CARE HOMES FOR OLDER PEOPLE
Elm Tree House 32 Crow Lane West Newton-le-Willows Merseyside WA12 9YG Lead Inspector
Lynn Paterson Unannounced 29th June 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 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 F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service Elm Tree House Address 32 Crow Lane West Newton-le-Willows Merseyside WA12 9YG 01925 228727 01925 228727 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) Living Developments Mrs Beverely Steele Care Home 20 Category(ies) of OP - 20 registration, with number of places Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service should employ a suitably qualified and experienced manager who is registered with the CSCI. 2. Service users to include up to 20 OP. 3. The service may accommodate up to a maximum of 5 persons in following age ranges: male - 60 to 65 years or female 55 to 60 years. Date of last inspection 5th November 2004 Brief Description of the Service: Elm Tree House is a large Victorian Detached property which has been extended and adapted to provide residential care for a maximun of 20 older persons.The home is situated on a main road locaiton in Newton Le Willows and is close to shops and other local amenities.Accomodation is provided on the ground and first floor and a passener lift and stair lift are in place for ease of access.The garden areas include a side patio and fish pond with open car parking facility to the front. Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection of Elm Tree House took place over a 4 hour period and was carried out on an unannounced basis. For the purpose of this report the deputy manager, 5 staff and 19 residents were spoken with and a full tour of the premises was undertaken. Care plans, staff rotas, policies, procedures, medication sheets and daily records were examined. Staff were also observed carrying out their care practices within the home. What the service does well: What has improved since the last inspection?
Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 6 Re decoration and refurbishment had taken place since the previous inspection and the home had an ongoing programme in place to upgrade, refurbish and redecorate all areas of the interior and exterior of the premises. Care plans had been updated to include all relevant information and the plans revealed that they had been completed in partnership with the resident. Staff training and development programme had been updated and staff stated that they felt valued and appreciated by the registered provider and home manager. Residents said that activities of daily living are discussed to include social activities and entertainment. The home has recently introduced an activities co-ordinator who it is anticipated will devise a daily activity programme in consultation with the residents. 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 F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 7 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 Standards Statutory Requirements Identified During the Inspection Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 8 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 standard(s) 3 Prospective residents are fully assessed by knowledgeable and experienced staff prior to being offered a placement in the home. EVIDENCE: Pre assessment documentation was thorough and held full information about prospective residents needs abilities and preferences. The assessments took into account mobility and it was noted that one recent assessment had been refused due to the location of the vacant room and the individual’s restricted mobility. This showed that staff assessed both the individual and the home environment to make sure that all needs could be met prior to admission. Staff spoken with showed in discussion that they had received training in assessment and had knowledge, experience and understanding of the process involved. Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 9 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 standard(s) 7.8.9. Care plans clearly set out personal social and health care needs, however medication records were not recorded in line with the homes medication policy and procedures at the time of the inspection and the home are therefore in breach of regulation 13 of the National Minimum Standards for Older People Care Homes Regulations 2001. EVIDENCE: Care plans were clear and consistent and held full details about the residents personal, social and health care needs. One care plan examined showed that needs which had been identified prior to admission had been planned for and that 3 trial visits had been undertaken to make sure that the identified need could be met within the home. Four more care plans viewed revealed that the care plans had been developed in partnership with residents and were clear and direct as to what care was needed for each individual. Staff spoken with identified in discussion that they had knowledge and understanding of the residents needs and of the process involved in reassessing need for each individual. Documentation seen showed that full daily records were kept for newly admitted residents, which provided information about abilities, capabilities and preferences. Staff advised that they used observational practices and
Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 10 discussion with the individual residents and records were maintained for between four to six weeks after admission with the details being discussed after that time with the resident and their representative and the relevant information being transferred to the care plan booklet. Records showed that health needs and accidents were recorded monitored and reviewed as appropriate and General practitioner, district nursing staff, dentists, opticians and other health professionals visits were recorded on file. Examination of medication storage showed that this was well maintained, however medication administration records were not consistent in their recording with staff signatures being missed and therefore not evidencing that medication had been given. This action revealed a breach of regulation 13.It is essential that staff make sure that medication is administered and recorded as per the homes medication policy and procedures. Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 11 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 standard(s) 12.15. Activities and interests occur but need to be more structured to ensure that all needs are met. The food is wholesome, balanced and plentiful and the menu provides choice and appeals to the tastes of the residents of the home. EVIDENCE: Residents spoken with said that activities took place in the home with bingo, craft and reminiscence sessions being arranged each week. However they said that they were not always aware of when the activities were happening and would like a programme to be written which showed something happening each day. Staff spoken with revealed that in the past they arranged activities as and when they could but the registered provider had recently appointed a staff member to be the activities co-ordinator. The activities co-ordinator said that she was in the process of writing an activities programme, which she had developed in consultation with residents, to ensure that choices, hobbies, interests and capabilities were addressed and incorporated into the programme. Residents spoken with were high in praise of the food provision of the home and comments included “the food is good here”, “the food is as good as you would get anywhere”, “the food is very well cooked”, “food is like home cooking it is so good”, ”meal choices are provided to make sure we all get what we want”.
Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 12 Observations of residents eating lunch showed that the meals were well presented in pleasant surroundings. Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 13 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 standard(s) 16.18 Clear complaints procedures were in place and complaints were well managed Residents knew of the complaints process and were confident they would be listened to. The vulnerable adults procedure was clear and all staff had received training in adult protection. EVIDENCE: The complaints procedure held clear information about the process involved with expressing concerns or complaints and residents said that they knew what to do if they were unhappy with anything. Residents said that the complaints book was always accessible in the main reception area of the home. Staff advised that they had been provided with training in how to handle, record and investigate complaints. Staff training records showed that staff had received training in adult protection and staff spoken with had good understanding in all aspects of the protection of vulnerable adults. Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 14 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 standard(s) 19.20.24.26. The building has been extended, adapted upgraded and refurbished to provide a safe well maintained environment in which residents feel comfortable and at home. EVIDENCE: The home has benefited from an ongoing refurbishment programme in which re decoration, adaptation and re furnishing has taken place. The dining areas have been repositioned to make sure that residents can dine together and lounge areas have been refurbished to make sure that residents have choices as to where they sit in comfort. The premises presented as being pleasantly decorated clean and hygienic and furnished in a traditional style within comfortable surroundings at the time of the visit. Six of the 19 bedrooms have en suite facility and all rooms provide sufficient space to enable residents to personalise them by having their own possessions around them. The call bell alarm system was tested and proved to be in full working order and maintenance records were clear and recorded to show that all essential services were tested and serviced as appropriate. Outside gardens and
Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 15 grounds appeared safe and accessible and door entry and exits provided ramps and rails as appropriate. Residents comments included “I am very comfortable in my room” ,”the home is lovely”, ”we all feel safe and secure here”,” what a nice place to live” ”the atmosphere is very homely”. Staff spoken with advised that the registered provider has worked hard to upgrade the home and provide more ”home comforts” for the residents. Staff said that they were delighted with the improvements to the home, which they felt benefited everyone. Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27.30 Staff are recruited, valued, retained and trained to meet the assessed care needs of the residents. EVIDENCE: Staff rosters showed that 3 care staff, 1 officer in charge, 1 cook and 1 domestic were on duty at the time of the visit to the home. All staff spoken with were clear and knowledgeable about their role and identified they were professional, experienced and fully committed to the provision of good quality care. Observations of staff carrying out their duties confirmed that care practices were carried out in accordance with care plans and meeting assessed need. Staff records revealed that the home has a low staff turnover and staff training was provided as an ongoing process. Staff advised that they were well looked after by the registered provider and home manager and felt valued in their role. They said that they received training and ongoing support and that the home now recognised the importance of NVQ training and of personal development and they were actively encouraged to devise their own development plans. They said that the care practices and care delivery is supported and promoted by the provider and manager through the induction process and ongoing training. Residents said that care was provided by good kind staff who “knew how to look after them”. Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31.32.35.36. The manager and deputy manager have the background and experience to enable them discharge their responsibilities and manage the home in an open and inclusive way. EVIDENCE: The manager and her deputy have vast experience in the care sector and have completed training in care delivery and care management. Through discussion with the deputy manager it was apparent that she has good understanding of the residents needs and of the care practices necessary to meet these needs. She was able to advise of the services that are available to support the home where needed including specialist advice. Staff advised that they are fully supported by the management team and found them to be very approachable and willing to listen. Staff advised that they received regular supervision, which was planned for, time limited and useful. Staff said they felt valued and found the atmosphere of the home to be friendly, inclusive and caring.
Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 18 Staff managed the “pocket money for four residents and records seen were clear and consistent with individual hard backed books being used for each individual. Residents spoken with said that they felt “part of the home” which they felt was owned and managed by “people who cared”. Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3
COMPLAINTS AND PROTECTION 3 3 x x x 3 x 3 STAFFING Standard No Score 27 3 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 4 x x x x x x Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 20 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. 1. Standard 9 Regulation 13 Requirement Residents must be protected by the homes medictaion polcieis and proecdures . Timescale for action 29.7.05 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 12 Good Practice Recommendations it is recommended that an activites programme be provided that details all daily activities and is located in all open areas of the home to make sure that residents and representative are`aware of each daily event. Elm Tree House F53 F03 S61681 Elm Tree House V235917 290605 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 2nd Floor Burlington House Crosby Road North Waterloo Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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