Inspection on 26/10/07 for Elmers Green (73)

This inspection was carried out on 26th October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elmers Green (73) 27/07/06

Elmers Green (73) 13/03/06

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 Mr Patrick Rooney Unannounced Inspection 26th October 2007 10:00 Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 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.V345412.R01.S.doc Version 5.2 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.V345412.R01.S.doc Version 5.2 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) Mrs Sonia Howard Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only: Code PC, to people of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Learning disability: Code LD The maximum number of people who can be accommodated is: 4. Date of last inspection 27th July 2006 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. The accommodation comprises four 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. Current charges for the home range from £1393.12 to £1399 per week. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was and unannounced inspection and took place over a two day period on 16th and 26th October. On the first day an “Expert by Experience” Deeann assisted with the inspection and spoke to all the residents. Surveys were sent out to residents and their families. Resident’s files and the homes policies and procedures were looked at. The manager and staff were spoken to. A full tour of the home took place. What the service does well: What has improved since the last inspection? Since the last inspection the home has amalgamated with Pinewood, which was situated nearby. The home now has a full compliment of residents and is better staffed, which ensures staff are able to provide a variety of activities for residents. The new “Great to Good” Person Centred Planning is being introduced and has meant better outcomes and improvements for residents in their daily lives. They are now being encouraged to take part more in the running of the home and are involved in the tasks associated with this. Observations made at reviews show that because of this residents are fitter and generally happier. Management support, staff meetings and the input of hands on approach by the manager have ensured staff are becoming familiar with the new processes being used. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 Page 6 United response, which runs Elmers Green, has produced an Equality and Diversity plan, which staff are required to sign and also to attend training in this. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 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.V345412.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome area is good. A clear needs assessment is carried out, which clearly identifies the individual needs of each resident. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home has amalgamated with Pinewood care home, which was situated near to Elmers Green. In this process two residents were transferred to the home. Prior to this careful preparations were made and residents introduced to each other. All residents have clear needs assessments, which identify their individual needs. These provide a good description of residents and include medical and social needs. Each resident is provided with a service users guide, which is provided in a picture format and details facilities and services provided by the home. They also have a detailed social work assessment and a contract stating service to be provided. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome area is good There are good arrangements to plan and enable residents to reach personal and individual goals. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents living at Elmers Green have complex needs; care plans and reviews were looked at for all four residents. The home has begun implementing the “Good to Great” planning approach, which is a person centred approach to care planning. Each resident has a personal learning plan with regular path reviews being carried out. Learning logs are scored and enable progress to be closely monitored. Each resident has a personal progress diary. There has been noticeable improvement in all residents and there are more and varied activities provided. All residents are becoming more involved in taking part in household jobs and are being enabled by staff to do more for them. Residents are more focussed, more relaxed and fitter. Risk assessments are in place and Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 Page 10 ensure risks are identified and that residents are able to do as much for themselves as possible. During the visit to the home an expert by experience took part in the inspection and was able to report that there are very good relationships and communication between staff and residents, who are described as caring and understanding regarding residents needs. They ensure residents are provided with a variety of activities every day. Residents and their families are encouraged to take part in the planning and review processes. The manager ensures that she is in regular contact with families. Families visit the home and one resident has regular visits home to parent’s home. One area for development is to enable residents to take part in more community activities such as gateway clubs etc. This would provide them with better external contacts on a regular basis. If support could be provided this may be more beneficial if provided on an individual basis. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17Quality in this outcome area is good. There is a caring and relaxed atmosphere in the home and staff have good communication with residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: All residents living in the home have complex and profound disabilities and rely on staff for most of their needs. With the implementation of the Great to Good person centred planning there has been improvement in daily living, choices and activities. Written logs and diaries for individual residents showed that there are always a variety of activities and daily life choices available. More contact with families is recorded and the manager ensures that she is in contact with families on a regular basis. Since the homes amalgamation with Pinewood staff recourses have improved and there are always sufficient staff on duty to ensure activities and outings can be arranged. More outings have been arranged and staff have taken Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 Page 12 residents swimming, to bowls, shopping, the library, visits to places of interest and family visits. As stated previously most activities are with staff and there is room for improvement in providing activities, which enable more external social relationships/friendships. Menus were looked at and showed that there are a variety of food choices available. Staff showed that they have a good idea of what individual likes and dislikes are and take residents on shopping trips when food is being purchased. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is good. Residents receive good personal and health care report from caring and dedicated staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care files for all residents were looked at during the visit and showed that personal and health care needs are identified and recorded. Medical profiles are in place for each person, which identify personal needs and personal intimate support plans showed respect for their privacy and dignity. Care plans in place ensure there is consistency in approach. The home is in the process of improving medical profiles incorporating the Great To Good person centre approach and will ensure each person has a health action plan. Key workers are responsible for monitoring and reviewing these. Care planning recognises individual needs and choices. Staff on duty showed a good understanding of residents needs and had good communication skills to identify what individuals wanted to do. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 Page 14 Professional help is available and advice obtained from speech therapists and psychologists. Good information is recorded on files of medical conditions and training provided to staff to help them deal with epileptic seizures. Policies and procedures are in place for the safe recording and administration of medication. Staff receive training in medication administration. However at the time of the inspection it was noted that there were two inaccuracies showing that medication administered had not been properly signed for. Staff should always check the MAR sheets and sign for medication at the time of dispensing. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is good. The home has suitable policies and procedures in place to ensure residents or their representatives have access to the complaints procedure and that residents are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Policies and procedures were looked at regarding adult protection and complaints. There is a protection of vulnerable adults procedure and a whistle blowing policy. Staff receive training in adult protection and those spoken to were aware of the procedures and knew what procedure to follow if they have any concerns. The complaints procedure is available in the service users guide and is written in easy to read and picture format. Copies were seen pinned up around the home. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24 and 30 Quality in this outcome area is good. The home is suitable for its stated purpose and is generally well maintained, is accessible and safe for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A full tour of the home was carried out, each resident has his or her own bedroom, which, is personalised by each resident. Bedrooms were safe and comfortable and provide private space for individual use. All areas of the home were clean and hygienic. Policies and procedures are in place to ensure infection control standards are maintained. Staff receive training in infection control Some of the communal areas of the home such as the lounge and hallways are in need of repainting and some wall need repairing where there are cracks. The manager said there is a budget available for this, however some alterations are needed to provide a staff sleeping in room and a better positioning of the “sensory room” which is currently situated near the office. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 Page 17 Facilities in the sensory room need repairing and up grading. The occupational therapist is consulted regarding any adaptation needed. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 and 36 Quality in this outcome area is good. The home is well staffed with experienced staff who receive training in the care of persons with a learning disability. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff training records showed that there are more than 97 trained to NVQ 2 and 3. In addition training has been provided in Equality and Diversity, Vulnerable adult procedures and awareness, Good to Great person centred planning, moving and handling, first aid, medication, infection control, health action planning, invasive medication and dealing with epilepsy. All staff receive a full induction using the Common Induction LDAF process, and receive regular supervision, which identifies professional development and training needs. At the time of the inspection not all staff had an up to date annual appraisal. Rotas showed that there are always good levels of staff on duty to meet resident’s needs. This has improved since the amalgamation with Pinewood. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 Page 19 Staff files showed that there are robust recruitment procedures in place, which ensure protection for residents. Prior to taking up post references and Criminal Records Bureau clearances are obtained. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 and 42 Quality in this outcome area is Excellent. The home is well managed and ensures resident’s interests are promoted. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is well managed by a qualified manager who is experienced and registered with the CSCI. She has a long and varied experience in the care of persons with a learning disability. There are good management structures with in the home, which provide good direction for staff, regular supervision and staff meetings. There has been a gradual introduction of the Great to Good Person Centred approach to care planning. This has seen improvements in the day-to-day lives of service users. The manager is in day-to-day hands on contact with the home, providing good role modelling and mentoring for staff Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 Page 21 to ensure the new processes are effectively implemented. Good records are maintained to ensure resident’s interests are maintained and promoted. There is a quality assurance policy in place, which monitors procedures to ensure quality of service is maintained. . A Path review monitoring the progress of the new system was held in July 2007. A copy of this was seen during the inspection. This highlighted successes and identified improvements to be made, including an understanding of staff’s individual learning styles. During the current year surveys of residents and parents has taken place and parental consultation questionnaires were sent out. United response has produced an equality and diversity plan and has required all staff to read and sign this. Training in this is also provided. Staff are required to value and celebrate diversity and the home aims to employ a work force that reflects both the people and community it serves. All staff receive core training, which ensures they are able to promote the health and safety and well being of residents. Health and safety policies and procedures and safety inspections were up to date. Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 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 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 3 32 X 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 4 X 4 X X 3 X Elmers Green (73) DS0000005951.V345412.R01.S.doc Version 5.2 Page 23 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. 2. Standard YA13 Regulation 17 Requirement The registered person must ensure medication record sheets are competed at the time of medication being given. Timescale for action 26/10/07 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) Refer to Standard YA13 YA24 YA24 Good Practice Recommendations Residents should be encouraged and enabled to be involved in more external social relationships with people other than family and staff. The sensory room should be upgraded and items repaired. Some communal areas should be repainted and walls repaired. 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