CARE HOMES FOR OLDER PEOPLE
Elm Tree House 32 Crow Lane West Newton-le-Willows Merseyside WA12 9YG Lead Inspector
Lynn Paterson Unannounced 8 January 2006
th 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. F53 F03 S61681 Elm Tree House V235917 080106 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 F53 F03 S61681 Elm Tree House V235917 080106 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 29th June 2006 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. F53 F03 S61681 Elm Tree House V235917 080106 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 on 8th January 2006 and was carried out on an unannounced basis. For the purpose of this report, the officer in charge, the registered manager and 3 staff and 20 residents were spoken with and a 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:
The mission statement of the home is to offer care and comfort to residents and to respect them and offer an environment, which is safe and stimulating and observations of staff and residents interacting confirmed that the home is meeting its objectives. Residents spoken with said they were well cared for by kind and professional staff who constantly asked them what they wanted and included them in all the decisions making about their daily living. Residents revealed that they were always treated with dignity and were afforded privacy with them being provided with keys to their rooms and locking facility for their personal belongings. Residents said that staff encouraged them to retain their independence wherever possible and the home provided such aids, adaptations and equipment to enable them to do this. Staff spoken with revealed that they received a high standard of support from the registered provider and the home manager and as a consequence felt valued. The home, have addressed the recommendations from the last inspection regarding activities and have devised an activities programme to include the choices, preferences and capability of the current residents of the home. Documentation viewed showed that staff, arrange regular residents meeting to discuss the running of the home and also invite residents families/representatives to attend family meetings with a view to gaining their thoughts on the daily management of the home. Resident’s relatives and friends are encouraged to visit and are welcomed to join their relatives for a meal or to enjoy outings or activities in the home. Records examined show that the home manager ensures that all staff receive appropriate training in all aspects of health and safety and documentation seen revealed that risk assessments, and health and safety checks are carried out on all essential services within the home.
F53 F03 S61681 Elm Tree House V235917 080106 Stage 4.doc Version 1.40 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. F53 F03 S61681 Elm Tree House V235917 080106 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 F53 F03 S61681 Elm Tree House V235917 080106 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) This standard was assessed at the previous inspection. EVIDENCE: F53 F03 S61681 Elm Tree House V235917 080106 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) 9.10. Staff are trained to treat service users with respect and afford them privacy in all aspects of daily living. However medication management and procedures are poor and policies need to be revised and staff retrained in all aspects of medication to ensure the protection of residents. EVIDENCE: Care plans were clear and consistent and held information about the residents wishes to include their choices in respect of their privacy. Staff advised that the homes policy was that residents are afforded privacy to live their lives with the least interference. Staff said they are trained to knock on doors before entering bedrooms, bathrooms and toilets and all residents are provided with room keys. Observations of staff and residents interacting showed that they treated each other with mutual respect and interactions were seen to be good with the use of gentle humour and it was noted that staff used great sensitivity when residents needed their assistance. F53 F03 S61681 Elm Tree House V235917 080106 Stage 4.doc Version 1.40 Page 10 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 the medication had been given. Staff, were observed “potting up” medication and passing the pots to another staff member for them to administer the potted medication to residents. The staff member who was potting up then signed the medication administration sheet to identify the medication had been administered. These actions revealed a breach of regulation 13.It is essential that staff make sure that medication is administered and recorded as appropriate and that the homes medication policies identify the way all aspects of medication should be managed to ensure that service users are protected in respect of all aspects of medication. The problems with medication management were noted at the previous inspection and now are seen as a major shortfall to standard 9, regualtion13. As a consequence an immediate requirement was given to ensure that medication is administered and signed for by the allocated person who has knowledge and understanding of the requirements of Regulation 13. F53 F03 S61681 Elm Tree House V235917 080106 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) 12.13.14. Activities and interests have been made more structured to ensure that the needs choice s and capacities of all residents are met. 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 the activities programme had been revised since the last inspection and was now much improved and they were aware of what was going on each day. Staff spoken with advised that the daily activity was now put up on the whiteboard in the dining area and on the notice board in the hallway to enable residents and their visitors to see the daily input. Residents said that they had residents meeting were they could decide what activities they wanted to include outings and they said that the standard of activities was good with an outing to Blackpool being recently arranged, which they all enjoyed. Staff revealed that they arranged various fundraising events to enable them to arrange external daytrips and activities for the residents and the had devised a bi-monthly newsletter for residents and their families that included information about forthcoming events. It was noted that the home had addressed the recommendations made at last inspection and had developed the activities programme to a high standard. This action was seen to be commendable.
