Inspection on 28/03/08 for Elm View Nursing Home

This inspection was carried out on 28th March 2008.

CSCI found this care home to be providing an Poor service.

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 View Nursing Home 24/09/08

Elm View Nursing Home 06/09/07

Elm View Nursing Home 06/03/06

Elm View Nursing Home 30/06/05

Elm View Nursing Home 12/10/04

Elm View Nursing Home 02/04/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Carentan House

Ravensworth Lodge

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

CARE HOMES FOR OLDER PEOPLE Elm View Nursing Home 2 Elm View Huddersfield Road Halifax West Yorkshire HX3 0AE Lead Inspector Paula McCloy Key Unannounced Inspection 28th March 2008 08:50 X10015.doc Version 1.40 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 View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 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 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 View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm View Nursing Home Address 2 Elm View Huddersfield Road Halifax West Yorkshire HX3 0AE 01422 362538 01422 362538 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 Bentley Mrs Barbara Bentley Position Vacant Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can accommodate one named service user under 65 years of age Date of last inspection 4th December 2007 Brief Description of the Service: Elm View cares for people over the age of 65 years. The home provides both personal care and nursing care. The home is a converted property and provides accommodation over three floors. Single and double bedrooms are available. There is a lounge/dining room on the ground floor and a separate quiet lounge. Each floor is accessed by a passenger lift. Elm View is situated on the main Huddersfield Rd about a mile from Halifax town centre. There is a small car park and on street parking close to the home. At the rear of the car park there is a small, garden seating area that people can use in nice weather. The current weekly charges at the home range from £331 - £443 per week. Additional charges are made for hairdressing and chiropody. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means the people who use this service experience poor quality outcomes. The last inspection of the home took place on 6 September 2007 and the service was assessed as being poor. Since then we have met with the owners and been back to visit the home to see what improvements have been made. This inspection was carried out to assess the quality of care provided to people living at the home. The inspection process included looking at the information we have received about the home since the last key inspection as well as a visit to the home, which was carried out over one day and lasted approximately 6 hours. During the visit we spoke to 4 people who live in the home, 2 relatives and 6 staff. We observed care staff delivering care, looked at various records and looked around the home. The home completed a self assessment form before the inspection in September 2007, which provided us with some information about the service. We have used some of that information in this report. Comment cards were sent to five people living in the home, 10 relatives, 10 staff and 5 health care professionals; these cards provide an opportunity for people to share their views of the service with us. Information received in this way is shared with the home without identifying who has provided it. One person living in the home, 3 relatives, and 2 members of staff wrote to us with their comments. Their comments have been used in this report. What the service does well: Anyone thinking of moving into the home is properly assessed before they are offered a place. This means that staff are sure they can meet that person’s needs before they move in. Relatives that completed a survey said that that they are kept up to date regarding their relatives’ well being and that the home meets the needs of their relatives. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 6 Relatives are made to feel welcome when they visit. The meals at the home are very good, offering choice and variety. There are enough staff on duty to meet people’s needs. People living in the home and their relatives like the staff and say that they are kind and caring. The home is kept clean and tidy. We asked people what the home does well. They told us the following: ‘There is a good rapport between staff, people living in the home and relatives.’ ‘The care staff are very kind, gentle and considerate. They always make visitors most welcome.’ ‘They look after people well. The staff are very kind.’ What has improved since the last inspection? What they could do better: People moving into the home must be given a contract or terms and conditions of residence document before or on the day they move in. This will make sure that people have clear information about their rights and responsibilities. Staff need to make sure that care plans are kept up to date so that staff know exactly what they must do to meet people’s needs. Staff need to involve people and/or their relatives in their care plans. This will make sure people are consulted about the care and support they want. Staff need to make sure that they take action to reduce or eliminate any identified risks to people living in the home. This will mean that people are kept safe and receive the right care. