Inspection on 21/08/09 for Elmbridge Residential Care Home

This inspection was carried out on 21st August 2009.

CQC found this care home to be providing an Excellent service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elmbridge Residential Care Home 30/04/07

Elmbridge Residential Care Home 30/01/06

Elmbridge Residential Care Home 18/10/05

Elmbridge Residential Care Home 14/03/05

Elmbridge Residential Care Home 12/10/04

Elmbridge Residential Care Home 24/02/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Random inspection report Care homes for older people Name: Address: Elmbridge Residential Care Home 21 Elmbridge Road Gloucester Glos GL2 0NY three star excellent service The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Janice Patrick1 Date: 2 1 0 8 2 0 0 9 Information about the care home Name of care home: Address: Elmbridge Residential Care Home 21 Elmbridge Road Gloucester Glos GL2 0NY 01452524147 Telephone number: Fax number: Email address: Provider web address: elnres21@hotmail.com Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Ms Caroline Ann Margaret O`Grady care home 16 Number of places (if applicable): Under 65 Over 65 0 2 10 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Conditions of registration: 4 0 0 The maximum number of service users who can be accommodated is 16. The registered person may provide the following category of service: Care home only Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) - maximum of 10 places Dementia (Code DE) - maximum of 4 places Mental Disorder, excluding learning disability or dementia, aged 65 years or over on admission (Code MD(E)) - maximum of 2 places Date of last inspection Care Homes for Older People Page 2 of 10 Brief description of the care home Elmbridge Residential Home provides personal care for sixteen older people. Within this number the home can accommodate two service users with specific mental health needs and up to four with dementia. The accommodation is a converted two-storey older style house, which has been adapted and extended for its current use. Service users rooms are provided on two floors, fourteen of which provide single accommodation, with one shared room. One single room provides an en-suite facility, though each room has its own hand washbasin. Communal areas consist of a lounge, dining room and a conservatory, all of which are situated on the ground floor. A stair lift provides easy access from the ground to the first floor. All areas have a call bell system. Information about the service to include the Commissions previous report and current fees can be obtained from the Registered Provider. Additional charges are made for hairdressing and chiropody. Care Homes for Older People Page 3 of 10 What we found: We carried out this unannounced inspection despite the home having been rated as an excellent service in April 2007 because the Registered Provider, in this case the owner/manager adjusted the homes registration category in May 2008 to accommodate four people with dementia. There were also four requirements outstanding from the 2007 inspection and the current Inspector had not previously visited the home. The main focus of the inspection was to see how the home has settled with the new category and to revisit the outstanding requirements and satisfy ourselves that these had been complied with. In the course of doing this various other things were noted and these have been included in this report. On the Inspectors arrival at 09.45am the lounge area was quiet with several people who live in the home, sitting in there. The owner/manager was contacted and joined the Inspector and remained in the home throughout the inspection. Various aspects about the care of the people that live there and the running of the home were discussed; including the previous requirements. One of the requirements was for the home to demonstrate that peoples needs were being assessed prior to their admission. In 2007 the Inspector was told that this was done but it was not always recorded. During this inspection we saw the pre admission assessment notes for one person. The records told us that this person had also visited the home to look around before moving in. The pre admission assessment had considered the funding authoritys assessment of the persons needs as well as the homes own findings. The owner/manager told us that staff are informed of expected new admissions and the needs are discussed as a team. The person is then closely monitored after admission with regular reviews by the staff team in order to monitor the persons adjustment to living in care. Any adjustments to the persons care or referrals to specialist health care professionals are then made. This then leads onto a process of care planning, which we could see examples of in peoples care files but did not inspect during this inspection. On returning to the lounge area just before coffee time in the morning, one carer was now leading a sing a long to old time music and a board game had been set up in the dining room with four SUs involved. One person in the back of the conservatory was having a hand massage. We were initially surprised that everyone moved from the lounge area to the dining room for mid morning drinks, but we were informed that they prefer to do this. Biscuits were provided with a choice of drink and some people had a sweet. We sat and chatted to one person whos appetite had not been good lately but which was now improving. Lunch was sausages and fried onion, because we were told that this is what the people who live in the home like. It was being served with cheesy mashed potato and two vegetables. There was jelly and fruit with ice cream for pudding. When asked how people make choices about what they eat we were told that they decide on the day whether they want the main dish or something else, which will then be prepared. The homes Annual Quality Assurance Assessment (AQAA) tells us that menus are devised with the people who live in the home so that any food cooked is a dish that the staff know the people Care Homes for Older People Page 4 of 10 like. One person has a specific diet, which staff said they have got used to preparing now and adhere to. We were told that people have an option of a cooked breakfast at the weekend. We observed a member of staff entering the kitchen and attending to the cooking without putting on any protective apron or tabard over her normal uniform. When we pointed this out she explained that she normally does put a kitchen tabard on which she did following our comment. We asked if the home had received any complaints or concerns and one was discussed with us. We were informed that this had been about the homes fire safety arrangements, which the owner/manager said were correctly in place and which had been inspected by the Fire Service. We were informed that the person raising the concern had been concerned about the weight of the fire doors and wanted alternative closures considered. The home owner/manager explained that this had not been possible following advice taken from the Fire Service as the doors that she referred to were main fire barriers between the back area of the home, where the kitchen