Inspection on 30/09/05 for Elm View Nursing Home

This inspection was carried out on 30th September 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Elm View Nursing Home 15/05/07

Elm View Nursing Home 18/09/06

Elm View Nursing Home 21/03/06

Elm View Nursing Home 04/03/05

Elm View Nursing Home 04/11/04

Elm View Nursing Home 02/02/04

Similar services:

Fairfields Country Rest Home

Queensmount

Poldhu

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor 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 Moor Lane Clevedon North Somerset BS21 6EU Lead Inspector Carolle Wise Scanlan Unannounced Inspection 30th September 2005 09:30 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 DS0000020304.V258537.R01.S.doc Version 5.0 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 DS0000020304.V258537.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Elm View Nursing Home Address Moor Lane Clevedon North Somerset BS21 6EU 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) 01275 872088 01275 872088 Belmont Care Limited Mrs Dawn Marie Higley Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate 42 persons aged 50 years and over who require nursing care of whom up to 3 persons may be aged 65 years and over and in need of personal care only. Staffing Notice dated 12/06/2000 applies Manager must be a RN on Part 1 or 12 of the NMC register 2. 3. Date of last inspection 4th March 2005 Brief Description of the Service: Elmview is a purpose built home providing 42 beds for residents requiring nursing care. It is situated in an urban area and surrounded by well-maintained gardens. The accommodation comprises 38 single and 2 double rooms, all with ensuite facilities, and situated on two floors. There is a large open dining area and two comfortable lounges. Part of one lounge is designated as a quiet area and can be used for receiving visitors or for family celebrations. A minibus is available to take residents to the local shops or for trips to Weston-Super-Mare or the surrounding countryside. Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection with the inspector arriving at 8.45am. The inspection took place over five hours. The inspector met with five residents in their own rooms and several residents in the lounge areas. During the course of the inspection a musical event was held in the dining room/reception area of the home, which was well attended and enjoyed by the residents and visitors alike. Some records, which need to be kept by the home, were reviewed during the inspection. What the service does well: What has improved since the last inspection? What they could do better: Security at the home needs to be improved to safeguard the residents. Care plans have improved but further detail is still needed in recording the actual care provided. Risk assessments such as nutrition should be reviewed at least when the residents needs change. This change then needs to be translated into the care that needs to be provided to mitigate the risk. Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 Page 6 The use of ‘Cot sides’ must be risk assessed and consents be appropriate and in place. Although staff supervision is in place, all staff should receive at least six supervision sessions per year. 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 DS0000020304.V258537.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 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 the following standard(s): 1 Residents and their families receive sufficient information to make an informed choice to live here. EVIDENCE: The home has a statement of purpose and service user guide in place. This has recently been the subject of review. Once completed the registered manager will forward a copy on to the commission. The prospective residents are invited to visit the home, view the vacant room, look around the facilities and meet staff and other residents. Several residents who now live at Elmview had been in hospital or quite frail when decisions regarding the choice of home had been necessary to make. Many said that they had let their families ‘deal with these matters’ but were happy living at the home. Residents felt that they and their families did receive sufficient information about the home prior to coming to stay. Several residents said that they wanted to stay local to family and friends and had already considered Elmview and chose the home on that basis. Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 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 the following standard(s): 7, 8 & 9 Care plans, although improved, should provide more detail on how residents needs are met by staff. Medication administration is robust however further attention is needed in recording residents medication stock. EVIDENCE: The inspector met with several residents some of which had recently moved into the home. Their impressions of the home were good with several stating that they had settled well and were well cared for. Residents care plans are reviewed monthly and are drawn up where able with the residents or their representative’s involvement. The care plans within the Belmont Care group of homes are in the process of redevelopment. The detail within the care plans and the risk assessments reviewed during this inspection had improved. There is still improvement needed in the application of transferring information regarding resident’s risk assessments into the care plans. A resident who had recently been unwell had a weight loss which the staff were aware of and in practice addressing however this information was not contained within the care Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 Page 10 records. Another resident with some worsening dementia care needs had