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 7 Staff must make sure that the medication administration procedures are followed properly. This will make sure that people get their medication at the right times. Activities need to be provided on a regular basis that keep people living in the home stimulated. The owners must make sure that complaints are dealt with properly and that a satisfactory outcome is reached. The owners must make sure that the adult protection procedures are followed. This will make sure that people living in the home are kept safe. The shower room must be completed. This will give people living in the home a choice of having a bath or shower. The owners must make sure that staff are not working too many hours. This will make sure that staff are not too tired to do their job properly. New staff must be properly checked before they start working in the home. This will make sure they are suitable and safe to work with older people. There needs to be a system in place to see what training staff have done and what training they need to keep them up to date. This will make sure that staff are competent to do their job. The owners must appoint a registered manager. This will make sure that there is someone taking responsibility for the running of the home. The owners need to introduce a quality assurance system. This will make sure that people living in the home and their relatives are able to give their comments about the way the home is run. 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. The summary of this inspection report can be made available in other formats on request. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 5 (standard 6 does not apply) People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are assessed before they move in to make sure that the home can meet their needs. They can visit to see if they think the service is suitable for them. Written information about the home is not up to date and people are not getting contracts that tell them about their rights and responsibilities. EVIDENCE: There is a service user guide that contains information about the home and the service it provides. This document needs to be kept up to date. For example it gives details of a registered manager, but there is currently no registered manager at the home. Clear information also needs to be included about the type of care the home can offer. For example the home are currently caring Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 10 for a number of people with dementia, who are reliant upon staff to meet all of their needs. This is not reflected in the service users guide. There is a copy of the home’s contract and statement of terms and conditions of residence document in the service users guide. We asked to see copies of this document that had been given to the two most recent admissions. These were not available. It is important that people moving into the home are given a contract or terms and conditions of residence document before or on the day of admission so that they are clear about their rights and responsibilities and the fees payable. The home’s admission procedures are good. Individual records are kept for people living at the home. The records for two of the people who had moved into the home recently showed that staff had completed the necessary assessment before they were admitted. This means that staff are sure they can meet people’s needs before they move into the home. Staff said that they encourage people to come and have a look around the home, although sometimes the relatives do this. This gives people the opportunity to see the home for themselves and decide if it is suitable for them. The home does not provide intermediate care. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Care plans are not kept up to date and do not accurately reflect the care that people need. This means that people may not always receive the care they require. Risks to people are identified but not always acted upon, which means that people’s care is not being managed and monitored properly. EVIDENCE: We looked at a selection of care plans because we wanted to see what individual needs had been identified and what action staff are expected to take to meet these needs. We looked at five care plans. We could see from these plans that people are receiving health care from a range of people such as doctors, opticians, Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 12 chiropodists and tissue viability nurse. Details of any visits are clearly documented in the care plan together with any advice given. There were care plans in place for people that gave staff information about what they needed to do in order to meet that person’s needs. Staff are reviewing the care plans on a monthly basis, but there was no evidence that people using the service or their relatives were involved in these reviews. It is important that people are involved in these reviews so they or their relatives have the opportunity to discuss the care and support that is being provided. Although staff are reviewing the care plans two of the care plans we looked at were not up to date. For example one stated that a person was being nursed in bed, but she was up and sat in the lounge all day. It also stated that she needed assistance with her meals. This person was feeding herself independently. In the assessment information it was noted that communication was difficult as this person is very deaf and the best way to communicate was to write things down on yellow paper with a black pen. From observation staff were having no problem talking to her. They told me that she could hear better on one side that the other. None of this information was in the care plan. In another care plan it noted that dressings were required on leg ulcers. There was no detail of what dressings should be used. Staff are also