Inspection on 19/06/07 for Elmglade

This inspection was carried out on 19th June 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 but made no statutory requirements on the home.

Other inspections for this house

Elmglade 03/04/06

Elmglade 15/11/05

Elmglade 23/05/05

Elmglade 06/07/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE Elmglade 399 London Road North Cheam Surrey SM3 8JH Lead Inspector Michael Williams Key Unannounced Inspection 18th June 2007 10:00 X10015.doc Version 1.40 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 Elmglade DS0000007141.V337788.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 Older People. 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. Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmglade Address 399 London Road North Cheam Surrey SM3 8JH 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) 020 8393 5593 020 8393 5593 nihal888@hotmail.com Mr Tissa Nihal Atapattu Mrs Nelum Vijayanthi Atapattu Mr Tissa Nihal Atapattu Care Home 23 Category(ies) of Dementia - over 65 years of age (13), Old age, registration, with number not falling within any other category (10) of places Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd April 2006 Brief Description of the Service: Elmglade is owned by Mr and Mrs Atapattu and Mr Atapattu is currently registered as manager but is handing over to Mrs Dawn Barnes who is currently acting manager pending her application to register as the manager of Elmglade. Elmglade provides care for older people including up to 13 who have dementia. The home itself is a large detached property (formally two houses adapted into single unit together). It is situated in a residential area of North Cheam. It is within reasonable walking distance of shops and transport. Built over two floors and, following the construction of a new extension, the home now has 23 beds in all. Some of the newer bedrooms have ensuite facilities. There are two separate communal areas comprising open-plan lounges and one is used as single large lounge/dining area. Sufficient numbers of bathroom and toilet facilities are conveniently located throughout the home. The home has the usual facilities including a small kitchen, and equally small laundry area, a very small office, and rather limited general storage space. Fees as at June 2007 were £419 to £490. Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in the summer of 2007 when the extension to the home was completed and registered and fully operational. To monitor all aspects of care the inspector ‘tracked’ the care provided to a sample number of residents and cross checked this information by examining the documentation supporting care, by observing the meals provided, and by cross-checking the arrangement for dealing with medication, handling money, and other records. Staff providing care were interviewed, and where possible the inspector met with relatives as well as interviewing or observing the residents themselves. Questionnaires were also distributed and feedback noted. All care homes are expected to respect the diversity of the residents and in Elmwood they do this by assessing the residents’ individual needs; by speaking to their relatives to ascertain specific needs and preferences; by providing service for those with diverse needs including sensory impairments and by employing staff from a range of backgrounds – although this does not always reflect the racial and cultural backgrounds of residents who are mostly English. There are both male and female staff to give residents choice in this matter. The premises are not well adapted to cope with residents and visitors with physical disabilities but it does have two chairlifts. Overall residents might regard this an adequate service. What the service does well: What has improved since the last inspection? What they could do better: Not all the matters needing attention at the last inspection have been fully dealt with and this includes staff recruitment records; staff training in the local authority’s procedures for protecting vulnerable adults (now referred to as ‘safeguarding adults’). Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 6 The Commission will be issuing updated Registration Certificates to all care homes and once the revised detail has been agreed with the provider he will need to revamp both his Statement of Purpose and Residents’ Guide so as to make clear the home’s criteria for admission and to ensure these two important documents contain all the required details listed in Standard 1 and Schedule 1 of the Regulations. Other problems identified include the poor grasp of English of some staff; the need to make better use of what are some good documentation such as care plan formats and in particular the reviewing process; the need to revise policies and procedures that were introduced by a consultant in September 2002 and now need updating. Some lapses in privacy and dignity were identified. Generally the home needs to be able to provide separate communal areas for each client group so the at those with dementia can be supported and cared for in some privacy in one area whilst those who retain their faculties can dine without the intrusion and interruption of more dependent residents. Staff were using towels rather than a more dignified napkin for dependent residents and some of the staff use of nickname was said with good intent and friendliness but can be somewhat undignified, for example to refer to an older woman as “good girl”. Improved hygiene is required to eliminate malodour; there is a need to replace old and worn furniture and a need for general improvement to the appearance of some bedrooms; the need to provide separate dining