continuation notes which suggested potentially worsening symptoms with no cross reference made to the care plan. Wound care plans are kept separately to the resident’s general care plans and could be developed further. An example of this would be measurements of the extent of any pressure areas or wound sites enabling a consistent approach in the evaluation of the wound. ‘Cot sides’ are used for those residents whose safety is felt to be risk with the residents or their representative’s agreement, which is good practice. The home uses a document in which a line is placed through words such as ‘I do’ or ‘do not’ consent, which is then signed. Care is needed by the staff to ensure that this document is completed correctly to reflect that which has been consented. Medications at the home are supplied by Pharmacy Plus. The qualified nursing staff are responsible for the medications within the home. Good practice was observed in the administration of medications by the staff. Recording on the Medication Administration Record sheet the actual stock of medication received from pharmacy on a monthly basis plus the medication remaining would enable easier stock control. Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 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 the following standard(s): 13 & 14 Residents continue to make their own life choices whilst living at the home. EVIDENCE: Residents enjoy the company of their families and friends at times of their own choosing. Residents’ visitors are welcomed into the home by the staff and their visitors are shown to the resident’s private rooms or the communal areas if they wish. The home has an open visiting policy in place. Residents who are able are encouraged to maintain their local links with the community such as church groups they previously attended. One resident said that they had met with former acquaintances who had also moved into the home. The residents felt that they had maintained control of their day to day lives, choosing the time they wish to retire of an evening, rise in the morning and where to take their meals. Some residents said they had found it difficult at times in establishing who they readily chat with. These residents found it useful talking to the staff and the social activities organisers to assist them in meeting up with other residents. There were several residents who were very frail and remained in their private rooms. The inspector noted that staff maintained regular contact with these Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 Page 12 residents during the course of the inspection. Residents all had access to the nurse call bell system. Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 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 the following standard(s): 17 & 18 Resident’s legal right to vote is protected. EVIDENCE: Residents are registered to postal vote should they wish to according to the registered manager. The residents met said that if they wanted to vote they would complete the postal vote forms which the home sorts out for them. They also said that if they wanted to attend a poling station their families or friends would assist them in doing so. In respect of use of ‘Cot sides’ and consent please see the Health and Personal Care section. Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 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 the following standard(s): 19, 20, 23, 24 & 26. The home provides a comfortable and well maintained environment for the resident’s. It offers appropriate aids and equipment to enable independence and meet the needs of the current residents. EVIDENCE: Elmview is in the process of extending the homes accommodation. The work was not complete at the time of the inspection and it was not inspected. The home is purpose built, light, airy and furnished to a good quality, arranged over two floors with a passenger lift to enable access. On the ground floor there are fifteen bedrooms, three with patio doors onto the garden area. The top floor has thirty bedrooms, two of which are doubles. All rooms are provided with ensuite facilities. The ground floor communal areas consist of two lounge areas, kitchen, dining room, laundry, hairdressing room, treatment room, reception area and offices for the registered manager and administration. Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 Page 15 One of the lounges overlooks the rear garden of the property, it is well decorated and homely arranged with various seating, a television and music centre. The majority of residents choose to sit in this lounge area. The other lounge is off the ground floor hallway and overlooks the side of the property, is set out with a television area on one side and tables and chairs on the other. The resident’s rooms were well presented, with evidence of residents choosing how to arrange their own personal effects and furniture within their room. Residents find the home to be clean, tidy and well maintained. One resident said that they enjoyed the ‘luxury’ of the fact the ‘laundry is all done for you if you wish it, it comes back pressed and the staff assist you putting it all away’. The home has infection control policies in place and has installed hand wash gel for the use of visitors and staff within the home. There was also evidence appropriate use of aprons and gloves during the inspection visit. One room visited did have a pervading odour which was discussed with the registered manager, this was looked into during the inspection and remedial action planned. Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 30 Resident’s needs are met by staff who are appropriately trained. EVIDENCE: Residents felt that although the staff appear ‘understandably busy at certain times, like first thing in the morning’ the care they received was unhurried and the staff do have ‘a chat and a bit of a giggle with you too’. The matron provides induction training for new the staff ‘in-house’. The new staff are orientated into the homes day to day practices which the staff and matron sign once completed. The induction program consists of observation, monitoring and supervision of staff to ensure safe practice. This training takes place over several sessions and the time taken to complete is dependant on the learning of the new employee. The training program details were clear and easy to follow demonstrating excellent practice. There are currently sixteen staff members who are NVQ level two or three, with five staff members currently on the course. The registered manager has also recently heard that the home has been successful in its application to offer placements for student nurses. Staff receive regular updates for their mandatory training, such as manual handling and food hygiene with certificates of the training held on the staff training files. Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 Page 17 There were sufficient staff on duty to safely meet the residents needs. There are two qualified nurses on duty during the day shifts, with eight care assistants and one qualified nurse at night, with four care assistants. Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32 & 36 Residents benefit from the clear management structures within the home. Staff supervision practice is in place but is in the process of development. EVIDENCE: Dawn Higley is the registered manager of Elmview and is an experienced qualified nurse. The registered managers role title at Elmview is that of Matron. She has nearly completed the Registered Managers Award having successfully completed six units so far. Residents appear to appreciate the management structure of the home referring to Matron as their point of contact should they need to discus any issues they had about the home, or one of the other qualified nursing staff. Staff supervision lies solely with Matron at present and as such not all staff have received regular supervision sessions. It is envisaged however, by the Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 Page 19 matron, that all staff will receive six supervision sessions within the twelve month period. She is hoping to develop a cascade system of supervision practice in that she supervises the qualified nursing staff, who then take responsibility for the senior care assistants supervision and so on. A recommendation made at the last inspection regarding fire procedures is now in place. Fire risk assessments are in place. Records kept regarding fire drills need to demonstrate who attended. One set of cot sides were seen by the inspector to be ill-fitting on a divan bed. The matron said that these were provided by the resident’s family. The inspector suggested that a risk assessment by the staff was needed to ensure that they were fit for use. On arrival at the home just before 9am the homes entrance doors were open with no one based at reception or in the administration offices. The inspector was seen but not approached or asked for identification by any of the staff. The inspector was able to access and roam around the home without challenge or question. The inspector approached a staff member on the ground floor and asked where the matron was and was pointed towards a qualified staff member, who alerted the matron. When discussed with matron, it was evident that this was normal practice. The doors are opened in the morning but unusually on the day of the inspection this was done before a member of the admin team arrived. It was said that the administration team would look after the reception area for visitors to the home. It was agreed that the security at the home must be improved to safeguard the residents. Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 Page 20 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 3 x x x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 3 18 2 3 3 x x 3 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 3 3 x x x 3 x 1 Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 Page 21 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 OP8 Regulation 15 Requirement If health care assessment tools are used then an appropriate action plan of care must be formulated to meet any identified needs. Cot side use must be risk assessed. Security at the home to be improved. Timescale for action 30/10/05 2 3 OP18 OP38 Sch3(3) (q) 13(6) 30/10/05 30/10/05 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 2 3 4 Refer to Standard OP7 OP9 OP18 OP26 Good Practice Recommendations Further detail within the wound care plans regarding size and extent of wounds to enable staff to measure improvements with treatment or deterioration. Staff must ensure that the residents medication stock is recorded on the MAR sheet on receipt of the medications. The care given, in respect of the consent for use of cot sides, must be that which the resident or representative has signed for. One of the resident’s rooms, named during the inspection, DS0000020304.V258537.R01.S.doc Version 5.0 Page 22 Elm View Nursing Home 5 6 OP36 OP38 had a pervading urinary odour which needed remedial action to be taken. All staff should receive supervision at least six times a year. In the recording of fire drills, the record should note those who attended, in order that the home can identify those staff who need fire drill practice. Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elm View Nursing Home DS0000020304.V258537.R01.S.doc Version 5.0 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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