new staff coming to work at the home is usually very good. In two instances staff started work after an initial check but before the police check came back. When this happens, which is only in exceptional circumstances, the staff must be closely supervised. The home must ensure that they are aware of the rules that apply when financial top up arrangements are in place so service users don’t pay for this out of their own savings or personal allowance. The home must have some system in place to monitor the safety of bed rails. Some of those checked did not comply with manufacturers instructions and could place service users at risk. These were replaced by the home quickly after an immediate requirement notice was issued. The manager should make sure staff have up to date information about medication. 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 Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 and 5 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided prospective service users with comprehensive information about the home and offered visits and trial stays so people could assess the services prior to making a decision. Service users had assessments of need completed prior to admission and the home obtained copies of assessments completed by care management. This enabled the home to have full information about the service user in order to decide whether they can meet needs. EVIDENCE: The home has a comprehensive welcome pack that they send to people making enquiries about the home. This includes an updated statement of purpose and service user guide, rights and key values embedded in their principles of care, information about carers support networks, contract details and the scale of charges, sample menus, the complaints policy and the most recent inspection Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 10 report. This enables potential service users and their relatives to be armed with information they can test out during visits to the home. The inspector examined seven care files during the visit, some of whom paid privately and others whose care was commissioned by the local authority. There was evidence the home obtained assessments and care plans completed by care management and the manager confirmed they visited service users at home or in hospital to complete the homes in-house assessments. The information gathered enabled the home to decide whether they were able to meet the persons’ needs within the home. Examination of the documents indicated all needs were identified and the date of completion was prior to admission. The manager needs to formally write to service users or their representatives, following the assessment stating their capacity to meet identified needs. Currently this information is provided verbally. After admission the staff completed strengths and needs assessments relating to service users activities of daily living and these informed care plans. They also completed personal profiles and fact files which identified diverse needs, routines and preferences. The manager and staff confirmed that the home offered short respite stays to enable people to see what the home was like. The first few weeks of admission were seen as a trial period, after which a review was held and the service user and their relatives discussed the option of permanent residency. The home does not provide intermediate care services. Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Service users health and social care needs were planned for and met in a way that promoted privacy and dignity. Some gaps in care plan formation and risk assessments means that staff may not have all the required written information about service users needs. The home safely managed and administered service users medication. EVIDENCE: The inspector examined seven care files and they contained a wealth of information and assessments, including those completed by care management, to enable staff to formulate care plans. The care plans generally indicated the identified needs and the tasks staff had to complete to meet them but these could be completed with more detail to ensure care is not missed. Some care plans were more comprehensive than others and it was noted that identified needs had not been planned for in some of the care plans. For example, Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 12 specialised diet for one person, psychological needs for another, continence promotion for a third, financial management for a service user without any relatives, preference for a female carer for one person and dementia care needs for another. In discussion with staff members it was clear they were aware of the needs but this informal process cannot be relied on totally and identified needs must be written down in care plans to give clear guidance to staff. The care plans were evaluated every month and audited by senior staff. Although there were some gaps this tended to be an effective process in highlighting areas to be addressed. All service users had a review at six monthly intervals, whether this was conducted by the home or care management. There was evidence that service users or their representative signed agreement to the care plans. There was also evidence that service users health needs were monitored and they had access to health professionals and services. A psychiatrist holds a clinic at the home on a monthly basis with nursing professionals present. These enable discussions about service users needs with staff and relatives present. The home had completed charts for special needs for example bowel care, weight and food and fluid monitoring. The manager audited accidents and made referrals to the GP where appropriate. Four service users had been equipped with high-risk pendants to wear when walking around the home so they can alert staff the minute they require assistance. Risk assessments had been completed for particular areas such as bed rails, challenging behaviour, moving and handling, falls, nutrition and pressure areas. Some of the risk assessments highlighted needs that required care planning but this was not always followed through to provide staff with clear tasks in how to support people in particular risk areas. One service user had a clear risk regarding swallowing particular food. A soft diet had been provided; staff members were fully aware and indeed had reacted very quickly to a choking episode but the service user did not have a risk assessment. Staff members spoken to and surveys received from them indicated that they had a good understanding of how to provide care that maintained privacy, dignity, choice and independence. This was confirmed in discussions with service users and they were observed to be smartly dressed in clean clothes, attention had been paid to nail and hair care and male service users had been assisted to shave. The inspector observed staff members speaking to service users in a respectful and genuinely caring way. Medication was well managed. It was stored, recorded, administered and stock controlled appropriately. Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home had flexible routines and promoted choice and individual decisionmaking. The home provided well-balanced meals, which met service users nutritional needs. EVIDENCE: There was evidence that the home provided activities for people such as bingo sessions, cards and dominoes, puzzles, karaoke, movement to music, reminiscing, one to one chats about family life and work, video afternoons, manicures and listening to music. The home has regular trips out to facilities in the local area and church services are conducted. Seasonal activities take place, for example summer fairs, and Christmas parties. Links have been made with a local school for carol services and the Bilton Amateur Dramatics for old time music nights. One service user described an event when staff members entertained everyone with a dance routine. Service users spoken with were happy with the arrangements for activities and one spoke of the days passing very quickly because they were kept busy. They Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 14 also confirmed that they were supported and enabled to make decisions and choices about aspects of their lives and that routines were flexible with no set times for rising or retiring. Some people had their own telephones installed and two people had fire doorstops in place, as they liked to sleep with the bedroom door open at night. Some comments were, ‘I have my own phone and keep in touch with family’, ‘I like to keep to myself’, ‘it’s a marvellous home and I wouldn’t live here if I didn’t like it’, ‘I can’t fault anything and wouldn’t want to change anything’. The home recorded when social events had been participated in and a plan of activities was on display. Previous hobbies and interests were detailed in the service users personal profile and fact files, which were completed after admission. Service users spoken with stated their visitors could come at anytime and could be seen in private. This was confirmed in discussion with relatives and in surveys received from them. All relatives surveyed felt they were kept informed of important issues and with general day-to-day activities, ‘I’m always kept informed if the doctor is called and informed of the results’, ‘they make mother feel part of a family and that they live together in a community’, ‘mum has a better social life than me’ and ‘they make the individual feel that they are a much valued person’. Staff showed a good understanding of how to maintain service users independence and decision-making. This was especially important for people with dementia and limited capacity, ‘we ask families for information and put it in the care plan to build up a picture’, ‘for people with dementia we would hold up clothes for them to choose or show them plates of food, minor things to encourage choice’. Two relatives spoken to on the day stated, ‘it’s a lovely home, they look after the little personal things’, ‘mum is not able to communicate, she is well looked after’, ‘the staff speak in a respectful way, its comforting to know she is well looked after’. Service users spoken with enjoyed the meals provided by the home, although one survey received stated they felt the meat was too tough and the menu was repetitive. Menus were on display and they indicated choice and alternatives and service users confirmed alternatives were available in practice. Special diets were catered for and the chef was seen speaking to service users asking if they had enjoyed their lunch. The inspector sampled a meal on the day and there were two choices for lunch; they were well cooked and presented. The chef stated they cooked approximately twelve meals of each choice for each bungalow. This could have the potential to limit choice for service users; indeed one staff survey indicated they sometimes ran out of one of the more popular choices at the main meal. However on the day people enjoyed their meals. Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provides an environment where service users and relatives feel able to complain. Robust recruitment and selection, staff training and adherence to policies and procedures ensure the protection of service users from harm. EVIDENCE: The homes complaints policy was on display and via surveys and staff discussions it was clear they were aware of how to record and action complaints. No formal complaints had been received at the home or with the Commission. Each bungalow had a book to record niggles and those few seen were minor in nature and had been resolved. Service users spoken with stated they would complain to someone if they were unhappy. Relatives spoken with knew the names of staff members and stated they felt able to complain and were confident issues would be sorted out quickly. One survey received from a service user supported by a relative did state that complaining didn’t do any good. The inspector was unable to follow this up as there was no name attached but it was mentioned to the manager to check out at the next service users and relatives meetings. Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 16 All staff complete training in the protection of vulnerable adults from abuse during induction. The home had policies and procedures in place and staff members spoken to were aware of what to do if they suspected abuse had occurred. All stated they would report any abuse immediately to the manager. They were a little unsure as to who would complete an investigation but after discussion the manager was aware of their requirement to refer any allegations to the lead agency responsible for investigation. The homes recruitment practices were generally robust and ensured via selection, interview, references and police checks that only appropriate staff members were recruited. Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 24 and 26 People who use the service experience excellent quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home provided a well-maintained, clean and comfortable environment for service users. People had the opportunity to personalise their bedrooms. EVIDENCE: The home is divided into three ground floor bungalows each having two separate lounges, a serving area and dining room, which leads onto a further lounge, a bathroom, a shower room and individual toilets. Each bungalow has access to an individual enclosed courtyard where service users can walk in safety. A further courtyard area is the central core of the home and an internal ‘street’ surrounds this. Located on the street are a small shop, hairdressers’ salon and seating. The home has a community feel, is well decorated and furnished, and Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 18 well maintained. One of the lounges had two settees that looked quite low and another was looking a little jaded. The manager was aware of this and confirmed plans to replace them. Bedrooms had been personalised to varying degrees and service users confirmed they were able to bring in small items to decorate their room. Some service users had their own telephones and fridges. One person had a memory board for information and messages from relatives and another kept a budgie for company. All bedrooms had privacy locks and lockable facilities were available. Service users and relatives spoken with were very happy with the home in general and the bedrooms, ‘dad had sky installed, he loved sport’, the home is clean and tidy, we always check it’, ‘if there is an occasional odour the staff always sort it’, ‘yes mum has her own china cabinet you can bring in little things’, ‘I have my own telephone’. The home had sufficient laundry equipment and was fresh and clean. One person spoken with was very happy with the laundry, ‘I just leave my washing out and it’s done’. Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): outcomes in this area. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. The home has a good staff training record, which means that staff members are well supervised and have opportunities to participate in mandatory and service specific training. Generally the company had sound recruitment processes, however a gap in the process identified during the visit may place service users at risk. EVIDENCE: The company ensured that new staff members completed a five-day block of induction, which included training in fire procedures, safeguarding vulnerable adults from abuse, moving and handling, health and safety, basic first aid and social care values and communication. The manager confirmed that skills for care induction booklets were to be available for new care staff to work through which covered required standards in separate modules and which will ensure that competency is assessed throughout the process. This will be an improvement on previous induction, as currently induction tasks were signed off but did not evidence any competency in care practices. The home had a training plan and there was evidence that mandatory and service specific training was covered. Each staff member had a personal Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 20 training plan that recorded the training participated in. According to information received from the manager during the visit the home had 42.5 of care staff trained to NVQ (national vocational qualification) level 2 and 3, however a further ten care staff were progressing through the training. When staff members have completed the training the home will have exceeded the requirement of 50 of care staff trained to these levels. This level of training indicates the company is very committed to ensuring staff have the required skills and knowledge for their roles. Although the home appear to have sufficient staff in terms of numbers overall, staff members spoken with and staff and relatives surveys received indicated a level of concern regarding staffing numbers at peak times, such as the mornings and mealtimes, ‘they could make improvements by having more staff to help the residents at mealtimes’, ‘resources are stretched’, ‘sometimes staff are available’, ‘we are short, its busy and hectic, one of the bungalows got extra staff recently and its made a big difference’. The manager confirmed an extra staff member had been employed for one of the bungalows and this had made a huge difference to how staff cared for the service users. They were in the process of collating evidence to put before senior managers to request further staffing. Each bungalow needs to have a separate calculation of service user dependency levels and required staffing hours in line with the residential staffing forum matrix. These levels were not calculated in the pre-inspection information received by the Commission. Service users and relatives spoken with and surveys received were complimentary about the care staff team. Comments were, ‘staff are approachable and contact is prompt if there are changes in his condition’, ‘well trained, caring staff’, ‘staff are well trained, professional and approachable’, ‘staff are friendly and approachable, they know who I am and who mum is’, ‘they look after mum really well, she has everything she needs in the home’, ‘they answer the call bell quickly’, ‘the staff are lovely and friendly, they help you as much as you can’, ‘I’m going off this earth a happy person’. Generally the home operated a robust recruitment process. References and criminal record bureau checks were obtained and checks made against the protection of vulnerable adults register. Care staff members were selected via an interview process. Usually staff only started work in the home after the return of the criminal records bureau check, however on two occasions staff members started employment after the return of the povafirst check but before the criminal record bureau check had returned. One was for ten days and another for one month. In exceptional circumstances this is acceptable but the home must put in place stringent supervision arrangements and the inspector could not see evidence of this. However the manager confirmed the first week would be induction, followed by a period of shadowing other staff. Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 21 Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35, 36 and 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. This judgement has been made using available evidence including a visit to this service. The home is managed well and has a good system for monitoring the quality of care services the home provides. The company has misunderstood the legalities regarding third party top ups for one service user, which has meant that their financial contribution to their care has been too much. Improvements in the monitoring system for bed rails will ensure service users safety and wellbeing are promoted and protected. Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 23 EVIDENCE: The registered manager has twenty-five years experience in care settings and has completed the Registered Managers Award and NVQ Level 4 in care. She has also kept herself up to date with other skills and knowledge required for her role, for example employment law, mental capacity legislation and budgeting. There was evidence that staff members were supported by the provision of regular supervision. Supervision records were well organised, up to date and covered all the required areas. Staff also had annual appraisals, which identified training needs. Staff spoken with felt supported by the manager and surveys commented on her supportive and approachable manner, ‘she’s brilliant’, ‘she’s worked her way up and gets things done’ and ‘you can ask her anything’. Meetings were held for service users and staff and a coffee afternoon is held for relatives every two to three months. There was evidence that the views of service users, staff and relatives were listened to and acted on. The manager and staff members reported that the company provided them with a good structure of support, which included an area manager and a health and safety officer. The home has a comprehensive quality assurance system in place, which consists of audits and questionnaires to seek the views of all stakeholders. The quality audit tool focuses on all areas of service provision with different tasks each month. Results of audits and questionnaires are analysed and plans produced to rectify any shortfalls. The manager keeps a monthly record of the action taken to address shortfalls and keeps senior managers informed of progress. The company produces an annual development plan, which looks at the organisation as a whole as well as each individual home. Service users finances were well managed with individual records maintained on a computerised system. Receipts were obtained for money deposited into the personal allowance system and when staff members assisted service users to purchase items form local shops and on outings. The company had introduced third party top ups last year and these were paid by someone other than the service user. However on checking records it was noted that one service user had agreed to a third party top up deducted from their own account. This situation is not permissible within current legislation and must cease. Documentation indicated that moving and handling equipment was serviced regularly and fire drills and alarms completed. Staff completed health and safety training in induction and safety posters were on display in the home. Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 24 Bed rails were checked throughout the home during the visit and three were found not conform to manufacturers instructions. An immediate requirement notice was issued to address the problem. Information received from the home satisfied the inspector that the company’s health and safety officer had checked all the rails and replaced the three mentioned. Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 25 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 4 X 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 4 X X X 3 X 4 STAFFING Standard No Score 27 3 28 2 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 4 4 X 2 4 X 2 Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? NO 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 OP3 Regulation 14(1)(d) Requirement The registered person must ensure that the home formally writes to service users or their representatives following assessment stating their capacity to meet identified needs. The registered person must ensure that all assessed needs have plans of care in place to provide staff with written guidance on the tasks they must perform to meet them. The registered person must ensure that service users with identified risks have them planned for with clear steps in how to minimise the risks. The registered person must ensure that stringent supervision arrangements are in place in the exceptional circumstances when staff members start work after the povafirst check but prior to the return of the criminal record bureau check. The registered person must ensure that top up arrangements for one service user complies with current legislation. DS0000000846.V334556.R01.S.doc Timescale for action 30/06/07 2 OP7 15 30/06/07 3 OP8 13(4) 30/06/07 4 OP29 19 30/06/07 5 OP35 20 30/06/07 Elm Tree Court Version 5.2 Page 27 6 OP38 13(4) Discussion to take place with the local authority regarding measures to rectify the situation. The registered person must ensure that bedrails for three identified beds conform to manufacturers instructions. Immediate Requirement notice issued – within 48 hours. The registered person must improve the monitoring of bedrail provision to include a system of documenting checks made on the ongoing need for them and maintenance of them. 30/06/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP9 OP27 Good Practice Recommendations The manager should provide staff with up to date information on medication, for example the British National Formulary. The manager should re-examine staffing levels in line with the residential staffing forum and based on the dependency levels of service users. Each bungalow should be calculated separately. The home should continue to work towards 50 of care staff trained to NVQ Levels 2 and 3. The registered manager should complete safeguarding adults training provided by the local authority specifically for managers. 3 4 OP28 OP31 Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Hessle Area Office First Floor, Unit 3 Hesslewood Country Office Park Ferriby Road Hessle HU13 0QF 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. Extracts may not be used or reproduced without the express permission of CSCI Elm Tree Court DS0000000846.V334556.R01.S.doc Version 5.2 Page 29 - 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. 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