as well as lounge areas for the different client groups catered for in this home. The menus are somewhat limited as was the cook’s grasp of English making it impossible for the inspector to discuss changes and improvements. The menu needs to be expanded beyond the present two-week cycle and to include at least two main choices for the midday meal. Several safety matters were identified including areas that might present a hazard to confused residents were not locked such as a cupboard holding chemicals; fire door was wedged open; fire and final exit doors have morticedeadlocks that should be available without the use of a key. Some fire escape routes were partially blocked by furniture, wheelchairs and other equipment including unprotected store cupboards (that is, not fire resistant). Whilst commendable to see staff helping a resident use a chairlift with some independence the resident was not provided with safety belt before descending the stairs. The owner advises the Commission that he intends installing a passenger lift when funds become available. However, even with a lift this home is not well suited to people with more than moderate mobility problems as there are numerous stairs, steps and narrow corridors and small bedrooms. There are two stair-lifts and the home has one lifting hoist sited on the ground floor and can therefore only be used for residents living on the ground floor. 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. Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1 and 3: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. New service users are being admitted only on the basis of a full assessment undertaken by people trained to do so and this involves the service user or, in many cases, their representative, so residents know that they will be provided with sufficient information about the home and that their needs have been fully assessed and can be met in this home. The registration certificate is to modified and so the document supplied at admission will need to be updated so resident receive accurate information and the home and its services. EVIDENCE: The home provides a Statement of Purpose that is specific to the individual home, and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a Resident Guide. The guide details what the prospective individual can expect, a description of the accommodation, information about the qualifications and experience of staff, and how to make a complaint, how to access recent Commission inspection findings. However it does not contain comments and experiences of residents living at the home. All residents are given a copy of the Guide. When Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 9 requested the service can provide a copy of the Statement of Purpose and guide in a format which will meet the capacity of the resident. Both Documents, the Statement and Guide will need to be revised to make clearer the criteria for admission when the registration certificate is renewed by the Commission; this will give the home an opportunity to bring these important documents up to date and to check they contain all the items listed in Standard 1 and Schedule 1 of the regulations. Admissions are not made to the home until a full needs assessment has been undertaken, usually by a care manager and these assessments now held on residents’ case files as required by the Commission. The home has a very good care plan format that enables senior staff to assess residents who do not have care managers or nurses to undertake the pre-admission assessment. The assessment, we are advised, is conducted professionally and sensitively and involves the individual and frequently their family or representative where appropriate. Where the assessment has been undertaken through care management arrangements Elmwood is now insisting upon receiving a summary of the assessment and a copy of the care plans. Areas of strength include the home acquiring care manager assessments and providing a guide to each new resident and matters requiring improvement include a need to revise the statement of purpose and guide to reflect proposed changes to the registration certificate and to ensure each document contains all the required items. This section, about choice of home, is assessed as good. Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7 to 10: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning, the provision of health care and the procedures for dealing with medication are all satisfactory so as to ensure the social, and health care of service users can be met. EVIDENCE: Personal care needs including and health, dietary and social requirements are clearly recorded in each resident’s plan; they give a comprehensive overview of their health needs and act as an indicator of change in health requirements. Care Plans are in the form of booklets and provide formats for assessing and planning care. The home is not making vest use of the care plans, particularly the reviewing process. The home needs to ensure that it is not only reviewing plans monthly to confirm any changes, which it is doing, but the home should also ensure more substantial reviews are take place on an annual cycle at least are these are used to revise and update care plans and goals; the current phrasing “New instructions: continue care with the plan”, does not indicate a substantive review of needs and changes in a resident’s condition. The Statement of Purpose and Guide detail the care that will be provided in the home and offers a commitment to person centred planning. These documents Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 11 also refer to the skills and ability of the staff group. But they will