Inspection on 27/07/06 for Elmers Green (73)

This inspection was carried out on 27th July 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 2 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) 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 27th July 2006 10:00 Elmers Green (73) DS0000005951.V299411.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.V299411.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.V299411.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) Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 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. 13th March 2006 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. Current charges for the home range from £1393.12 to £1399 per week. Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit and took place over a four-hour period from 10:00 am. Both of the residents were seen during the visit. The manager and another member of staff were on duty and were spoken to individually. Resident’s files and the homes policies and procedures were looked at. Staff files were examined and one of the members of staff on duty were interviewed. A full tour of the building was carried out. What the service does well: What has improved since the last inspection? Since the last inspection a manager has been appointed and will be applying for registration with the CSCI. This has improved organisation within the home and provided stability and continuity. Extensive building work has been carried out and environmental standards have therefore improved. Communal and private space meets the needs of residents and is easily accessible. Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 6 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. Elmers Green (73) DS0000005951.V299411.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.V299411.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 Quality in this outcome group is good. A full needs assessment is carried out which clearly identifies the individual needs of residents. EVIDENCE: There have been no recent placements made in the home, however the assessments for the two existing residents were looked at. These contained appropriate care assessments from Social Service departments involved along with the homes own assessments. These provide a good description of the residents and their needs, including medical and social. Elmers Green (73) DS0000005951.V299411.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 Quality in this outcome group is adequate. Residents changing needs are reviewed and risk assessments carried out, however these need some improvement. EVIDENCE: Residents currently living at Elmers Green have complex needs care plans and reviews were looked at for both residents. Information on care plans was incomplete and it was therefore difficult to formulate a picture from the records of the residents as individuals. Due to the residents complex needs and the fact that they cannot verbally communicate it is necessary that all information is carefully detailed and is fed into an appropriate care plan. During the visit the inspector was told that there are plans in place to rectify this. The registered provider “United Response” is implementing a “Good to Great” plan which includes a person centred approach to care planning. A training programme to implement this has begun and all staff will be involved in the training to implement the new system. The outcomes of this approach are to enable resident to be able to make more decisions about what they wish to do. Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 10 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): 12,13,15,16 and 17 Quality in this outcome group is adequate. The home provides a caring relaxed atmosphere and there are activities provided by the home. However there is a lack of a structured and proactive approach to care provision and of involvement in educational or external group activities. Menus provide a variety of healthy diet options available to residents. EVIDENCE: The residents living at the home have complex and profound disabilities and are therefore dependent on staff for all their needs. A list of activities was provided for the visit, these included TV, music, sensory equipment (though some of this was not in working order), local walks, swimming, theatre, shopping and pub visits. One resident regularly visits family. Most activities are catered for within the home environment and residents do not appear to have regular contact with the outside community or opportunity to mix with their own peer group. A recent report prepared for a care review on one resident said that the personal care plan could not be developed due to a lack of consistency of Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 11 service delivery. This was due to staffing problems within the home. At the time of the visit both residents looked happy and related well to the member of staff on duty. There is normally one member of staff on in the morning and one in the afternoon. Another member of staff works from 11 am to 7pm Residents are not able to take care of their own finances and require help with this. Records of these are maintained. Menus were seen and showed that there is good variety of food offered to residents. Their likes and dislikes are known and planned for. Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 12 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): 18,19 and 20 Quality in this outcome group is good. Residents receive appropriate personal care and support from a caring and dedicated staff. There are policies and procedures in place to ensure medication is administered safely, however these are not always followed. EVIDENCE: Residents living at Elmers Green have severe learning disability and require full personal care. There were personal support assessments on file, with check lists in place to ensure that individual personal support needs are monitored and reviewed. Professional help is and advice is obtained from speech therapists and psychologists, which helps staff to understand body language and mood. Good interaction was observed, during the visit, between staff on duty and the residents. Good information is recorded on files of medical conditions and training is planned for staff in order that they are able to deal with epileptic seizures. Appointments with doctors and psychologists are recorded and monitored. Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 13 There are policies and procedures in place to ensure the safe recording and administration of medication and staff have received training in medication administration. However at the time of the visit it was noticed that medication administered that morning had not been signed for. It also appeared that medication was being given out and block signed for. Medication should always be checked with the MAR sheet, administered and signed for at the time of being administered. It was suggested that staff receive more training to ensure the procedures are correctly followed. A key worker system is in place, which helps to promote trust and confidence between residents and staff. The new person centred care plans, which are proposed, will also enhance this process. Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 14 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): 22 and 23 Quality in this outcome group is good. The home has suitable policies and procedures in place to ensure residents are protected from abuse and that they or their representatives have access to a complaints procedure. EVIDENCE: The inspector looked at the homes policies and procedure, these include protecting residents from abuse and a whistle blowing policies to enable staff to voice any concerns they may have. The home has provided an easy to read document for residents about how to complain. This is in written and picture format and gives details of how to contact Social Services or the CSCI. All staff receive training in the Protection of Vulnerable adults from abuse. This was confirmed from staff training records and in discussion with staff. Staff spoken to were aware of the protection of vulnerable adults procedures and knew what action they should take if required. Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 15 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 Quality in this outcome group is good. The home is suitable for its stated purpose, is well maintained, and is accessible and safe for residents. EVIDENCE: The home has recently had major renovation work carried out, which has greatly improved environmental standards for residents. A full tour of the home was carried out. Each resident has their own bedroom, which is personalised with their own belonging to them. There is ample personal and communal space, which is easily accessible to residents. Staff receive training in infection control and there are policies and procedures in place to ensure the home is kept clean. Gloves and protective clothing are provided. There is a laundry facility, which is suitable to ensure items can be properly cleaned. Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome group is good. The home is staffed with experienced staff who receive training in the care of persons with learning disability. There are good recruitment procedures in place to ensure resident are protected. EVIDENCE: Training records showed that there are 97 of staff who have achieved NVQ 2 or above in care. Staff have also been provided with training in Equality and Diversity, Abuse awareness and Good To Great (Person Centred Approach Training). Additionally staff have receive training in moving and handling, first aid, medication, abuse awareness, infection control and Health Action Planning. As stated in the previous inspection report, staff require training in dealing with epilepsy and invasive medication. This training is currently being planned. During the visit it was observed that there was good interaction between residents and staff, who demonstrated an d awareness and understanding of residents needs. Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 17 The home recruitment policy was looked at and staff files examined. These showed that there are good procedures in place to ensure the protection of residents. Only those suitable to work with vulnerable adults and able to support them are selected to work in the home. Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 18 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 Quality in this outcome group is good. The running of the home has improved, however does not currently have a registered manager. EVIDENCE: Elmers Green does not currently have a registered manager, however is currently being run by one of the United Response service managers. This person has a long and varied experience in the care of persons with a learning disability and is qualified in management of a home. An application for registration will shortly be submitted. Since the last inspection there have been improvements made due to the input of the manager and a better structure implemented. The home has a quality assurance policy in place, with monitoring procedures to ensure that quality of service is maintained. Questionnaires had been sent to relatives, though no responses had been received. Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 19 The manager is confident that the implementation of Person Centred Care Plans will ensure that residents needs and wishes will be better identified and acted upon. All staff receive core training, which ensures they are able to promote the health, safety and well being of residents. All health and safety inspection certificates for the premises were up to date. Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 20 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 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 2 2 3 X X LIFESTYLES Standard No Score 11 3 12 2 13 2 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 X X 3 X Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 21 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 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. Previous timescale (31/05/06) not met The registered person must ensure medication record sheets are competed at the time of medication being given. Also ensure staff receive updated training re medication Timescale for action 30/09/06 2 YA13 17 30/09/06 Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Elmers Green (73) DS0000005951.V299411.R01.S.doc Version 5.2 Page 23 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. 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