is and the main stairwell. We were also informed that this had been explained to the person raising the concern. We observed some people moving between these doors, which were correctly closed during our inspection and did not observe any problems at the time. We were also informed that some people use an alternative door from the lounge to access the nearest toilet rather than going through the main heavier fire door. We were informed that no issues had been raised by the Fire Officer on their last visit. The home does have a current evacuation procedure in place. We spoke with the Fire Service and they confirmed that they were currently satisfied with the Fire Safety arrangements at the home. While looking around the home we we did notice that one bedroom door could not be closed properly, making this a hazard in an event of a fire. On reporting this to the owner/manager we were informed that the maintenance person was looking into it. We were assured that this would be rectified as soon as possible. We noted in the 2007 inspection report that although staff were able to explain what they would do in a situation where an allegation of abuse had been made or if they suspected or witnessed an abusive incident taking place, they had not actually received any formal training on the subject. We were told during this inspection that all staff have attended safeguarding adult training. Certificates for this were not requested during this inspection but will be inspected at the next main inspection of the service. We were also told that staff had received information on the Mental Capacity Act 2005 and the Deprivation of Liberty Safeguards (DOLS). We were shown around the home which has two floors. The ground floor has a large lounge and large conservatory area attached which is used as the dining area and provides another small area to relax in. The outside area can be accessed through a door at the back, which was open when we visited. We inspected several bedrooms on both floors and each has its own colour scheme. The AQAA tells us that people can choose what colour they would like their room to be decorated in and they are encouraged to bring in personal items to help personalise their own private space. We saw that some bedrooms were very personalised and others were devoid of personal affects. All bedrooms contained what is required in the national minimum standards. One bedroom on the first floor smelt strongly of urine including the immediate area outside, which was also noted by the person showing us around. We noticed that there were plug in air fresheners in the vicinity. We were told that the carpets are regularly Care Homes for Older People Page 5 of 10 cleaned not just vacuumed but this needed addressing. One other room had a slight smell of urine and we were informed that a special mat is put alongside this bed at night to help protect the carpet. The mat was folded up on top of the wardrobe and we wondered how hygienic this was and if the smell was coming from this. We pointed this out whilst in the room and the practice of storing the mat on the wardrobe may need to be reconsidered. On the ground floor, at the entrance of one bathroom and outside two bedrooms, we noticed the corridor carpet had frayed away from the door strip, providing a potential hazard for trips and falls. We also noted that the carpet leading to one of the main toilets was very discoloured along the central walking area, making it look quite dirty. We were informed that it is also cleaned regularly, but the owner/manager also explained that the carpet in the corridor had not been down that long and that they have ordered a replacement due to the poor wear and tear. Acknowledging this we said that in the meantime the areas posing a risk must be secured. We talked about how the home is staffed and what the arrangements were for staff training and supervision. We were told that there are four staff on duty each day which includes the owner/manager. At night there are two staff on duty; one stays awake and the other sleeps for the main part of the night and is available for emergencies. The day staff meet all the needs of the home as well as the people living there, so they also do the cleaning , laundry and cooking. One carer explained that the jobs are allocated so that each member of staff knows what they are responsible for and everything gets done. The majority of the staff have worked at the home for several years but there has been one new member of staff but we did not inspect any recruitment records on this occasion. At the time of this inspection there were sixteen people living in the home and we were informed that there were three people currently under the new category for dementia care. The owner/manager explained that staff have had in depth training on the subject of dementia and are used to caring for people that have degrees of memory loss and other problems that are associated with certain types of dementia. The new category means that the home can now formally accept people who have a diagnosis of dementia. The home also has links with the Alzheimers Society and wants to pursue further training with them. The home has various policies and procedures in place relating to peoples health and safety and there are arrangements in place to help the service ensure good practices are maintained. We were informed that all related checks and servicing of equipment and utilities are carried out once a year. We were also informed that hot water temperatures are checked regularly to make sure people are not at danger of scalding injuries. One of the previous requirements was to ensure arrangements are made to reduce risks in relation to hot radiators. We have been informed that any potential risk is assessed and the radiator covered or some form of other action is taken if it is felt necessary. We also understand arrangements are in place for the reduction of any risks from Legionella. We asked if there had been any recent falls or injuries involving the people who live in the home and were told there had not been. We were informed that all staff have safe moving and handling training and that a refresher in this was due soon. Another previous requirement was for the home to demonstrate that it has a Quality Care Homes for Older People Page 6 of 10 Assurance system in place. This requirement was not fully inspected during this inspection but the AQAA would imply that the home listens to the views of the people living there and acts on these to improve the service given to them. Audits are also carried out but again we did not specifically inspect these on this occasion. The final requirement made in 2007 was to notify the Commission accordingly of any incidents, accidents and deaths which relate to regulation 37 of the Care Home Regulations. The Commissions records show that we are receiving notifications under this regulation. What the care home does well: What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 2. Care Homes for Older People Page 7 of 10 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 8 of 10 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. 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