CARE HOMES FOR OLDER PEOPLE
Elm View Nursing Home 2 Elm View Huddersfield Road Halifax HX3 OAE Lead Inspector
McCloy Paula Unannounced 30 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 View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service Elm View Nursing Home Address 2 Elm View Huddersfield Road Halifax West Yorkshire HX3 OAE 01422 362538 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) Mr Philip Bentley CRH 27 Category(ies) of OP - Old Age - Over 65 - 27 registration, with number of places Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 6,7 & 8 October 2004 Brief Description of the Service: Elm View cares for service users over the age of 65 years. The home provides both personal care and nursing care to male and female service users. 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, for use by service users. Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was carried out over 7.5 hours by two inspectors. Six residents, one relative and four members of staff were spoken to. Residents records, duty rotas and staff records were inspected. What the service does well: What has improved since the last inspection?
Staff are thoroughly checked to make sure that they are suitable to care for older people, before they start work in the home.
Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 Page 6 There are now 7 staff members who are appointed first aiders. Minor repairs that were needed have mostly been completed. 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 View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 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 View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 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, 4 & 5 The home’s admission procedures are good. Any prospective resident is fully assessed before they move into the home. This ensures that their care and support needs are planned for and can be met. Prospective residents or their representatives are encouraged to visit the home so they can assess the suitability of the facilities for themselves. EVIDENCE: Individual records are kept for each of the residents. The records for the most recently admitted resident showed that a full assessment of their needs had taken place before admission. This information had then been used to formulate the care plan to ensure that the residents identified needs were met. Staff confirmed that they encourage prospective residents to come and have a look around the home, although it is more usual that relatives do this. This gives people the opportunity to see the home for themselves and make and informed decision about its suitability. Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 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, 10 & 11 Care plans are detailed and give staff the information they require to meet residents needs. The health care needs of residents are being met with health care professionals being involved as necessary. Residents’ medication is well managed which promotes good health. EVIDENCE: Care plans are well organised and it is easy to find the relevant information quickly. The care plans set out in detail what action needs to be taken by staff to ensure residents needs are met. Staff are vigilant and new care plans are developed as peoples needs change. Care plans are being reviewed on a monthly basis and there was some evidence of relatives being involved in the planning process. The reviews tend to be based around reviewing the individual elements of the care plan. The reviews would be better if they were more holistic, taking account of the overall care package and residents satisfaction with their care and support. Care plans do not address residents social needs, and there is very little documented information about individuals life history or personal preferences. This information would be very valuable for staff who provide direct care.
Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 Page 10 Residents health care needs are being identified and met. Staff are vigilant and GP’s and other health care professionals are being involved as necessary. Care plans clearly document each doctors visit and advice that has been given. It would be helpful if the doctors visit sheet was used to record all visits by health care professionals, so it is easy to check when people were last seen by the chiropodist, for example. The personal and oral hygiene needs of residents are clearly documented in the care plans. Medication records are well maintained and show that residents are getting their medication at the prescribed times. However, some medication had not been booked in properly and a ‘brought forward’ system needs to be used for any ‘as required medication.’ This will ensure that the balances of medication held at any one time are easy to calculate. Residents living at Elm View looked smart and well cared for. From observation any personal care that was offered by staff was completed in a respectful and dignified way. Relatives are made to fell welcome and can use the communal areas or the residents bedroom when they visit. There is no separate visitors room. Staff were able to give a good account of the care given to residents that are dying. Their accounts would confirm that residents are treated with dignity and respect. Care plans do not contain information about residents wishes regarding the care and support they want during illness and following death. This needs to be addressed. Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 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 & 15 Social activities at the home are not being provided consistently or on an individual basis to keep residents stimulated. Relatives are welcome to visit at any time. Residents are able to bring personal possessions with them on admission. The meals at the home are good offering choice and variety. EVIDENCE: Entertainers are booked by the home on a regular basis and there is also an aroma therapist who visits every 2-3 weeks. Sometimes care staff arrange bingo, dominoes etc. to keep residents occupied. Activities need to be provided in a planned way so that each individual residents is offered an appropriate individual and/or group activity on a regular basis. Details of activities people participate in need to be recorded. The visitors book showed that relatives and friends visit at different times throughout the day. The relative who was spoken to said that they are made to feel welcome. The lunchtime meal was observed. Residents took their meals in the dining room or in the lounges. Everyone was served in a timely way, with a hot nicely presented meal. Tables were suitably laid and serviettes were available. Residents said the food was good. There is a choice available for every meal,
Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 Page 12 However, some residents were not aware of the choices on offer. Staff need to make sure that people are asked about their preferences. Those residents that needed assistance with their meal were supported appropriately. Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 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 The complaints process in this home is poorly publicised and residents do not have information about how they can complain. There are procedures in place to protect residents from abuse or neglect. However, without staff being trained in these procedures residents may be placed at risk. EVIDENCE: Residents were able to identify a member of staff that they would go to if they had any concerns, although none had been told about the complaints procedure. The complaints procedure is not on display in the home. There is a complaints log available where staff would record any complaints together with the action they have taken in order to resolve them. The home have copies of the adult protection procedures. However, staff have received no formal training. The acting manager has recently dealt with an adult protection issue. Although the result of her actions effected the right action, the adult protection procedures were not followed. Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 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) These standards were not assessed on this visit. EVIDENCE: Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 Page 15 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, 28, 29 & 30 There are enough staff on duty to meet the needs of service users. Any new staff are thoroughly checked to ensure they are suitable to work with older people. There are enough staff on duty to meet the needs of residents. EVIDENCE: There are 4 care assistants on duty throughout the day and two care assistants on waking night duty. In addition there is always a qualified nurse. There were good levels of staff supervision observed, and there was always a member of staff in the vicinity of the lounges. There is no registered manager at the home. One of the registered nurses is taking responsibility for the day to day management of the home. To be able to do this effectively she needs some time when she is supernumerary to the duty rota. There are 33 of care staff in the home who are trained to NVQ level 2 in caring for older people. The care staff team are well supported by cooks, domestics and laundry assistants. Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 Page 16 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) These standards were not assessed. EVIDENCE: Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 Page 17 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 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 1 10 3 11 1 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 x x x x x x x x Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 Page 18 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 All medication received into the home must be booked in. The date, amount of medication and the signature of the member of staff taking receipt must be rcorded on the medication administration record. The balance of and as required medication must be brought forward onto the next months administration record. Residents wishes about how they wish to be cared for during illness and following death must be recorded in their care plan. All staff must attend adult protection training. Timescale for action 14 July 2005 and thereafter 2. 11 12 31 August 2005 and thereafter 30 September 2005 3. 4. 18 13 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 7 Good Practice Recommendations Life histories and personal profiles should be added to the care plans.
J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 Page 19 Elm View Nursing Home 2. 3. 4. 5. 6. 7. 7 7 8 15 18 27 8. 26 Residents social care needs should be identified and met through the care planning process Monthly care plan reviews should be developed so that they become more holistic. Details of all medical related visits e.g. chiropodist, optician, dentist etc. to be recorded on the current doctors sheets. staff need to make sure that rsidents are aware of the choice of meal on offer, and that they are encourage to make a choice. The complaints procedure should be displayed In the absence of a registered manager, an additional nurse should be rostered on duty in the mornings so that the nurse, who is taking management responsibility for the home, can deal with some of the management tasks. If the odour in the entrace hall cannot be removed by cleaning, the carpet should be replaced. Elm View Nursing Home J52J01_s1050_Elm View_v230940_300605.doc Version 1.30 Page 20 Commission for Social Care Inspection Park View House Woodvale Office Park Woodvale Road Brighouse HD6 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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