getting information about people likes and dislikes and their preferences, but are not using this information in the care plan. For example in one person’s ‘getting to know you’ questionnaire it states that she likes Amontillado sherry, likes her hair done in a certain way and needs new dentures. None of this information has been included in the care plan. From observation her hair had not been done in her preferred style and from looking at the care plan nothing had been done about getting new dentures. Staff are completing all of the necessary risk assessments but they are not always using this information effectively. For example one person’s nutritional risk assessment identified that she is at high risk of malnutrition. In her care plan under ‘wound care’ it states that she needs a high protein diet. When I asked staff about this they said that she was just on a normal diet. Staff are also noting incidents but not completing risk assessments to look at how they can reduce potential risks. For example on the daily records night staff noted that one person had been unsettled and had been up and wandering on the first floor. When staff found her she had a skin tear to her arm. This person is confused and staff need to look at the risks involved. For example she has already been assessed as being at risk of falling, there is a risk of her entering someone else’s room and risk of falling down the stairs. The care plan needs to show clearly what the risks are and what staff are doing to minimise them. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 13 In December 2007 a neighbour contacted us with concerns that they could hear a woman screaming at night. We contacted the home and asked them to look into this. They told us that there are two people living at the home that are distressed when staff assist them with any personal care and that their room adjoins the house next door. We received another complaint just before this inspection about the same thing. We looked at the records for these two people, which clearly show that they shout out or scream during the night when staff are attending to them. Staff have taken no action to improve the situation. For example they could ask for specialist help from the community mental health team. Look at the possibility of people moving rooms take and active role in talking to their neighbours about the problem. There has been little improvement in the care plans since the last key inspection in September 2007. Individual nurses are completing the care plans but there is no manager to make sure the care plans are properly reviewed and monitored. For example food diaries are being completed for some people to monitor their food intake. These are not completed with enough regularity for anyone to judge if they are having sufficient food and fluids. Moving and handling plans are in place for people who require assistance. These are clear and are followed by staff. This means that people living in the home and staff are not at risk of any injury from poor practice. The one person living in the home, who completed a survey, confirmed that they get the right care and support and the medical help he needs. The three relatives that completed a survey said that that they are kept up to date regarding their relatives well being and that the home meets the needs of their relatives. From observation people look smart and well cared for. Staff were seen to treat people with respect and there were some good humoured exchanges between people. There was a nice atmosphere in the home and people living there looked comfortable and relaxed. Generally the medication system is well managed, this means that people get their medication at the right times. There were a few occasions where staff had not signed the medication administration record to show that the tablets had been given or entered a reason why they had been omitted. There was one afternoon when none of the records had been signed. This means that staff are not signing the records at the time they give the medication. Staff must follow the medication procedures to make sure that people are not left at risk of not getting their medication or being given too much. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Social activities are not provided consistently or on an individual basis to keep people stimulated. Relatives are made to feel welcome and can visit at any time. The meals are very good offering choice and variety. EVIDENCE: Some of the care plans we looked at had lots of information about people’s preferred routines, likes and dislikes, interests, life history and religious needs. At the last inspection we told staff that this information needed to be used to develop social care plans for each person. This has not been done. It is important that staff do this to make sure that people’s individual social needs are met. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 15 Although the service user guide states that the home employs an activities organiser to stimulate people, this is not the case. Staff do have time to spend with people living in the home, but they need training in how to provide stimulating and interesting activities on either an individual or group basis. We did see staff talking to people and one member of staff had a game of cards with one man. Relatives said that they are made to feel welcome when they visit. One relative told us that she can have a meal if she wants. From observation staff know relatives very well. They know what they like to drink and whether or not they have sugar. The meals at the home are very good. There is a wide choice at breakfast time and choices available for all of the other meals. During the week there is a dining room assistant on duty. She has a really good knowledge of people’s likes and dislikes and their individual dietary needs. She talks to the cook about what people like and the menus are changed accordingly. People living in the home, relatives and staff all said that the food was really good. The lunchtime meal was observed. The meal was nicely presented, everyone was served in a timely way and those people who needed assistance were supported appropriately. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. Complaints and adult protection issues have not been dealt with appropriately, which means people at the home are not protected. EVIDENCE: The complaints procedure is on display in the dining room, however, this needs to be updated with the new contact details for the Commission for Social Care Inspection. The one person living in the home that completed a survey said that they knew about the complaints procedure and who to speak to if they were unhappy about anything. They also said that staff listen to them and act on what they say. All three relatives that completed a survey said that they knew about the complaints procedure and that if they had raised any concerns these had been dealt with appropriately. One relative told us that any problems she has raised have been sorted out. We received one complaint about the home, which we asked them to investigate. (See section on health and personal care). The home haven’t done anything to solve the problem and we have recently received another Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 17 complaint about the same thing. Staff have taken the view that they can’t do anything to stop two people screaming and shouting at night. They have not taken into consideration that this must be very distressing for their immediate neighbours. The owners need to make sure they follow up this complaint to ensure a satisfactory outcome. When we spoke to one person living at the home she was making various allegations about staff. We looked at her care plan and this told us that she will make accusations about staff and that there are always two staff present when any care is provided. We looked in her daily notes and found details of one incident that she had told us about and her account was different to that of the staff. For everyone’s protection staff must make sure that any allegation that is made is fully documented. Details should be given of the allegation, the staff that were present, what happened, time and location and the action that was taken. Staff should also contact the adult protection coordinator to make sure she is aware of the allegations that are made. This will make sure the person concerned and staff are protected. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a clean, safe, comfortable, well maintained home. EVIDENCE: Elm View is situated on Huddersfield road in Halifax. The town centre is easily accessible by car or public transport. There is a small car park to the front of the building. The kitchen was inspected by environmental health in January 2008 and was awarded 4 stars for hygiene. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 19 There are four bathrooms in the home, but only the assisted bathroom on the ground floor is used. Following the inspection in September 2007 the owners told us that they were going to convert the bathroom on the second floor into a shower room. They said this would be done by the end of November 2007. This has not happened and there is still only one bathroom that all 22 people living in the home use. Staff told us that this means that people will often have to wait for their bath. The person living at the home that completed a survey said that the home was always kept fresh and clean. Relatives also said the home was kept clean. The laundry is in the basement and is suitably equipped for the size of the home. There is no access to the basement by the passenger lift. This means that the laundry assistant is carrying large baskets of laundry up and down the stairs. Since the last inspection a risk assessment has been completed to make sure that the laundry staff are safe doing this. Infection control procedures are in place and there have been no outbreaks of any infectious diseases since the last inspection. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 20 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are enough staff on duty to meet the needs of people living in the home but some staff are working very long hours, which my affect their ability to do their jobs properly. Staff are not being properly checked before they start working in the home, which leaves people at risk of being cared for by staff who may not be suitable. EVIDENCE: At the time of the inspection there were 22 people living at the home. The duty rotas were examined. These show that during the day there is one nurse on duty with five care assistants in the morning and one nurse and four care assistants in the afternoons/evenings. At night there is one nurse and two care assistants on duty. There is cook, domestic and laundry assistant cover during the day. During the week there is also a dining room assistant who takes responsibility for serving breakfast and lunch. Staff said that at the current time the numbers of staff on duty were adequate to meet people’s needs. