Inspection on 22/03/06 for Elm Tree House

This inspection was carried out on 22nd March 2006.

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 House 06/03/07

Elm Tree House 16/06/05

Elm Tree House 16/11/04

Elm Tree House 27/04/04

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 Elm Tree House 8 Chandag Road Keynsham Bath & N E Somerset BS31 1NR Lead Inspector Karen Walker Unannounced Inspection 22nd March 2006 09:30 Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 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 DS0000008164.V286296.R01.S.doc Version 5.1 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 Adults 18-65. 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 DS0000008164.V286296.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Elm Tree House Address 8 Chandag Road Keynsham Bath & N E Somerset BS31 1NR 0117 9867791 0117 9867791 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) Treehome Ltd Mr Stephen Charles Wilkins Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 8 persons aged 18 - 64 years with Learning Disabilities 16th June 2005 Date of last inspection Brief Description of the Service: Elm Tree is a registered care home owned by Treehome Ltd, a subsidiary of Craegmoor Healthcare (Parkcare No 2 Ltd). Mr Wilkins manages the home on a day-to-day basis. Elm Tree is registered with the Commission for Social Care Inspection to provide accommodation and personal care to eight people with a learning disability aged between 18-64. Elm Tree House is a two storey property situated in a residential area of Keynsham. Local amenities include a leisure centre, shops and recreational park. Transport to Bristol, Bath and other areas can be accessed by rail or bus. Due to the accessibility of the building, the home is unable to provide a service to people with a physical disability or for those people who use a wheelchair. All service users are provided with a single bedroom. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection following the visit in June 2005. The purpose of the visit was to review the progress of the requirements and recommendations made at the last inspection and to monitor the quality of the care provided to the residents accommodated at Elm Tree House. Standards that were omitted from the last inspection were assessed at this visit. The home keeps the Commission for Social Care Inspection informed of incidents that affect the wellbeing of the individuals living at Elm Tree House. The provider has sent monthly appraisals of the service and information gained has also been used to ascertain the quality of service provision. The inspector met with the manager for the service and 3 support workers. Three residents were spoken with and records examined in respect of them. The opportunity was taken to tour the environment and permission gained from some of the residents to view their bedrooms. The inspector would like to take this opportunity to thank the team and the residents for their welcome and their assistance in the inspection progress. What the service does well: From examining individual records and ‘case tracking’ it is evident that the residents benefit from an individualised care package. Staff were aware of the care needs of the residents and it was evident that positive relationships have been forged. The environment was comfortable and homely and residents’ bedrooms were individualised and decorated in a way that reflects their personality. The home has built good relationships with the local community learning disability team in supporting the needs of the individuals living in the home complimenting the skills of the staff. All residents spoken with described a high level of support and satisfaction from living in Elm Tree House. It was evident that they were involved in making decisions about their care and the home does this well. There is a commitment to ensuring that staff are skilled and have the relevant training to be able to fulfil their roles within the home. Staff spoken with were aware of their roles and responsibilities and the manager ensures that this is reviewed through regular supervision sessions. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 Residents and their supporters have adequate information made available to ascertain the quality of service provision. Prospective residents also have enough information to make a decision about where to live. EVIDENCE: The manager confirmed that all residents received a copy of the updated service user guide. One senior support worker said “I read and discussed it with my key-person and left a copy in his bedroom”. This was confirmed during a tour of the environment. It was also noted that the statement of purpose had been updated to include the staffing levels provided throughout the week. It also recorded the new inspector contact details for the home. Copies of letters were seen in individual care folders informing relatives of the updated statement of purpose and service user guide. It also informed them of the web site details for Craegmoor Healthcare contact and information and the service they can expect from the home. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,9,10 Residents know that their assessed and changing needs will be met. Residents are supported to take risks as part of an individual lifestyle. Residents can feel confident that information gained in respect of them is handled appropriately. EVIDENCE: One staff member was able to describe his role as a key-worker and confirmed that this was discussed at a residents meeting. Residents stated that they had been involved in the allocation demonstrating that choice had been given. Three residents were ‘case tracked’ and records were examined in respect of them. Information relating to their care and support was also gained from the appropriate key-worker or other staff members. Information was person centred and individualized and was being reviewed at the appropriate intervals. It was evident that the assessed and changing needs of individuals were being met. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 10 The home reacts positively to the changing needs of individuals and risk assessments are put in place accordingly. Where behaviours that may be seen as challenging are identified this is adequately recorded and managed. There are ABC charts in place to identify the antecedent, behaviour and the consequence to the behaviour. This informs the action plan and associated risk assessment. There was evidence that the home seeks support from the occupational therapist and physiotherapist and other healthcare professionals where necessary. One staff member confirmed she was aware of the confidentiality policy and knew when a confidence must be broken. She said “ I would break a confidence if I thought the resident or someone else was at risk but I would also tell them that I was going to do so”. Team meeting minutes also evidence that the importance of confidentiality was discussed with the team. Records were stored appropriately and records of a confident nature including supervision notes were kept in a locked facility. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X EVIDENCE: All of the above standards were assessed and met at the last inspection and have not been reassessed. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,21 Residents can feel confident that their emotional and physical needs will be met. Residents can feel satisfied that their wishes in the event of their deaths will be recorded and acted upon. Their changing healthcare needs will be reassessed and the appropriate healthcare professional will be accessed. EVIDENCE: It was noted that there was information available in some plans of care relating to ‘wishes in the event of death’. One care plan evidences that information was sought from relatives and feedback had been provided. The manager said he would be working on sensitively gaining information from the other residents with the support of their key-workers and families. The statement of purpose makes it clear that nursing care is not provided by the home although the appropriate healthcare specialist can be obtained. The statement of purpose states that ‘where individual needs change we will look to meet those needs externally’. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 13 Care records demonstrated that the home liaised with a number of professionals, complimenting the skills of the staff team in supporting individuals in the home. Where individuals have needed reassessment this has taken place promptly and by the appropriate professionals. The Commission for Social Care Inspection has been informed of all incidents that affect the wellbeing of the individuals as per legislation. Action plans have been put in place where necessary. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): X EVIDENCE: These standards were assessed and met at the last inspection and have not been reassessed. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,29 Residents have access to specialist equipment where needed to maximise their independence. Residents live in a comfortable, homely, safe environment. EVIDENCE: Elm Tree House is a two-storey property in keeping with the local area. The home is close to services and amenities in Keynsham and there is regular transport to Bristol and Bath. It was noted in June 2005 that the home had undergone a major refurbishment programme including electrics, new windows, making the garden safe, new kitchen, refurbishment of the laundry facilities and decorating all communal areas and a most of the bedrooms. The home is now homely and comfortable. All areas seen were clean and free from odour. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 16 The manager has a programme of redecoration in place and is able to control part of the budget ensuring smaller items can be purchased quickly. There are plans to purchase a new fridge. A tour of the building was undertaken and it was noted that the recommendation to provide a downstairs shower room has been met. A staff member said, “The walk in shower is really great it means one resident hasn’t got to struggle on the stairs getting to the bathroom”. There are handrails situated appropriately and residents have use of a toilet seat raiser should they need it. Staff members spoken to were aware of the personal care needs of residents and knew how one resident in particular liked to be supported in the shower. At the last inspection it was noted that one of the bedrooms required carpeting to finish off the extended part of the room. This was not looked at on this occasion due to the resident using the room. However staff and the manager confirmed that the carpet had been replaced along with two others. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 17 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,34,35 Residents’ benefit from sound recruitment practices and staff know their roles and responsibilities within the home. Residents assessed needs are met by appropriately trained staff. EVIDENCE: The registered manager has ensured that all staff are aware of their roles and responsibilities within the home and all have received job descriptions. One staff member confirmed that her role and responsibilities were discussed at supervision sessions. She added, “We all know what we have to do and if I don’t know something I ask”. The manager explained how he operates a thorough recruitment procedure. The inspector saw Criminal Record Bureau Checks (CRB) take place and the manager confirmed staff do not begin employment without the CRB or POVA first check taking place. Two references are gained in respect of potential new staff. The manager said that some residents have taken part in the interview process but others are not interested. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 18 There are sound policies and procedures in place to ensure residents are protected by the recruitment process. Staff were aware of the whistle blowing and complaints procedure. Competent and trained staff support residents. The manager stated that all staff have undertaken or are undertaking a National Vocational Award at either level 2 or 3. Staff confirmed this. There was a strong commitment for staff training and the manager was able to demonstrate that staff had undertaken training relevant to their roles and the care needs of the individuals living in the home and further courses were planned throughout the year. The manager stated that the home has accessed training on management of aggression for all staff. They are also planning a training day with an expert in the field of ‘fragile X’ syndrome this is in response to the care needs of the newest resident to move into the home. The home has already carried out extensive research into the subject to update and inform staff. This is commendable. The manager was able to demonstrate that staff undergo formal supervision at the appropriate intervals and regular staff meetings were occurring. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 40,42,43 Residents’ rights and interests are safeguarded by the homes policies and procedures. Their health and safety is promoted and respected. Resident’s benefit from an accountable management of the service. EVIDENCE: Staff members explained how they are made aware of new policies and procedures. The manager discusses new policies with staff at team meetings or information is passed via the communication book. Staff are expected to read and sign all policies. There are a number of policies in place to ensure the health and safety of residents these include, whistle blowing, protection of vulnerable adults, disciplinary, emergency procedures, manual handling, COSHH and fire. All of the appropriate fire alarm checks and fire drills take place within the timescales prescribed by the Avon Fire Brigade. Records are kept. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 20 Records show that portable appliance testing has taken place and is now included in a rolling programme of maintenance and will be checked annually. The manager stated that they receive regular supervision from an area manager and budgets and financial monitoring is discussed during these regulation 26 visits. The Commission for Social Care Inspection are receiving copies of the monthly visits. Lines of accountability within the home and with the external management team are clearly understood by staff. Lines of accountability are also detailed in the statement of purpose. Residents and relatives are also made aware and residents said they find the manager approachable. The appropriate insurance certificates are displayed in the home and were seen to be up to date and current. Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 X 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 3 30 X STAFFING Standard No Score 31 3 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 X X 3 3 LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 X 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 3 X 3 X X X 3 X 3 3 Elm Tree House DS0000008164.V286296.R01.S.doc Version 5.1 Page 22 No 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 DS0000008164.V286296.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG 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. 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