F53 F03 S61681 Elm Tree House V235917 080106 Stage 4.doc Version 1.40 Page 12 The home manage said the registered provider had supplied a car for the purpose of transporting residents to contact meeting within the community and this was seen to be of great value to the home. Residents revealed that they were encouraged to maintain contact with family and friends and with the local community in general. Residents said that visitors were given food and drinks when they called and they were invited to stay and join in with mealtimes as appropriate. Residents said that some visitors had joined the residents on Christmas day for a meal. It was noted that several visitors arrived and departed during the visit, one visitor being a member of the local church who had visited to offer communion. Daily records revealed that residents visited the local library, went shopping and visited friends and family. Residents said they were always consulted about what they wanted to do and staff arranged residents meetings, care reviews and other meetings to enable them to have full choice and control over their lives. F53 F03 S61681 Elm Tree House V235917 080106 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) Standards 16-18 were assessed during the previous inspection and achieved full compliance. EVIDENCE: F53 F03 S61681 Elm Tree House V235917 080106 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 grounds appeared safe and accessible and door entry and exits provided ramps and rails as appropriate.
F53 F03 S61681 Elm Tree House V235917 080106 Stage 4.doc Version 1.40 Page 15 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. F53 F03 S61681 Elm Tree House V235917 080106 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) .29 The procedures for the recruitment of staff are robust and offer protection to the people living in the home. EVIDENCE: Records show that staff turnover is low and staff spoken with said they felt valued by the registered provider and home manager who provided training and support as an ongoing process. The home manager was able to provide full details of the homes recruitment and selection policy, which appeared through. The format of the interview was structured with standardised questions and scoring and was underpinned by equal opportunity policy. Documentation seen showed that police checks are carried out and references taken up and verification processes undertaken prior to staff being employed in the home. All staff spoken with said that they had provided references and had been police checked as part of the employment process. F53 F03 S61681 Elm Tree House V235917 080106 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) 33.38. The home is run in the best interest of residents. The manager utilises clear health and safety practices to promote and safeguard the health, safety and welfare of the people using the service. EVIDENCE: The registered provider and home manager utilise care reviews, quality assurance questionnaires and hold residents and family meetings to ensure that all information about the running of the home is clear, transparent and open for discussion at all times. Discussions with the manager and staff revealed that they were totally committed to the home being run in the best interests of service users and they advised that they consulted with residents and their families on a daily basis to ensure the sharing of information took place. F53 F03 S61681 Elm Tree House V235917 080106 Stage 4.doc Version 1.40 Page 18 Staff advised that they had received training in all mandatory health and safety policies and procedures and a tour of the building revealed that fire doors were used as appropriate, wheelchair storage was clearly organised and hazardous substances were locked away. It was noted that the home used the services of a maintenance person who dealt with any issues identified in the managers daily building risk assessment and an overall assessment had been carried out by an independent occupation therapist to ensure that the premises had aids, adaptations and equipment suitable for the people living in the home. It was noted also the home manager and staff constantly review the abilities and changing needs of the residents to ensure that the home can continue to meet their changing need, a process of which was seen to be commendable. F53 F03 S61681 Elm Tree House V235917 080106 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 x 8 x 9 1 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 x
COMPLAINTS AND PROTECTION 3 3 x x x 3 x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x 3 x x x x 4 F53 F03 S61681 Elm Tree House V235917 080106 Stage 4.doc Version 1.40 Page 20 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 9 Regulation 13 Requirement Residents must be protected by the homes medictaion policies and procedures . Timescale for action immediate 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 The registered provider should ensure that all staff receive updated training in all aspects of medication management. F53 F03 S61681 Elm Tree House V235917 080106 Stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection 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
© 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 F53 F03 S61681 Elm Tree House V235917 080106 Stage 4.doc Version 1.40 Page 22 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