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 21 We saw that there was always at least one member of staff in the lounge area to make sure that people are comfortable and safe. When we visited the home in August 2007 and September 2007 we found that some staff at the home were working excessively long hours. We met with the owners to discuss this in October 2007. In their improvement plan they told us that they had taken steps to reduce staff hours to acceptable limits. On this visit we found that some staff are still working excessive hours. The planned rotas for week ending 4/4/08 and 11/4/08 showed that three staff are working between 60 hours and 72 hours per week. The rota for a week in February showed that a nurse had worked 3 consecutive night shifts followed by a day shift. It is not safe practice to have staff working long hours and leaves people living at the home at risk of being cared for by tired, overworked staff who are unable to offer the best care and support. We have discussed this with the Health and Safety Executive. Risk assessments must be put in place for staff who work over 48 hours per week and kept under review. We told the owners that this must be done when we visited in December. There are no risk assessments in place. We looked at the recruitment files for the three newest members of staff. One contained the necessary checks and references. The other two files only contained one written reference for each person. It is very important that before staff start working in the home that all of the necessary checks are made. This will make sure that staff are suitable and safe to work with older people. It was not possible from the files to find out when staff had started working in the home. This means that it is not easy to check that the protection of vulnerable adult and criminal records bureau have been completed before people have started working in the home. There are 50 of the care staff who have completed their NVQ (National Vocational Qualification) level 2 training in care. This means that staff are competent to do the job. People living in the home said that they liked the staff and that they were kind and caring. In September 2007 it wasn’t possible to establish what training each individual member of staff had completed and if their training was up to date. We found the same on this visit. In their improvement plan the owners told us that they were getting a chart to record staff training on so that information would be accessible and any deficiencies would be highlighted. This information must be available to make sure that staff have all the up to date training they need. On this visit we noted that there are a lot of people living in the home that have dementia. When we talked to staff we asked them if they had been given any specific training in this area. They told us that they hadn’t. Staff need to have training in caring for people with dementia to make sure that understand people’s very specific needs. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 22 Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 23 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is not being managed properly. There is no registered manager and no one taking overall responsibility for the service. EVIDENCE: The home is not being managed properly. There has been no registered manager at the home since October 2004. The member of nursing staff that was the manager in September 2007 has decided that she doesn’t want to manage the home and is now working as one of the nursing staff. One of the other nurses who has previously acted as the manager has now reverted to that role. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 24 The management of the home is poor. Following the inspection in September 2007 we met with the owners, they provided us with an improvement plan telling us what they were going to do to meet the requirements that were made after that inspection. We found that very few improvements have been made. Staff are not being provided with the leadership and direction they need to improve the service they provide. No one is actively looking at how improvements can be made. Examples of poor management highlighted in this report are: Care plans are not developing. People and/or their relatives are not being consulted about their care. Staff are not taking appropriate action when risks are identified. Complaints and adult protection issues are not being dealt with properly. Some staff are continually rostered to work very long hours. The staff recruitment process is not through. Staff training records aren’t up to date and it isn’t clear if staff have received up to date mandatory training. There are no formal quality assurance systems in place or formal systems for consulting residents and their relatives about how the home is managed. The owners told us in their improvement plan that this would be in place by 31/12/08, but this hasn’t happened. One of the owners undertakes monthly visits to the home and as part of his visits talks to residents, relatives and staff about the service provided. Written reports of these visits are available at the home, There are certain things that the home need to tell us about. We call these ‘notifications’. For example the death of anyone living at the home and any accident in the home that people need medical treatment for. Although we have received some notifications staff have not told us about some things they should have. It is important that the home let us know about certain things that happen so that we can check they have taken the right action. The manager does hold money on behalf of residents. The records examined were well maintained and accurate. One of the nurses is a moving and handling facilitator and is responsible for making sure that all staff have up to date training. The fire alarm test records were up to date and new staff have received fire safety training. The service Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 25 records for the fire alarm system and the hoists were seen and were up to date. Staff in the home need health and safety training. During this visit we noted that : 1. A wheelchair had been left in front of a fire exit. 2. Cleaning materials, a vacuum cleaner and mop and bucket had all been left unattended on the second floor corridor. These practices are unsafe and staff must make sure that wheelchairs and cleaning equipment and materials are put away properly. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 26 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 2 3 X 3 x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 3 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 1 X 3 X X 2 Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP1 Regulation 5 Requirement Timescale for action 31/05/08 2. OP2 5 3. OP7 15 4. OP7 15 The service user guide must be kept up to date and include information about the care and support the home provides. This will make sure people are given up to date information about the service the home provides. Contracts or terms and 30/04/08 conditions of residence documents must be given to people moving into the home before or on the day of admission. This will make sure that people are aware of their rights and responsibilities. Staff must make sure that care 31/05/08 plans are kept up to date. This will make sure that people’s changing needs are met. (previous timescale of 14/10/07 not met) Staff must make sure that all of 31/05/08 the available information about a resident is considered at the monthly reviews. Staff must also involve people and / or their relatives in the reviews. This will make sure that people are consulted about the care and DS0000001050.V361352.R01.S.doc Version 5.2 Elm View Nursing Home Page 28 5 OP7 13 6 OP9 17 7 OP12 16 8 OP16 17 9 OP18 12 10 OP21 23 support they receive. Previous timescales of 30/11/06 and 14/10/07 not met) Staff must make sure that they use the risk assessments properly and take appropriate action to demonstrate how they will reduce those risks. This will make sure that people are kept safe. (Previous timescale of 14/10/07 not met) Staff must make sure medication administration records are signed properly. This will make sure that people get their medication. (Previous timescale of 14/1/07 not met) Individual and group activities must be provided. This will make sure that people are kept mentally active and stimulated. (Previous timescale of 30/11/07 not met) The owners must make sure that any complaint that is made is thoroughly investigated and appropriate action taken to resolve the complaint. This will make sure that any problems are sorted out. (Previous timescale of 14/10/07 not met) The owners must make sure that the adult protection procedures are followed and any allegations of abuse are reported. This will make sure that people living in the home are kept safe. (Previous timescale of 14/1/07 not met) The bathing facilities in the home must be reviewed and an action plan submitted to show how the owners intend to make bathing or shower facilities more accessible to residents. (Previous timescale of DS0000001050.V361352.R01.S.doc 31/05/08 31/05/08 31/05/08 30/04/08 30/04/08 31/05/08 Elm View Nursing Home Version 5.2 Page 29 11 OP27 18 12 OP29 19 13 OP28 18 14. OP31 9 15. OP33 24 12/05/06, 30/11/06 &31/12/07 not met) The owners must make sure that staff are competent to work their shift. They must take into consideration the number of hours that staff are working to make sure that individual members of staff are not too tired to fully carry out their role. This will make sure that people living in the home are care for properly by staff. (previous timescales of 24/08/07 & 14/10/07 not met) The owners must make sure that all of the necessary checks are made on new staff before they start working in the home. This will make sure that staff are suitable and safe to work with older people. (previous timescale of 14/10/07 not met) All care staff must complete training in caring for people with dementia. This will make sure that staff understand the specific needs of the people they are looking after. A permanent manager for the home must be appointed and registered with the Commission for Social Care Inspection. This will make sure that the home is being run properly. (Previous timescale of 30/05/06, 31/12/06 & 31/12/08 not met) A quality assurance system must be introduced. This will make sure that people living in the home and their relatives are consulted about the service that is being provided. (Previous timescale of 30/06/06, 30/11/06 & 31/12/08 not met) DS0000001050.V361352.R01.S.doc 30/04/08 30/04/08 31/05/08 31/05/08 31/05/08 Elm View Nursing Home Version 5.2 Page 30 16 OP38 37 17 OP38 18 The home must make sure that they make reports to us about any notifiable incidents. This will make sure that we can check they have taken appropriate action. All staff must have up to date training in the following: Moving and handling First aid Health and Safety Fire Safety Infection control Food hygiene This will make sure that staff have completed the basic courses. 30/04/08 30/06/08 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 OP30 Good Practice Recommendations Staff training records must be brought up to date. When this is done it will be easy to establish what additional training staff need. Elm View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 View Nursing Home DS0000001050.V361352.R01.S.doc Version 5.2 Page 32 - 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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