Inspection on 27/04/05 for Elm Tree House

This inspection was carried out on 27th April 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 but made no statutory requirements on the home.

Other inspections for this house

Elm Tree House 31/07/07

Elm Tree House 07/09/06

Elm Tree House 25/10/05

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 Unannounced 27 April 2005 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 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 Stationary 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 D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 3 SERVICE INFORMATION Name of service Elm Tree House Address 4 Kilkenny Avenue, Taunton, Somerset, TA2 7PJ Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01823 32408 01823 322408 Mr Philip Mark Coggins Mrs Elizabeth Anne Coggins Personal Care Home only 9 Category(ies) of Mental Disorder (9) registration, with number of places Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 19th October 2004 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. 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 D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out over a five hour period. The inspector was able to talk with five service users in private and in communal areas, speak with staff on duty and discuss issues with the manager of the home. Staff, service users and management were welcoming and provided all documentation requested by the inspector. During the time span of the inspection all service users were able to leave the home, some with staff support and others unaccompanied. What the service does well: What has improved since the last inspection? Since the last inspection the service user assessments and care plans have improved. Each service user now has a comprehensive, up to date assessment from which a care plan has been created. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 6 Each service user now has a personal bank account and the home no longer takes responsibility for any service user’s personal finances. The manager has begun the Registered Managers Award (NVQ level 4) in line with recommendations made at previous inspections. 2 staff are currently undertaking NVQ level 3. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 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 Standards Statutory Requirements Identified During the Inspection Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 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 standard(s) 1, 2, 3, 4 &5. The newest service user had had their needs fully assessed before moving to the home. There is evidence that prospective service users are able to visit the home prior to making a decision about moving in. All service users are provided with a copy of their written contract. EVIDENCE: There have been no changes to the statement of purpose or the service user guide since the last inspection. One new service user has moved to the home. The inspector was able to view the personal file of this person and speak with them in private. A full assessment had been completed by the placing authority and the file also contained information that had been forwarded from the service users’ previous home. The service user stated that they had visited the home prior to making a decision to move in. The service user felt that their needs were being met and that they had been consulted about their care plan. The inspector viewed the personal files of 2 service users, both contained a written contract. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 9 Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 10 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 standard(s) 6, 7, 8, 9 &10 The quality of service user assessments and care plans has improved since the last inspection, however personal files are, at times, confusing to the reader due to the volume of out of date information that is stored. Service users are able to make choices about their day to day lives and any limitations on personal freedom are discussed. Service users are not fully involved in the running of the home. EVIDENCE: Since the last inspection the manager has updated the assessment and care plan documentation for each service user. The inspector closely examined the personal files of two service users and briefly looked at a further two. Each assessment was comprehensive covering areas such as physical health and well-being, abilities relating to personal care, communication, emotional wellbeing, relationships/lifestyle and financial. The home accommodates people who have mental health needs and the individual signs of illness were clearly documented. Risk assessments had been completed in respect of environmental hazards and behaviour that may pose a risk to the service user or others. From each assessment a brief care plan has Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 11 been created. Service users sign when they have read and agreed their care plan. Personal files seen contained some out of date information, which was at times confusing for the reader. All personal files are securely stored and can be accessed by service users on request. Staff are aware of the home’s policy in respect of confidentiality. Service users spoken to stated that they were able to make decisions about their day to day lives. People said that they chose when they got up, when they went to bed and how they spent their day. One service user was able to tell the inspector how they had discussed issues of risk with staff before agreeing their care plan. Staff stated that the home have tried to hold regular service user meetings in order to more fully involve service users in the running of the home. The meetings have been poorly attended. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 12 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 standard(s) 11, 12, 13, 15, 16 & 17. Service users living at Elm Tree House are able to access local amenities with and without staff assistance. Service users are able to maintain contact with family and friends. EVIDENCE: Some of the service users living at Elm Tree House are able to access local facilities without staff supervision. Service users spoken to were accessing clubs in the local area and using the shopping facilities in the town. Some service users, who require staff assistance, have activity programmes, which include, walking, sports activities, shopping and developing household skills. One service user told the inspector that they had enrolled in a computer course at the local college and another person was considering a college course. The home assists service users to use public transport where appropriate to enhance their independence. Since the last inspection service users have been assisted to set up individual bank accounts in line with the new methods of paying state benefits. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 13 Service users stated that they are able to choose when they get up, when they go to bed and when they eat meals. All service users have keys to their rooms and are able to spend time alone if they choose to. The inspector saw that everyone has unrestricted access to the communal areas. All meals in the home are frozen and are cooked by the care staff. Service users stated that the quality of the food was very good. There is a set menu but service users stated that they could choose an alternative at each meal. The main meal is at mid day but the inspector noted that some service users choose to eat their main meal at other times and this is accommodated. Service users have access to the kitchen at all times and are able to make drinks in line with abilities and care plans. Some service users have kettles and small fridges in their rooms. Visitors are welcome at the home at all reasonable times with the agreement of service users. The staff enable some people to visit relatives by providing transport and supervision. One person attends church and is regularly visited by a representative of the church. Service users asked, stated that they were registered to vote in the forthcoming general election. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 14 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 standard(s) 18, 19 & 20. Service users have access to healthcare professionals appropriate to their individual needs. Some shortfalls were found in the recording of medication administration. EVIDENCE: Care plans seen gave individualised details of the assistance required with personal care. All rooms have shower facilities and sinks where personal care can be carried out in private. There are no bathing facilities in the home. Service users stated that they are able to choose their own style of dress. 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. Service users spoken to stated that they felt comfortable to discuss physical and mental healthcare needs with staff. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 15 Currently nobody living at the home administers their own medication. The home uses a Monitored Dosage System for medication. The Medication Administration Records were viewed and some shortfalls were found. One person’s medication had not been signed when administered the previous day and some hand transcribed entries had not been signed and witnessed. There was evidence that the effects of medication is monitored by staff and guidance is sought from appropriate professionals. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 16 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 standard(s) 22 & 23 All service users have access to the complaints procedure. Staff receive appropriate support in respect of recognising and reporting suspicions of abuse. EVIDENCE: The home has a complaints procedure, which is displayed in each bedroom. No complaints have been received by the home or the Commission for Social Care Inspection since the last inspection. All 5 service users spoken to stated that the staff were approachable and they would feel comfortable to discuss any concerns or complaints with them. The home has policies and procedures in respect of recognising and reporting abuse and whistle blowing. Staff receive copies of these when they commence work at the home. Staff stated that they have access to a person outside the home if they wish to discuss issues that they feel unable to discuss with the management. The home does not take responsibility for the financial affairs of any service user living at the home and as previously mentioned all service users now have personal bank accounts. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 17 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 standard(s) 24, 27, 28 & 30 There have been no changes to the décor or furnishings since the last inspection, and although this does not pose a risk to service users it does not create a homely and pleasant environment to live in. The laundry facilities in the home are poor. EVIDENCE: The home is located within walking distance of the town centre and local transport links. A fire detection system is fitted throughout the house and this is regularly tested. Environmental risk assessments have been completed All communal areas are located on the ground floor, these consist of a lounge, dining room and small smoking room. The décor and furnishings in the lounge and smoking room would benefit from updating. The manager stated that there are plans to refurbish many areas of the home. There are 7 single bedrooms and one double. Seven of the bedrooms can only be accessed by stairs, meaning that service users need to be physically mobile. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 18 Only one personal room was viewed on this occasion but service users spoken to stated that they were happy with their bedrooms. All bedrooms have shower facilities and there is a toilet on each floor. There are no bathing facilities in the home. The only washing machine is located in the smoking room. There are no handwashing facilities by the washing machine and the tumble drier is located in an outbuilding at the rear of the property. