Inspection on 13/03/06 for Elmers Green (73)

This inspection was carried out on 13th March 2006.

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 no outstanding requirements from the previous inspection report, but made 6 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elmers Green (73) 26/10/07

Elmers Green (73) 27/07/06

Elmers Green (73) 28/11/05

Elmers Green (73) 17/01/05

Elmers Green (73) 16/06/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Elmers Green (73) 73 Elmers Green Skelmersdale Lancashire WN8 6SG Lead Inspector Phil McConnell Unannounced Inspection 13th March 2006 10:00 Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 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 Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 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 Adults 18-65. 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. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Elmers Green (73) Address 73 Elmers Green Skelmersdale Lancashire WN8 6SG 01695 732615 01695 559299 elmers.green@unitedresponse.org.uk None United Response 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) Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Registered Provider should, at all times, employ a suitably qualified and experienced Manager who is registered with Commission for Social Care Inspection. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in care homes. 28th November 2005 2. Date of last inspection Brief Description of the Service: 73 Elmers Green is a detached bungalow in its own grounds in a quiet cul-desac in the Elmers Green area of Skelmersdale. The home provides ground floor accommodation for up to four service users with learning disabilities. There were only two service users living at Elmers Green at the time of the inspection. The accommodation comprises three bedrooms, separate toilet and bathing facilities, kitchen/dining area, large lounge and attached quiet area, office, and an attached garage. There is a garden at the back of the home. Local community facilities can be accessed via a bus route approximately 10 minutes walk from the home, although the home does have its own transport. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced which meant that the provider was unaware that the inspection was to take place. Both of the service users and two members of staff were present during the inspection and there was the opportunity to speak to everyone individually. Service users’ files were inspected along with staff files and the organisations Policies and procedures. What the service does well: What has improved since the last inspection? What they could do better: A manager needs to be appointed who is registered with CSCI; this would hopefully improve the organisation within the home, give stability, continuity and give confidence to the staff. The home has been in the process of having extensive building work done, this has been for approximately 1 month with the service users moving out of their home for the first 2 weeks, in order for the building contractors to do the majority of the work which, included removing asbestos from the walls and ceilings, replacing the window frames and complete redecoration throughout. During the first 2 weeks the service users went to stay in satisfactory temporary accommodation and it was hoped and planned that the building work would be completed before they returned home, or at least there would only be superficial work to be completed. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 6 Unfortunately this was not the case, resulting with only part of the house being habitable, with major work still being done whilst the service users live in a cordoned off part of the house. Service users would benefit from planned, structured, regular and meaningful activities. It would benefit the staff and service users alike if staff supervisions were held more regularly, in order to identify any issues or training needs, (epilepsy training) which would ultimately improve the quality of care and support for individuals. 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. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 There was sufficient documented evidence to indicate that service users have been appropriately assessed to identify their support and care needs. EVIDENCE: Service users’ files were inspected and they contained appropriate care assessments from the social services and the agency’s own assessment. There were pen pictures, with background information for each person. There were service users’ guides in place and individual charters in service users’ files, which gave details of the terms and conditions about living at Elmers Green, covering such things as finances, food and menus, staffing, bedroom, health issues, and contact with family and friends. The charters were in picture format, which were appropriate to service users needs. They were signed and dated by the service manager and the service users’ representative, demonstrating that service users or their representatives are consulted and involved in this process. Service users’ files contained information regarding a list of ‘likes and dislikes’, which had been compiled by family members and other people who were familiar with the individual person. This helped the staff to support the person appropriately, with accurate and important information. One persons’ file had a behavioural plan, which identified any potential triggers that may cause the person to be upset, distressed, annoyed, happy or content Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 9 and in discussion with the staff they were familiar with the document and had a good understanding and awareness of how the person maybe feeling or what they may need at that time. Family contact / involvement is encouraged by the staff and during the inspection a parent came to collect his son and take him to the family home for a couple of days. The parent commented that this is a regular event and it was apparent that the service user was delighted that he was going to stay with his parents. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not assessed at this inspection. EVIDENCE: Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 There is a lack of a structured and a proactive approach to meaningful activities for service users, in order to motivate and provide stimulation. EVIDENCE: The service users who live at Elmers Green have complex and profound disabilities and therefore are dependent on staff for all of their needs. Neither of the service users have employment or attend any educational facility. The service users are supported on walks in the local community and shopping, with occasional day trips being arranged. One staff member said, “ service users sometimes go swimming”, but could not remember the last swimming activity and there was no documented evidence to confirm this or any other meaningful outside activity. It would appear that most activities or interests are catered for within the home environment, demonstrating that the service users have insufficient contact with the outside community and have little opportunity to mix with their own peer group. This would help to encourage and motivate service users, so that they are stimulated and given opportunities to develop and reach their full potential. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 12 Service users are unable to take care of their own finances and the staff help with all financial aspects, including benefits, budgeting for household bills and shopping. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 and 19. Service users receive appropriate personal care and support from caring and dedicated staff. EVIDENCE: The service users living at Elmers green have complex and severe learning disabilities and are in need of full personal care. There were recently reviewed ‘Intimate and personal support assessments’ with specific checklists in place, highlighting that peoples’ personal support needs are monitored and reviewed to ensure they are being met. One service user had a ‘communication assessment’ by a speech and language therapist, giving clear guidance of how the individual person maybe feeling or trying to communicate at a particular time and how this could be interpreted by observing the persons’ body language or mood. This also highlighted that other professional help and advice is welcomed and acted upon, in order to improve the quality of support and care to the individual. During the inspection, staff were observed interacting with service users in a respectful, sensitive and courteous manner clearly demonstrating an awareness and understanding of a person with a profound learning disability. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 14 There were comprehensive care plans in place with specific guidelines for each service user. There was also a medical profile for each person with detailed information including: any medical conditions, past operations or treatments, any sensory impairments and a ‘health action plan’, with medication review dates and information for a well mans clinic. There was up to date information regarding medical treatment, with records showing dates for hospital appointments, indicating that individuals’ health needs are observed and reassessed if needed to promote their health and wellbeing. However, in discussion with staff, some concern was expressed about a service users’ hearing impairment, asking, “What can be done?” and also about receiving training on epilepsy, “training would give us more confidence if a service user has a severe seizure, we would know what to do” There was a key worker system in place; helping to promote trust, confidence and a rapport between the service user and the staff member, thereby, helping to ensure a service users’ changing needs are identified and acted upon as quickly as possible. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: These standards were not assessed at this inspection. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30. At the time of the inspection parts of the home were unsafe and failed to fully meet these required minimum standards. EVIDENCE: At the time of the inspection extensive renovation work was still being carried out to the property. (See summary of report) This meant that part of the house could not be used, reducing the space that the service users and staff could use. The living room, the sensory room (light and sound) the garage and the original office (3rd bedroom being used for office) are not accessible. The home in general was quite uncomfortable due to the work being carried out and although the service users do not appear to be affected by the disruption, members of staff were unhappy about the conditions and restrictions that the service users had to endure. One member of staff had written their concerns in the communication book, about the problems being experienced including: electrical, lighting, heating and the lack of privacy in some of the rooms, especially the service users bedrooms, with new windows having been installed without blinds or net curtains, therefore curtains were remaining closed throughout the day to help maintain some privacy for service users. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 17 The area manager and the service manager were contacted as part of the inspection regarding the situation, which was not acceptable. They both gave assurances that these issues would be dealt with as a matter of urgency and would give the commission for social care inspection (CSCI) clear and specific timescales when the renovation work would be completed. The training of staff incorporates a course on infection control with a relevant policy and procedures being in place. Staff are supplied with rubber gloves and aprons and in discussion they were fully aware of the importance of using protective clothing. The laundry is situated separately from the kitchen and there are adequate hand washing facilities sited throughout the home, helping to reduce the risk of cross infection. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 34 and 35. Staff are well trained and competent, but would benefit from training relating to specific medical conditions affecting service users. Thorough recruitment procedures were in place, ensuring as much as possible the safety and protection of vulnerable adults. EVIDENCE: The training schedule was observed and it was up to date, with all staff having achieved the National Vocation Qualification (NVQ) at level 2 or level 3. The staff on duty during the inspection were going on Person centred planning (PCP) training the following day, giving the assurance that service users are supported by suitably qualified and skilful staff. Staff members have varied experience in working with people from different cultures and faiths. In discussion with staff, there was an understanding and awareness of people’s cultural and religious needs. Members of staff were observed interacting with service users and they showed that they were respectful, courteous, tolerant, interested and committed to the people that they supported. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 19 A thorough recruitment policy was in place with satisfactory procedures, which took into account the need to protect service users. Criminal Record Bureau (CRB) checks had been carried out and staff are only employed on the satisfactory completion of these checks. This helps to ensure that service users are protected and safeguarded by having a robust recruitment and selection process. During their induction, staff receive training in equal opportunities, disability awareness and anti discriminatory practice. Further training needs are identified in supervision sessions and as previously mentioned some staff said, they would appreciate having more extensive training in the management of epilepsy, in the event of a service user having a severe epileptic seizure, they would feel more confident and proficient. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 20 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39 and 42. The running and management of the home at the present time appears to be disorganised and lacks structure. EVIDENCE: Elmers Green does not have a registered manager at the present time; however, it is planned for the service manager to apply to become the registered manager who already has a long and varied experience in care work, having obtained the National Vocation Qualification level 4 (NVQ) and is presently responsible for the day-to-day running of the home. There was a quality assurance policy in place, with monitoring procedures helping to ensure that a quality service is provided. There was evidence that questionnaires had been sent to relatives, asking relevant questions referring to the level of care, décor and the environment of the home, although none of these questionnaires were available for inspection. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 21 The inspector was informed that the implementation of Person Centred Plans (PCP), would soon be taking place, which will help to further ensure that service users’ needs are being met. All staff have received relevant and appropriate training, including: moving and handling, protection of vulnerable adults (POVA) mental health awareness, first aid, fire safety, the control of substances hazardous to health (COSHH) and infection control. However, during an inspection of the premises some hazardous substances were observed being stored in an unlocked toilet, which could have caused an unnecessary risk to the service users. These substances were immediately removed by staff and locked away in a safe and secure place. All health and safety inspection certificates, including: gas, electric, fire extinguishers, fire alarm, water supply and environmental health food safety were available for examination and up to date, indicating that the provider is compliant with the legal requirements to help ensure safety for service users and staff. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 X 23 X ENVIRONMENT Standard No Score 24 1 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X X X X X LIFESTYLES Standard No Score 11 X 12 2 13 X 14 X 15 X 16 X 17 X X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 X X 2 X 3 X X 2 X Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 23 NO 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 YA12 Regulation 16 (2) (m) & (n) Requirement 2 YA24 23 (2) (b) & (e) The registered person shall having regard to the size of the care home and the number and needs of service users. (m) consult service users about their social interests, and make arrangements to enable them to engage in local, social and community activities and to visit, or maintain contact or communicate with, their families and friends; (n) Consult service users about the programme of activities arranged by or on behalf of the care home, and provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation, fitness and training. The registered person shall 30/04/06 having regard to the number and needs of the service users ensure that (b) the premises to be used as the care home are of sound construction and kept in a good state of repair externally and internally; (e) adequate private and DS0000005951.V276371.R01.S.doc Version 5.1 Timescale for action 31/05/06 Elmers Green (73) Page 24 3 4 YA30 YA37 23 (2) (d) 8 (1) (a) 5 YA19 13 (4) (c) 6 YA42 13 (4) (a) communal accommodation is provided for service users. All parts of the care home are required to be kept clean and reasonably decorated. The registered provider shall appoint an individual to manage the care home where – (a) there is no registered manager in respect of the care home. The registered person shall ensure that – (c) unnecessary risks to the health or safety of service users are identified and so far as possible eliminated, and shall make suitable arrangements for the training of staff. The registered person shall ensure that – (a) all parts of the home to which service users have access are so far as reasonably practicable free from hazards to their safety. 30/04/06 31/07/06 31/08/06 30/04/06 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 YA36 Good Practice Recommendations It is recommended that staff are supervised every 6 to 8 weeks. Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 25 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ 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 Elmers Green (73) DS0000005951.V276371.R01.S.doc Version 5.1 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!