Inspection on 25/10/05 for Elm Tree House

This inspection was carried out on 25th October 2005.

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 found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elm Tree House 31/07/07

Elm Tree House 07/09/06

Elm Tree House 27/04/05

Elm Tree House 19/10/04

Elm Tree House 13/05/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOME ADULTS 18-65 Elm Tree House 4 Kilkenny Avenue Taunton Somerset TA2 7PJ Lead Inspector Jane Poole Announced Inspection 25th October 2005 09:30 Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 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 DS0000016047.V251424.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 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 DS0000016047.V251424.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Elm Tree House Address 4 Kilkenny Avenue Taunton Somerset TA2 7PJ 01823 322408 01823 322408 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) Mr Philip Mark Coggins Mrs Elizabeth Anne Coggins Mrs Elizabeth Anne Coggins Care Home 9 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (0) of places Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named resident over 65 years of age Date of last inspection 27th April 2005 Brief Description of the Service: Elm Tree House is registered with the Commission for Social Care Inspection to provide care to up to 9 people under the age of 65 who have mental health difficulties. The home itself is a large semi detached Victorian house which provides accommodation on three floors. There are seven single bedrooms and one double. One single bedroom is on the ground floor and all others can only be accessed by stairs and therefore people living at the home need to be physically able. All communal areas are located on the ground floor. The home is owned by Philip and Elizabeth Coggins, Elizabeth Coggins is the registered manager. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a 4 hour period. There were 8 service users living at the home at the time of this inspection. The inspector was able to speak with service users and staff in private and in communal areas. All records requested were made available and the inspector was given unrestricted access to all areas of the home. The manager was available throughout the inspection. What the service does well: What has improved since the last inspection? Since the last inspection the quality of the care plans has improved and they are now much more readable for service users and staff. An ongoing requirement has been for the home to improve the laundry facilities. Since the last inspection the laundry has been moved to an outbuilding that is accessed from the garden. The new laundry has a commercial type washing machine, a tumble drier and hand washing facilities. The opportunities for staff training have also improved with 8 members of staff about to begin National Vocational Qualifications in care. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 6 Some improvements have been made to the quality assurance systems in the home and views are now being sort from service users families. 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 DS0000016047.V251424.R01.S.doc Version 5.0 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 DS0000016047.V251424.R01.S.doc Version 5.0 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): No standards in this section have been assessed. EVIDENCE: There have been no changes to the service user guide or statement of purpose. No new service users have moved to the home since the last inspection and therefore no standards in this section have been assessed on this occasion. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 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, 7, 8, 9 & 10. Service users are able to make decisions about their day to day lives and any restrictions are agreed. The quality of the care plans has improved since the last inspection and they can now be more easily read by staff and service users. EVIDENCE: All service users living at the home have a personal care plan. The inspector looked at one plan of care in depth and briefly at another two. All contained a full assessment of need which had been updated within the last few months. These assessments are comprehensive covering areas such as physical health and well-being, abilities relating to personal care, communication, emotional wellbeing, relationships/lifestyle and financial. The inspector saw information relating to the mental health difficulties experienced by each service user and behavioural issues. Each care plan seen by the inspector had been signed by the service user. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 10 At the last inspection the personal files were difficult to read as they contained a large amount of out of date information. At this inspection the files were much more organised and therefore much more accessible to staff and service users. The personal files also contain risk assessments in respect of environmental and behavioural risks. At the last inspection the a recommendation was made for risk assessments in respect of people who smoke in their rooms to be updated. This has been done. Service users spoken to stated that they continued to make decisions about their day to day lives. People decide when they get up, when they go to bed and how they spend their day. Many of the people living at Elm Tree House are able to go out without staff assistance. One person spoken to stated that they only went out with staff, although they were unhappy about the situation, the service user was fully aware of the reasons why and stated that this had been agreed with them. Staff spoken to, and minutes of staff meetings, demonstrated that they are trying to involve service users more in the running of the home. There are still no regular service user meetings but the inspector saw evidence that staff are consulting with service users on an individual basis. All personal records were appropriately stored and staff were aware of issues of confidentiality. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 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): 12, 13, 14, 15, 16 & 17. Service users are able to access local amenities and facilities, with and without staff assistance. Service users have access to communal areas and their personal rooms at all times and are able to choose how they spend their day. The home assists people to maintain contact with family and friends. EVIDENCE: Service users spoken to were happy with the level of activity in the home. Some service users have comprehensive activity programmes that are supported by staff on a one to one basis. These activities include shopping, cricket, walking and developing household skills. The inspector spoke with the majority of service users and discussed how they occupied their time. One person has started a college course, another stated that they liked to go to town every day. Two people stated that they went out shopping, to a local club and to cafes. One service user has a community access worker from the community mental health team. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 12 Service users are encouraged and assisted to use public transport where appropriate to do so. Staff spoken to stated that they gathered information about community facilities and events to share with service users. Two people told the inspector that they had tickets to the local theatre. Most people have TV’s, videos, DVDs and radios in their rooms. All service users are able to lock their personal rooms and receive their mail unopened. People are free to spend time in their private rooms or in communal areas. Service users stated that their privacy is respected. Visitors are welcomed at the home at all reasonable times. Service users stated that they are able to meet with friends and family either in communal areas or in their rooms. Some service users are assisted by staff to visit family members and some have overnight stays away from the home. All food in the home is frozen and is prepared by care staff. There is a four week menu which shows a choice at every meal. However service users stated that they do not have to have to choose anything from the days menu and can have an alternative of any sort. The dining room is pleasant and large enough to accommodate all service users. The main meal of the day is at lunch-time but there appears to be no set time with service users choosing to have their meal anytime between about 11am and 2pm. The manager stated that they are trying to narrow this time scale by providing mid morning snacks and a slightly later lunch. The inspector noted that this had been discussed at a recent staff meeting. Many of the service users have small fridges and facilities for making hot and cold drinks in their personal rooms others are able to use the main kitchen in line with their assessed abilities and care plans. All service users spoken to were happy with the quality of food and the choices available. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 13 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): 18, 19, 20 & 21. Service users have access to healthcare professionals in line with their individual needs. EVIDENCE: All service users are registered with local GP’s and other healthcare professionals such as dentists, opticians and psychiatrists in line with their specific needs. Some service users visit healthcare professionals without staff support and other people said that staff were made available to help them to attend appointments. Records are kept of all healthcare appointments. One GP completed a comment card prior to the inspection, they answered YES to the questions “Does the home communicate clearly and work in partnership with you?” and “If you give any specialist advice is this incorporated in the service user plan?” Since the last inspection one person has died at the home. The home was able to demonstrate that they were conscious of the service users wishes and respected these. The home was supported by the hospice and district nursing team. All service users are asked to complete forms outlining their wishes for the time of their death. These are maintained on personal files. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 14 The manager is aware that the needs of some service users are changing as they become older and is looking at ways to ensure that the environment and care adapts to their changing needs. The home uses a monitored dosage system for medication. All is securely stored and the inspector viewed administration records, which were correctly signed when administered or refused. It was noted that some hand transcribed entries on records were not signed and witnessed. Staff have received medication training from the dispensing pharmacy and are now undertaking a 12 week distance learning course through the local college. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 15 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): 22 & 23. All service users have access to the homes complaints procedure. Staff are aware of issues of abuse and the ability to take serious concerns outside the home. EVIDENCE: The home has policies and procedures in respect of making a complaint, recognising and reporting abuse and whistle blowing. The majority of staff have received training in issues of abuse. Staff spoken to were aware of the ability to take serious concerns outside the home. All service users have a copy of the complaints procedure. All those spoken to stated that if they had any worries or concerns they would feel comfortable to raise them with a member of staff. Recruitment files showed that all staff had undertaken a Criminal Records Bureau check before commencing work at the home. Neither the home or the Commission for Social Care Inspection has received any complaints about the service since the last inspection. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 16 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, 25, 26, 27, 28 & 30. The home is ideally situated to access community facilities and public transport links. Many areas of the home would benefit from redecoration and refurbishment. EVIDENCE: Elm Tree House is located in a quiet residential area within walking distance of the town centre and other local amenities, such as post office, pubs and public transport links. Service user accommodation is located over three floors. There is one bedroom on the ground floor but all other rooms are assessed by stairs, meaning that it is only appropriate for people who are physically mobile. All communal areas are on the ground floor. These consist of a large lounge with smoking area and a dining room. There are seven single bedrooms and one double, which is currently shared by two people who made a decision to share. All rooms have shower cubicles and wash hand basins. There is a toilet on each floor. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 17 There are no bathing facilities in the home. The inspector was able to speak with service users in their personal rooms. All rooms seen were comfortable and adequately furnished, all had been personalised in line with individuals tastes and wishes. Some areas of the home would benefit from redecorating and refurnishing, this was discussed with the manager during the inspection. Since the last inspection the homes laundry facilities have improved greatly. A laundry room has been created in an outbuilding that is accessed via the garden. The laundry contains a commercial type washing machine, tumble drier and hand-washing facilities. All areas viewed during the inspection were clean and fresh. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 18 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): 32, 33, 34, 35 & 36. The home is adequately staffed to meet the needs of the current service user group. Staff appeared confident in their roles and well motivated. EVIDENCE: Staff observed during the inspection interacted well with service users in a respectful manner. Service users spoken to were complimentary about the staff who assisted them, describing them as friendly and approachable. 3 recruitment files were examined; they contained job descriptions, records of supervision and all other appropriate documentation. Staff appeared confident and enthusiastic in their roles. The GP who completed a comment card prior to the inspection answered YES to the question “Do staff demonstrate a clear understanding of the care needs of service users?” Each member of staff has a personal training record, these showed that staff have undertaken training in various mental health related issues including abuse and dealing with aggression. Other training undertaken has included Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 19 manual handling, food hygiene, 1st aid, fire safety and administration of medication. 8 members of the care staff team are due to begin NVQ’s in care on the 9th November. Staff asked appeared enthusiastic about this and keen to begin. The staffing levels in the home are appropriate to the needs of the current service user group. There is three staff on duty each morning and two each afternoon. Overnight one member of staff sleeps in. Additional hours are available for one to one activities. The managers’ hours are in addition to this. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 20 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): 37, 38, 39, 41 & 42. The home has taken reasonable steps to ensure the health, safety and wellbeing of service users whilst allowing people to maintain independence. The home have improved the ways in which they seek views of interested parties and now need to expand on this to include relevant professionals. EVIDENCE: The registered manager and joint proprietor of the home is Liz Coggins. She has many years experience of working with people who have mental health needs. Since the last inspection Liz has completed the Registered Managers Award and a National Vocational Qualification (in care) at level 4. The deputy manager has recently left the home and has not yet been replaced. Staff and service users stated that the manager spends a large amount of time in the home and was open and approachable. There are regular staff meetings and two members of staff described communication as excellent. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 21 The home regularly sends questionnaires to service users to seek their views on the quality of care provided and to invite comments. Questionnaires have recently been sent to family members and interested parties and the inspector was able to view a sample of those returned. The home should build on this to ensure they receive views from all interested parties including care managers and visiting professionals. The inspector did not view the homes policies and procedures at this inspection. All records requested were made available and all seen were up to date and reasonably maintained. The home has taken reasonable steps to ensure the health and safety of service users whilst enabling people to maintain autonomy and independence. The home is fitted with a fire detection system and records seen by the inspector showed that this is regularly serviced by outside contractors and tested in house. All staff have received fire safety training. All accidents are recorded and filed in personal files. All care staff hold an up to date first aid certificate and therefore there is always a qualified first aider on duty. The home has up to date certificates for the testing of Portable Appliances (13/05/05) and the gas installation (08/01/04) There is a lone working policy in place for staff taking service users out of the home and for overnight staff. This was reviewed in September of this year. Up to date certificates of insurance and registration are displayed in the home. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 22 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score 3 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 2 3 3 Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 2 3 2 X 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 3 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X 3 3 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Elm Tree House Score 3 3 2 3 Standard No 37 38 39 40 41 42 43 Score 3 3 2 X 3 3 X DS0000016047.V251424.R01.S.doc Version 5.0 Page 23 Yes 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. 1 Standard YA24 Regulation 23(1) [a] Requirement The manager must have an action plan for the up grading of the environment. This plan must be forwarded to CSCI. (Carried over from previous inspection.) Timescale for action 30/11/05 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 3 4 Refer to Standard YA8 YA17 YA20 YA39 Good Practice Recommendations The manager should explore ways in which the service users can be more involved in the running of the home, including service user meetings. The manager should review the timing of meals. All hand transcribed entries on Medication Administration Records should be signed and witnessed. The manager should expand the quality assurance systems to include seeking the views of relevant professionals. Elm Tree House DS0000016047.V251424.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL 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 DS0000016047.V251424.R01.S.doc Version 5.0 Page 25 - 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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