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 19 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32, 33, 35 & 36 The home is appropriately staffed to meet the needs of the service users. EVIDENCE: There have been no new staff employed since the last inspection therefore recruitment files were not looked at on this occasion. Evidence was seen that staff receive regular training sessions in caring for people who have mental health difficulties. Staff spoken to stated that they found these sessions extremely beneficial. Staff also undertake training in first aid, food hygiene and fire safety. Currently two staff are undertaking NVQ level 2 in care. Staff observed during the inspection interacted well with service users. Service users stated that staff were kind and always ready to listen. Copies of duty rotas were given to the inspector, these showed that there are 3 staff on duty each morning and two in the afternoon. There is one member of staff sleeping in each night. The manager’s hours are in addition to this. Additional hours are made available to provide one to one support for service users. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 20 There is an on call system that is clearly marked on the duty rota. There is a handover meeting at each shift change and staff spoken to felt that the communication between staff and management was very good. All staff receive regular supervision with a member of the management team. Records of supervision were not viewed at this inspection but staff and management both stated that they felt these sessions were very worthwhile. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 21 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37, 38,39,40 &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 do not seek the views of interested parties outside the home. EVIDENCE: The registered manager, Liz Coggins, is also the joint proprietor of the home. She has many years experience of working with people who have mental health needs. Since the last inspection Liz has begun the Registered Managers Award (NVQ level 4) Service users and staff stated that the management in the home is open and approachable. There is only one office in the home that is shared by the manager and all staff, meaning that the manager is available to staff at all times. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 22 The home regularly distributes questionnaires to service users living at the home. The inspector viewed some of the completed forms and noted that they were mainly complimentary about the service. A requirement of the last inspection was that quality assurance monitoring methods must include consultation with service users and their representatives. The home has still not sought the views of people outside the home. The home has produced a comprehensive handbook of policies and procedures, which has been given out to all staff. Staff stated that they found the handbook extremely useful. Reasonable steps have been taken to ensure the health, safety and welfare of service users whilst allowing people a degree of independence. Environmental risk assessments are in place these include risk assessments in respect of service users who choose to smoke in their bedrooms. The home must ensure that these are regularly reviewed and up dated. One member of the management team has been appointed as the responsible fire person. The fire log was viewed and this gave evidence that alarms and emergency lighting are tested weekly and staff last received fire safety training in February 05. There are notices in all bedrooms explaining what to do in the event of a fire. Appropriate records are kept of maintenance in the home and the inspector noted that portable appliances in the home now require to be re-tested. All accidents and incidents are recorded. 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. Where there is no score against a standard it has not been looked at during this inspection. The scale ranges from: 4 Standard Exceeded Elm Tree House (Commendable) 3 Standard Met (No Shortfalls) Version 1.20 Page 23 D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc 2 Standard Almost Met (Minor Shortfalls) 1 Standard Not Met (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 3 3 3 3 3 Standard No 22 23 ENVIRONMENT Score 3 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 2 3 3 Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x 3 2 x 1 Standard No 11 12 13 14 15 16 17 3 3 3 x 3 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 3 3 2 3 x 2 x Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 24 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 20 Regulation 13(2) Requirement The manager must ensure that Medication Administration Records are correctly signed when administered. The manager must have an action plan for the up grading of the environment. This plan must be forwarded to CSCI. The home must provide appropriate laundry facilities, which include hand washing facilities. (This requirement was made at the last inspection.) The quality assurance systems in the home must include seeking the views of interested parties outside the home. Timescale for action 27/04/05 2. 24 23(1)[a] 30/06/05 3. 30 13(3) 30/06/05 4. 39 24(1)[a][ b] (3) 31/07/05 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. Refer to Standard 6 Good Practice Recommendations Up to date information in service users personal files should be easily distinguishable from that which is out of date. D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 25 Elm Tree House 2. 3. 4. 5. 6. 8 20 27 42 42 The manager should explore ways in which service users can be more involved in the running of the home. All hand transcribed entries on MAR should be signed and witnessed. The manager should consider installing a bath in the home. Risk assessments in respect of service users who smoke in their bedrooms should be more regularly reviewed and up dated. Electrical portable appliances should be tested annually. Elm Tree House D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 26 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier 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 D53 - DO2 S16047 Elm Tree House V221640 270405 Stage 4.doc Version 1.20 Page 27 - 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. 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