Inspection on 17/11/05 for Elm Tree House

This inspection was carried out on 17th November 2005.

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 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 House 03/11/08

Elm Tree House 30/11/07

Elm Tree House 19/02/07

Elm Tree House 11/05/06

Similar services:

Trevayler Residential Care Home

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

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

CARE HOMES FOR OLDER PEOPLE Elm Tree House 37a Ogle Street Hucknall Nottingham NG15 7FQ Lead Inspector Jayne Hilton Unannounced Inspection 17th November 2005 9:00 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 House DS0000064368.V253782.R01.S.doc Version 5.0 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 House DS0000064368.V253782.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Elm Tree House Address 37a Ogle Street Hucknall Nottingham NG15 7FQ 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) 0115 960 5724 Carisbrooke Healthcare Ltd Elizabeth Pasik Care Home 17 Category(ies) of Dementia - over 65 years of age (17), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (2), Old age, not falling within any other category (17) Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Within the total number of beds, a maximum of 17 may be used for the category OP Within the total number of beds, a maximum of 17 may be used for the category DE(E) Within the total number of beds, a maximum of 2 may be used for the category MD(E) 31st May 2005 Date of last inspection Brief Description of the Service: Elm Tree House is a converted family house providing residential care for up to seventeen (17) older people. The home is situated in a residential area near the heart of Hucknall, within walking distance of shops and local amenities. The home is comfortable and homely and has pleasant gardens to the rear. There is a car park available at the front of the building. The home has recently made an application to vary the registration to include/extend the service in provision for Dementia Care and Mental Disorder for people over the age of 65 years which has been approved. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection took place at 9am on 17th November 2005 by Jayne Hilton and took five hours. The methodology used was, a follow up on requirements set for the previous inspection and to assess the key standards not assessed at that visit. The methodology included a tour of the environment, speaking with three service users, three staff and the manager. A sample of records was examined also. The new provider has made good progress in addressing the requirements handed over from the previous owner. What the service does well: The service users continue to be well cared for and reported that they were satisfied with the care and were happy living in the home. They continue to have control over their lives. New service users needs are assessed prior to moving to the home and know the home will meet their needs. The home is clean and free from any mal odour. Staff reported that new management systems were being implemented for the better. The service users health, personal and social care needs are set out in an individual’s plan of care and are protected by the homes policies and procedures for dealing with medication. Service users wishes for the end of life are documented in the care plan. There is provision of activities which service users enjoy, and on the whole service users have control over their lives and maintain contact with family and friends and the local community as they wish. Service users receive a wholesome appealing balanced diet in a supportive environment, Service users benefit from a clear complaints procedure and those spoken with are confident in making a complaint. The procedures in place for protecting service users from abuse need reviewing to bring the home in line with current reporting requirements. Service users benefit from a homely, well decorated, comfortably furnished, clean and generally adequate and safe environment. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: Evidence of this is needed that the Statement of Purpose and Service User Guide provide information for current and prospective service users. The registered provider must address the issues regarding the statements made by service users about low food stocks. The procedures in place for protecting service users from abuse need reviewing to bring the home in line with current reporting requirements. There are issues to address in relation to heating of bedrooms, regulation of water temperatures, supplies of toilet rolls and personal protective clothing for staff. The recruitment practices in the home do not fully protect service users. An immediate requirement is therefore set in order to resolve this. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 Page 7 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 House DS0000064368.V253782.R01.S.doc Version 5.0 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 House DS0000064368.V253782.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3, 4 The Statement of Purpose and Service User Guide has been produced to reflect the new registration category, but evidence of this is needed that they provide information for current and prospective service users The provider has introduced a new care plan format. New service users needs are assessed prior to moving to the home and know the home will meet their needs. EVIDENCE: A new statement of purpose and Service user guide has been produced regarding the change of ownership and recent change in registration categories. A copy had been sent to CSCI but on the day of the inspection, t he Statement of Purpose was not seen in the home and those service users spoken with could not find a copy in their rooms. It is recommended that a copy be displayed in the home and that service users or their relatives sign to say they have received a copy. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 Page 10 Within the admission documentation it is recommended that a section be included for the issue of door keys and keys for lockable facilities also with a signature sheet for issue of these. Where service users are not able to manage their own door-key a risk assessment should be in place regarding this. A new care plan format has been introduced. All service users are assessed prior to moving in. Signatures of service users and their relatives were seen in the plans. There was some identified needs/preferences in relation to one service user not drinking tea or coffee, not covered within the care plan documentation. Staff reported that the home is managed well and that their terms and conditions have improved. Service users spoken with were generally happy with the provision of care and were happy that the home is meeting their needs. The staff were praised for their helpfulness. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 The service users health, personal and social care needs are set out in an individual’s plan of care and are protected by the homes policies and procedures for dealing with medication. Service users feel they are treated with respect and their right to privacy is upheld. Service users wishes for the end of life, is documented in the care plan. EVIDENCE: A new care plan format has been introduced. Nutritional assessments, dependency assessments, mobility and manual handling assessments and tissue viability monitoring tools were in place on the three care plans examined. Specific care plans were identified from the assessment documentation, and service users had signed that they agreed to these. There are to be further additions such as key allocation and likes and dislikes and preferences of refreshment and opportunities for self-medication to be added. At the previous inspection one service user with a sight impairment reported he tended to stay in his room as he was finding it increasingly difficult to get Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 Page 12 about. He also reported that he did not know what meals he was served, as he couldn’t see what was on the plate. It was identified that the care plans for this service user need to address these needs. The service users care plan was examined and found now to include these issues, however on speaking with the service user, he reported that staff do not always explain to him what is being served on the plate. The manager is requested to address with this staff. Daily notes were examined and although improvement is noted, staff need to be encouraged to cover the holistic needs of service users, rather than just write for example, ‘Joyce is fine today’. It may be useful to provide staff with a possible list of areas to evaluate each day, when reporting on service users daily lifestyle. Weight records were again, not up to date on those care plans examined. All three-service users spoken with were happy with their care and stated that their health care needs were met. One service user commented that the home had no faults. One service user had requested a GP appointment, via the inspector and the manager advised to arrange this promptly. Service users reported that their privacy was respected at all times. The medication system has been changed to the Nomad system. The pharmacist providing these is ‘Cinderhill pharmacy’. A new controlled drug record book was noted to be in place. On examination of the medication record sheet all were completed satisfactorily. Temperatures of the storage room and medication fridge were examined and satisfactory. The acting manager reported that the policies and procedures had been reviewed to meet with the requirements of the last inspection; unfortunately the inspector did not have time to view these. Several training sessions are in process for the safe handling of medicines. It is recommended that a copy of the medicines policies are kept with the medication record charts, particularly a flow chart to inform staff what to do in the event of a drug error. Service users wishes upon the end of life, are now included in individual care plans. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14, 15 There is provision of activities which service users enjoy, and on the whole service users have control over their lives and maintain contact with family and friends and the local community as they wish. Service users receive a wholesome appealing balanced diet in a supportive environment, but the registered provider must address the issues regarding the statements made by service users about low food stocks. EVIDENCE: All service users spoken with confirmed that they retired to bed and got up when they wished and that visitors were not restricted. The activities co-ordinator incorporates trips out and about in the community as service users request this. Participation in activities is now recorded in the new care plan format but still is mainly focused around bingo, dominoes and quizzes. A new menu has been devised and offers two choices apart from ‘roast days’, although staff and service users reported that sausage has been provided if service users don’t want the meat. There was evidence that service users Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 Page 14 choose their meal options daily, however there was comments from all three service users that there had been some occasions where their menu options had not been provided, due to there not being enough of the choice option to go around. There were some contradicting statements from staff, service users and the manager about the availability of certain food items. A service user also reported that on one occasion service users had been told was no tea bags in stock to make morning tea and no cereals. The manager stated that she was not aware of this. Stocks of food on the day of the inspection were plentiful. Staff reported that they were not aware of food stocks being insufficient. Service users reported that on the whole, they were satisfied with the food but it did vary depending on the cook. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 Service users benefit from a clear complaints procedure and those spoken with are confident in making a complaint. The procedures in place for protecting service users from abuse need reviewing to bring the home in line with current reporting requirements. EVIDENCE: There was a complaints procedure on display which states complaints will be responded to within 28 days. The acting manager reported that she asks service users daily if they have any concerns, staff and service users confirmed this. There have been two complaints recorded since the last inspection. Service users reported that they would be confident to make a complaint should they have reason to do so but felt that some service users moaned about things but didn’t speak up when asked. One of the complaints should have been reported under POVA [Protection of Vulnerable Adults procedures] and the manager was requested to initiate this promptly by contacting social services who take the lead in such instances to co-ordinate and possibly investigate the complaint. A POVA notification form must be submitted to the Adult Protection Unit for monitoring purposes. The manager is required to update knowledge on the reporting procedures for future reference. The complaint also necessitates a regulation 37 notification to CSCI, which had not been complied with either. Most staff has undertaken training in adult protection. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 Page 16 The other complaint was from service users relative about various issues and is currently being dealt with by the Registered Manager and Registered Provider. The inspector requested that a copy of the response be sent to CSCI to ensure matters are resolved satisfactorily. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20,21, 24.25, 30 Service users benefit from a homely, well decorated, comfortably furnished, clean and generally adequate and safe environment. There are issues to address in relation to heating of bedrooms, regulation of water temperatures, supplies of toilet rolls and personal protective clothing for staff. EVIDENCE: A tour of the home found that the home was comfortably furnished, clean and smelled fresh. The new provider has attended to many of the requirements set at the previous inspection. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 Page 18 The home has a range of adaptations and equipment, which meet the needs of the current service users. All ensuite to individual service users rooms have sliding doors to aid access. A passenger lift is available and in full commission. Grab rails are fitted in communal toilets and bathrooms and throughout the corridors (on one side). There is a ramped entrance to the home that is wheelchair friendly. The ramp and steps to the front of the building is regularly jet washed. All communal facilities have been attractively decorated and furnished. There are adequate toilets and bathing facilities as service users have en suite facilities in their rooms. A bathroom on the first floor is in need of refurbishment, which the provider has plans to do and reported that a new Parker Bath is to be fitted. There were some comments from service users that there had been occasions that he home had run short of toilet rolls in the ensuites and conflicting comments from staff and the manager. The toilet rolls are stored in the office currently, but the manager did agree that a supply could be kept in the home to ensure that a reasonable supply is available as needed. One service user remarked that the quality of the toilet paper was not satisfactory. Lighting in the home is of a domestic style and service users had no complaints regarding the lighting provision in the home. All light fittings had shades provided. The communal areas of home was found to be very warm on the day of the inspection, however some service users rooms were found not to be so warm. One service user reported that he had felt cold in bed at night. The manager was advised to ensure that individual preferences regarding heating in bedrooms, is regulated accordingly and that a service user survey be used for this purpose. The manager and staff reported that there had been a recent problem with the heating and the plumber had been called in to rectify this. At least three bedrooms were examined, all were found to be comfortably furnished, well equipped and clean. All were well personalised. Lockable facilities were provided, but not all service users had keys. Radiator covers are now in place. The manager reported that regulator valves for water outlets have been fitted and tested, however. Two sample tests were carried out and both were above 43 degrees. Action must be taken to remedy this. The laundry facilities were not examined at this visit, however paper towels and antibacterial hand wash was provided throughout the home. The home was clean and free from malodour throughout. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 Page 19 There were no supplies of disposable gloves seen in the home and a delivery of these did arrive during the inspection. There was again conflicting information as to whose responsibility it was to ensure adequate supplies of personal protective clothing is maintained. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 The recruitment practices in the home do not fully protect service users. An immediate requirement is therefore set in order to resolve this. EVIDENCE: A sample of three newly employed staff files were examined and one existing staff members personal file. There was no evidence of CRB checks or POVA] Protection of Vulnerable Adults register] checks for any of the three new staff. Other documentation required by legislation [Schedule 2] was not complete either. The Manager was advised that this must all be in place within 14 days. An immediate requirement was set in order that no new staff are employed without evidence of appropriate recruitment checks, which are satisfactory. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 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): 33,35 The quality monitoring systems demonstrate the home is run in the best interests of service users, and that service users financial interests are safeguarded, however these could be further improved. EVIDENCE: Service users and staff were aware of a recent service user survey and a sample of questionnaires was examined. It is recommended that another survey be carried out in relation to the issues of concerns raised by the inspection and the recent complaints and the outcome notified to all service users and relatives. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 Page 22 The manager was not aware of the provider undertaking regulation 26 visits and this is required. The home hold small amounts of cash for three service users and the records of these were examined. The system of recording is noted to be improved, however the system for receipts is not adequate as it was difficult to audit trail the income and outgoing expenditure. It is recommended that the registered provider periodically audit the accounts to support the manager in this process. Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 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 2 x x 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 3 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 1 3 3 2 x x 3 x 2 STAFFING Standard No Score 27 x 28 1 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x 2 x x x Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 Page 24 Are there any outstanding requirements from the last inspection? 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Elm Tree House DS0000064368.V253782.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 House DS0000064368.V253782.R01.S.doc Version 5.0 Page 26 - 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!