Inspection on 21/07/05 for Elmbank Care Home

This inspection was carried out on 21st July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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

Elmbank Care Home 26/09/07

Elmbank Care Home 06/02/07

Elmbank Care Home 17/11/05

Elmbank Care Home 08/03/05

Elmbank Care Home 14/06/04

Similar services:

Hillside

Applegarth

122 Scorer Street

Byars Care Home

St Marys Nursing Home

Jubilee Villa Care Home

Bramble Lodge

Parkmanor Residential Home

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

CARE HOMES FOR OLDER PEOPLE Elmbank Care Home 35 Robinson Road Mapperley Nottingham NG3 6BB Lead Inspector Merly Bailey Unannounced 21 July 2005, 09:00 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. Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Elmbank Care Home Address 35 Robinson Road Mapperley Nottingham NG3 6BB 0115 9621262 0115 9523726 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) Elmbank Nursing Home Limited Ms Karen Larwood Care home with nursing 35 Category(ies) of LD Learning disability, 50 years and over x 4 registration, with number OP Old age, 65 years and over x 35 of places PD Physical disability, 50 years and over x 2 TI Terminally ill, 47 years and over x 3 Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: 1 Within the total number of beds a maximum of 2 bed maybe used for the category PD 50 2 Within the total number of beds a maximum of 3 beds maybe used for the category TI 3 One bed maybe used in the category LD to specifically accommodate the named person referred to in the variation application dated 16.07.02. This person was aged 47 years on admission. 4 Within the total number of beds a maximum of 4 beds maybe used for the category LD 50 5 One bed maybe used in the category LD(E) to specifically accommodate a named person referred to in Variation application dated 29.06.04. This person is aged 67 years on admission. 6 The maximum number registered should remain at 35. Date of last inspection 8 March 2005 Brief Description of the Service: Elmbank is registered to provide a service for up to 35 service users in single and shared rooms, some with ensuite facilities. The premises are an extended residential house in Mapperley, close to a shopping area and four miles from Nottingham city centre. Both nursing and care staff are provided. The home is accessible for wheelchair users and there are accessible gardens. Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted by two inspectors during one day. 23 current residents were at home and conditions of registration were met. Many of the bedrooms previously shared are now used as single so the number of residents is lower than the possible maximum registered. One registered nurse and four other staff were seen on duty in addition to the manager. Some residents and staff gave their views about the care provided. The communal areas of the home were inspected and a sample of bedrooms was also seen. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 6 contacting your local CSCI office. Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3 and 4 Appropriate assessments are carried out prior to admission. The home has the capacity to meet the needs of older people with nursing needs including those terminally ill. Further materials are needed to meet the needs of those with learning disabilities. EVIDENCE: The manager carries out assessments prior to admission and evidence of these assessments is clear on service users’ files. These are in addition to community care assessments obtained for those funded by the local authority. The main service user group in this home is older people with nursing needs and there is a clear demonstration through staffing ratios and training that the home has the capacity to meet these needs. There are currently three service users with learning disabilities in addition to nursing needs. Three staff have undertaken further training with respect to working with service users with Learning Disability, but there are still no pictorial representations around the environment to meet the needs of those with learning disabilities. Some of these specialist needs are met through part-time attendance at day centre. Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 and 9 Care plans are not complete and some are not updated, leaving some care needs unmet. Health care needs are met in practise and medication is well organised. EVIDENCE: Five care plans were examined and found to contain action plans for various needs leading from areas identified in assessments, but some basic needs were not fully addressed. For example, an assessment identified the need for specialist cutlery and bowl, but the service user concerned was observed being fed by a care assistant. There was no action plan regarding this area of need. There was evidence that existing plans were regularly reviewed on a monthly basis, but plans were not amended as a result of changes and some confusing information resulted from this. It was not clear if one service user required one or two carers to transfer and mobilise. It is recommended that any out of date assessments and plans be archived to give a clearer, up to date, plan of the action needed. Some changes are also noted in separate daily progress notes, but again the care action plans have not been updated as a result. Staff stated that they get instructions verbally and from reading the daily progress notes. There is still no recorded evidence of service users’ involvement in the Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 10 care planning process, though the manager stated that attempts were being made to engage families in this. Health needs are more clearly met. There is at least one nurse on duty at all times and some good examples of action being taken to prevent pressure sores and falls. Again action plans should be updated to reflect the current action being taken. Weights are monitored where appropriate. Access to various external health services is facilitated and recorded in the daily progress notes or on care plan files. Accident records are kept, but see under standard 37 regarding filing these. Medication is securely stored and administered by trained staff. On examination the Medication Administration Records were clearly documented and the policies and procedures on safe administration were being followed. Though where service users are capable of having some responsibility for their medication this should be made clear in their care plans. One service user was issued with his tablets to take later and this was safe, but not documented in his care plan. Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 15 Suitable activities for older people are available, but there is currently no clear demonstration that a full, balanced diet is offered to all service users. EVIDENCE: Some arranged activity is available each weekday and an activities worker is available on three days. Card games, music quiz, and other stimulating activities are available for those who wish to join in. Two service users attend a day centre on some days. Most meals are taken in the dining room, though some service users are served individually in lounge areas or bedrooms. Breakfast and lunch were served during this inspection. A choice was available for breakfast, but all service users were given the same lunch of lamb stew, carrots and potatoes. Afterwards, there was sponge pudding and custard. The cook said that no alternatives were offered, but the manager said that, if people did not like what was on the menu they could request an alternative. The menu was displayed in the dining room, but had not been amended to reflect the meal actually offered. Some service users commented that the main course is never very good and several did not eat the meat. Some requested that it be reheated and this was done. There are no facilities for service users to make their own drinks and snacks, but additional drinks are served mid-morning and mid-afternoon. It is still not clear if all service users have supper and the Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 12 manager must ensure that there is not a gap of more than 12 hours between meals offered for any service user. Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) A complaints procedure is in place. EVIDENCE: There is a clear complaints procedure displayed in the reception area and within the Service User Guide, but none of the standards in this section were fully assessed on this inspection. Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 24 and 26 The premises are suitable for the purposes of a care home. Service users are satisfied with their individual rooms and all areas are kept clean. EVIDENCE: The home appears generally clean, well maintained and comfortable with assorted seating in a choice of sitting areas. Since the last inspection chairs in the small lounge have been thoroughly cleaned. There is further space in the garden for service users and their visitors to sit. However, quotes are still being obtained for work to be done regarding the steps in one part of the garden, which are uneven and have no handrail (see under standard 38). The home is otherwise accessible to wheelchair users. A sample of bedrooms were seen and found to be equipped with most minimum standard furnishings. Adjustable beds and other equipment were provided as needed. Two service users commented on their bedrooms, stating that they were comfortable and provided good views. For those still sharing, fixed curtain screening was in place to ensure privacy for personal care. All areas seen were clean and odour free. The laundry was not inspected on this occasion. Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 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, 29 and 30 Staff are sufficient in numbers as long as they attend as on the rota. Appropriate checks are made on new staff and training is provided and supported. EVIDENCE: The staffing rota showed there are six staff in the mornings, five during the afternoons and two at night, with a further person on call at home. A registered nurse is included in these numbers. On the morning of this inspection one care assistant was off duty due to illness and could not be replaced at short notice. The effect of this was observed in that service users had to wait longer for assistance in the dining room during breakfast. Three staff were involved in assisting with washing and dressing on other floors. Twenty of the twenty-three current service users have nursing needs and the day time staffing numbers are in line with current guidance to meet such needs. At night, with such a high number with nursing needs, it is recommended that the situation be monitored, especially as at least one service user is reportedly wandering around during the night. When the manager is on call, it could take over an hour for her to arrive and assist. Three staffing files were seen and show that satisfactory references have been obtained and Criminal Records Bureau checks have been carried out on staff. An induction training programme is in operation for all care staff and ongoing training is planned. Staff described training undertaken, which included safe working practices, medication, dementia, challenging behaviour and continence. Care staff are also supported to undertake National Vocational Qualification training. Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 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) 37 and 38 Health and safety around the home is well monitored with records of safety checks. Safety equipment in place, with the exception of one outside area. EVIDENCE: All records are held securely. However, accident records are left in the accident record book. The book is compliant with the Data Protection Act if it is used correctly, by removing and filing completed forms. All radiators are appropriately covered for safety and all windows have restricted openings. Since the last inspection fire escape doors on the upper floor have been fitted with buzzers to alert staff if they are opened. However, the uneven steps to one part of the garden still have no handrail. Arrangements are made for nursing and care staff to receive training in safe working topics, and this is ongoing. A fire practice for staff was held during this inspection and records show to be a regular occurrence. Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 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 2 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 x 15 1 COMPLAINTS AND PROTECTION 3 x x x x 3 x 3 STAFFING Standard No Score 27 x 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x x x x x x 2 2 Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 18 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. Standard OP 7 OP 37 Regulation 15 17(1)(a) and Data Protection Act 1998 13(4), 23(2)(o) Requirement Ensure up to date written action plans are prepared as to how all service users needs are met. Ensure the Accident Book is used in compliance with the Data Protection Act, by removing and filing completed forms. Take appropriate action to safeguard steps in the garden. The previous target date of 30th May 2005 was not met. Timescale for action 31st August 2005 21st July 2005 30th September 2005 3. OP 38 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 OP 4 OP 7 OP 7 OP 15 Good Practice Recommendations Use pictorial representations around the environment to meet the needs of those with Learning Disability. (See www.mencap.org.uk for links to relavent information.) Obtain signatures of agreement from service users or their representatives to evidence their full involvement in the care planning process. Remove out dated assessments and plans from the current files and archive. Provide a menu offering a choice of meals to suit he needs and preferences of all service users. C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 19 Elmbank Care Home 5. 6. OP 15 OP 27 Ensure all service users have a gap of no more than twelve hours between meals offered. Ensure sufficient staff are on the premises at all times, particularly during the night, to meet the needs of all service users. Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 20 Commission for Social Care Inspection Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT 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 Elmbank Care Home C53 C03 S26433 Elmbank V239668 210705 Stage 2.doc Version 1.40 Page 21 - 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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