Inspection on 28/11/05 for Elmers Green (73)

This inspection was carried out on 28th November 2005.

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 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 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) 27/07/06

Elmers Green (73) 13/03/06

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 28th November 2005 10:00 Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 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.V264373.R02.S.doc Version 5.0 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.V264373.R02.S.doc Version 5.0 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.V264373.R02.S.doc Version 5.0 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. 17th January 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 complex needs. 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.V264373.R02.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day. During the inspection, the inspector had discussions with the senior support worker and with two members of the support staff. The service users who live at Elmers Green have no verbal communication, but the inspector was able to observe, throughout the day how the staff interacted with the, service users by using non-verbal communication skills. The service users files policies and procedures were examined. All of the rooms within the home were inspected. What the service does well: What has improved since the last inspection? What they could do better: There is a need for the documentation within the home to be better organised and all care files and records to made available for inspection. Service users care plans need to be regularly reviewed, updated and used on a daily basis, to ensure that service user’s assessed needs are being met. Social services reviews need to be maintained and records kept within the service users files. Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 Page 6 Additional training needs to be provided for those staff who do not feel confident in the administration of medicines. 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.V264373.R02.S.doc Version 5.0 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.V264373.R02.S.doc Version 5.0 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): 5 Service users have appropriate contracts in place which demonstrate the services and facilities that will be provided at the home. EVIDENCE: There were service users guides in place and individual charters were contained within service users files, which gave details of the terms and conditions about living at Elmers Green. These details covered such things as finances, food and menus, staffing, bedroom, health issues, and contact with family and friends. The charters had been produced in picture format, which were appropriate to service users needs. These documents had been signed and dated by the service manager and the service users representative, demonstrating that service users or their representatives were consulted and involved in this process and ensuring that their rights to access information was upheld within the home. Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 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, 8, and 9 Care planning procedures did not effectively guide care practice to ensure an appropriate response to identified need. Risk assessments are in place promoting opportunities to increase service users independence and confidence however some of these were out of date. The rights of residents to be treated with dignity and respect were upheld by the procedures and practices within the care home. EVIDENCE: The service users who are presently living at Elmers Green have complex needs. One of the service users had a care plan in evidence however the staff were unable to locate the care plan for the other service user. Service user files contained communication sheets, which were in need of reviewing. There were active support sheets, which were also noted to be out of date. Due to the service users complex needs and the fact that they cannot verbally communicate, there is a necessity that all information is detailed and up to Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 Page 10 date, to ensure that service users assessed needs are identified and adequate directions for staff intervention are documented. Service users care plans are working tools and must be available at all times, to guarantee that service users are being supported and cared for according to their assessed needs. The inspector was informed that social workers had held annual reviews this year for the service users, but there were no minutes or documented evidence to support this. Medical profiles were available for each of the service users with information, identifying that a number of professionals had been involved providing services to the service users in order to promote their health and welfare. It was evident that intervention had been provided from the speech and language therapist, health access nurse and community nurse’s from the learning disability team. The inspector observed throughout the day that service users are supported and encouraged as much as possible to make decisions, by showing pictures and photographs, recognising facial expressions and body language. Service users are empowered by staff where possible to make decisions and choices. It was recognised that it is difficult for service users to be involved in consultation and to fully participate in the daily running of the home however, service users are encouraged by staff to be involved as much as possible in order to promote their independence. General risk assessments were in place and were noted to be up to date. There were some individual risk assessments in place, which need to be reviewed and updated, to ensure that people are given opportunities to increase their independence and confidence. Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 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): 13, 15, 16 and 17. Service users are supported to make informed and appropriate choices in their lives. EVIDENCE: Staff informed the inspector that the service users access the local community and people are supported to go for daily walks weather permitting. This activity was observed on the day of the inspection so helping to promote, fitness, a healthy lifestyle and community awareness. The home has it’s own transport and service users are supported to access different venues and activities, for example shopping, going to places of interest, going for meals out and visiting the local pub encouraging community participation. Service users meet up periodically with other people from one of the other homes run by United Response for birthdays and parties giving people the opportunity to develop friendships and build relationships. Service users have the opportunity to both go out together or by themselves. Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 Page 12 Service users are able to communicate their needs regarding going out of the home to the staff. Service users are encouraged to make decisions and community participation is enabled and promoted. Service users have access to all safe areas of the home, giving the opportunity for people to be alone and have their own space should they choose to do so. The inspector spoke with some staff members and examined staff rotas. Rotas are well planned and staffing levels are adequate. There is also a staff on call system in place which was working well. The service users files contained details of family members and friends with addresses, telephone numbers and birthdays, to help maintain contact with their families. One relative who was picking up a service user to go and stay at the family home informed the inspector that they were “very happy with the support and care that was given at Elmers Green.” Healthy diets are provided within the home. A four weekly menu system was in place. There are also regular set days for going out for meals to local cafes and pubs ensuring a variety and choice for the service users. Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 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): 20. Appropriate policies and procedures were in place relating to the control of medicines in order to maintain the safety of service users. Not all staff feel confident and competent in the administration of medication. EVIDENCE: There were appropriate policies and procedures in place relating to the control of medicines in order to maintain the safety of service users. The present service users are unable to self-administer any medication; therefore the staff team supports them in this element of their care. There were up to date records of medicines, received and administered, with a weekly stock check document, which had been signed and dated, to ensure that accurate monitoring and administration is in place. There was evidence that all staff have had medication training, however, a staff member said, “The basic training is OK but we need more in depth medication training” There was documented evidence that the service users GP has carried out medication reviews regularly in order to ensure that the appropriate Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 Page 14 medication and dosage is maintained and ensure a clinical overview of prescribed treatments. Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 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): 22 and 23. There were suitable policies and procedures in place to ensure as far as possible that service users are protected and safeguarded from harm and abuse. Staff were aware of the action to take to ensure the protection of service users. Some records required to be available at inspection could not be accessed. EVIDENCE: There were relevant policies and procedures in place to deal with concerns and complaints. There was a document entitled. ‘ How to complain’ which was in written and picture format, with details of how to contact the local social services directorate (SSD) and the commission for social care inspection (CSCI). The inspector spoke to three members of staff and they were fully aware of how complaints would be managed at the home. There had been no complaints since the last inspection. The senior support worker informed the inspector that no employee could start employment without a criminal records bureau check (CRB) and a protection of vulnerable adults check (POVA) being made. However, the inspector was unable to examine the CRB checks, because they were locked away in a filing cabinet. The inspector advised that these documents are required to be available for inspection purposes. The policies and robust procedures that are in place indicate that service users are protected as much as possible from any form of abuse. Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 Page 16 Staff are adequately trained in the protection of vulnerable adults and were aware of the actions they should take should they become aware of an allegation or have a suspicion that abuse has taken place. Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 Page 17 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): EVIDENCE: These standards were not inspected on this occasion. Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 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): EVIDENCE: These standards were not inspected on this occasion. Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 Page 19 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): EVIDENCE: These standards were not inspected on this occasion. Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X 3 Standard No 22 23 Score 3 2 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 1 3 3 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score X X X X X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score X X X X X X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Elmers Green (73) Score X X 3 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000005951.V264373.R02.S.doc Version 5.0 Page 21 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA6 Regulation 15 (2) (3) Requirement Timescale for action 31/03/06 2 YA34 17 (2)(3)(b) sch 4 The registered provider must keep the service users care plan under review and make revisions as necessary. Where possible service users should be involved in this process. (Timescale of 28th February 2005 not met) The registered provider must 28/02/06 ensure that all records listed in schedule 4 are available for inspection in the care home. (Timescale of 30th April 2005 not met) 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 Refer to Standard YA9 YA20 Good Practice Recommendations A system for reviewing and updating risk assessments for individual service users need to be implemented. Additional training needs to be provided for those staff members who do not feel confident in the administration of medicines. DS0000005951.V264373.R02.S.doc Version 5.0 Page 22 Elmers Green (73) Elmers Green (73) DS0000005951.V264373.R02.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Chorley Local Office Levens House Ackhurst Business Park Foxhole Road Chorley PR7 1NW 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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