need to be updated to make clearer the criteria for admission and to include any items not already listed such as the existing residents’ views of the home. The acting manager asserts that personal support is responsive to the varied and individual needs and preferences of the residents as outlined in each care plan. The home therefore aims deliver personal care that is individual and is flexible, consistent, reliable, and person centred. Staff are usually respectful privacy and dignity and are sensitive to changing needs but lapses were noted such as the use of towels instead of more tasteful linen napkins (which we were told are available) at meal times and the use of too informal pet names such as “good girl” neither is very dignified for an older lady however well meaning and friendly. The service listens and responds to individuals’ choices and decisions about who delivers their personal care; the home does employ male and female staff so a choice about gender can be made but as most residents are English and few of the staff are residents have little choice about being cared for by staff who share a common background. Residents are supported and helped to be independent and can take responsibility for their personal care needs when possible but many residents are very frail and need a lot of support but good examples of staff supporting independence were noted such as use of chair lift and accessing bedrooms independently. Staff listen to residents and take account of what is important to them – one good example is the acting manager’s willingness to provide two dining areas as some residents would prefer a quieter setting in which to eat than the very busy main dining room, which now caters for up to 23 people. Residents have access to healthcare and remedial services, such as the dentist who was on site at the time of our visit and confirm the service he provides to residents. The Dentist did however confirm that residents are now assessed the same as other people in the community and some will have to pay either NHS or Private fees when the service is not free at point of delivery. Staff make sure that those residents who are fit and well enough are encouraged to be independent and go out to attend local health care services (rather than have all services coming into the home). For the frailer residents the home ensures that the health care needs of residents unable to leave the home are managed by visits from local health care services including dentists, nurses, chiropody, options and so forth. Residents have the aids and equipment they need and these are well maintained to support both residents and staff in daily living. However, this home is based upon a pair of family homes and is not ideal for residents with mobility problems, for example residents who use walking frames or wheelchairs. The home has no passenger lift but does have to chair lifts. The corridors are narrow and winding and many rooms, both communal and private bedrooms, are not large enough to manoeuvre wheelchairs. The home has just one lifting hoist and it can’t be used upstairs so only easily accessible ground floor bedrooms should be used for residents with restricted mobility. Staff now have access to training in health care matters and they are now encouraged and given time to attend seminars on specialist areas of work such as dementia care as required by the Commission. Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 12 The home has a medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff who have received training. The manager advised us that she regularly checks to monitor compliance. No problems with the administration of medication were identified on this occasion. Residents are given the support they need to manage their medication. If individuals prefer o lack capacity, care staff can manage medication and this is the case for almost residents in Elmglade. Thought has been given to providing safe but sensitive facilities for keeping medication such as a lockable cabinet but not all bedrooms have this facility. The home has a good record of compliance with the receipt, administration, safekeeping, and disposal of medication including Controlled Drugs. Staff who administer medication have completed a medicine course, with a certificate in their staff folder, and the manager has confirmed that these staff are competent to handle, record and administer medication properly. Areas of strength include the detailed care planning books, the caring approach of staff in meeting residents needs, access to health care services and medication is safely managed whilst matters requiring improvement include greater attention to the privacy and dignity of residents including use of language and areas for residents to make choices about where and with whom they spend their day. The lack of a lockable cabinet in some bedrooms, the need for curtains in some of the higher bedroom windows needs attention, the use of towels as table napkins and the lapses in how residents are addressed are noted and need attention. Other shortcomings in the environment including aids and adaptations are dealt with under the environment section. This section, about health and social care, is assessed overall as good. Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12 to 15: Quality in this outcome area is Good. This judgement has been made using available evidence including a visit to this service. The daily routines in this home are reasonably flexible, within the constraints of a large service. Residents are being supported and encouraged to maintain links with family, friends and to exercise choice and control over their lives in so far as they wish and are able to do so. Residents are receiving a reasonably wholesome, appealing and well balanced diet in a fairly congenial setting in accordance with their recorded requirements and preferences but improvements are indicated. EVIDENCE: Residents are involved in some meaningful daytime activities according to their interests and capability and, in so far as it is possible, the residents and their families have been involved in the planning the way they will spend their time in Elmglade. The acting manager states that she is committed to the principles of inclusion and is promoting good relationships with neighbours and other members of the community. To this end the home is planning a garden fete later in the summer so as to involve residents, visitors and close neighbours. The acting manager has also widened the range of social and recreational activities offered to residents and has learned from experience that brief local trips to local places of interest are more manageable and popular then large scale trips over greater distances such as coach trips to the South Coast which residents, and staff, found rather exhausting. Within the home there is now a Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 14 designated member of staff whose role is to develop daily activities. On the day of inspection residents were having enjoying modelling clay; the manipulation of the clay and the feel and smell of this material was clearly stimulating for residents and is an imaginative approach to daily activities. There is now a revised weekly programme for residents compiled from a longer list of possible events and this is commended. Unfortunately the two long, narrow lounge/dining areas rather limit the way in which communal space can be used in this home so residents have limited choice about where they sit each day and with whom; we have suggested that better use is made of the layout by re-arranging dining and seating areas so residents have optimum choice. The menu is not as varied as it should be and lacks planned choices including a healthy option. The very limited menu does not include a variety of dishes that encourage individuals to try new and sometimes unfamiliar food. The existing range of meals appear balanced and nutritional and can cater for the varying cultural and dietary needs of the individuals using the service – we understand that almost all residents prefer ordinary English fare to Continental or Asian meals. Meals provided must however be reviewed, if necessary in consultation with a nutritionalist - as well as residents and families. The home was also advised that the Food Standards Agency provides detailed information in their report “Food served to older people in residential care”. We require that the range of meals is increased, that the cycle of menus is increased from two weekly cycle to at least four-weekly and is periodically changed to suite the changing seasons. For a home catering for 23 residents we also require that for the main midday meal a second choice be offered – in addition to any snacks prepared as ‘alternatives’. We note that the cook has a rather poor grasp of English, a point conceded by the cook himself and the acting manager; if there is to be effective communication between cook and manager then his communication skills must be improved to avoid the risk of misunderstandings that might lead to a poorer service for residents. We note and commend however the acting manager’s use of the ‘Better Food, Better Business’ kitchen guidance and records. We noted that some crockery was cracked, this is both undignified and unhygienic. Whilst many residents were unable to give an opinion about the quality of food several residents commended the cooking in Elmglade and we observed that care staff were sensitive to the needs of those residents who find it difficult to eat and generally gave assistance with feeding in a kindly and dignified way – we did however see some lapses in this, two residents were given hand-towels instead of linen napkins and one resident was referred to as a “good girl” when the towel was being adjusted – neither point was very dignified no matter how well meaning. Staff were however aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. Areas of strength include the increased range of activities and opportunities to go out and the involvement of friends and visitors in events such as a summer fete; resident meetings are now being held and along with meetings for family and friends this commended. Matters requiring improvement are the layout of dining areas, menus and staff conduct at meals. This section, about daily life, is assessed as adequate. Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16, 18: Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. The home has a clear and simple procedure for dealing with complaints so service users’ are confident their concerns will be dealt with promptly and effectively but it does need updating. To ensure vulnerable service users are safeguarded from abuse the home has written policies and procedures about the protection of residents but this also needs to be updated to include procedures for passing on concerns to the relevant authorities. EVIDENCE: The service has a complaints procedure but it does not meet the National Minimum Standards and Regulations. The procedure is not up to date and it is not as widely available as it might for example on display in the entrance hall and similar locations throughout the home. It is not yet available in any alternative formats such as large print or alternate languages. From this it will be evident that some residents and visitors say they know how to make a complaint but others do not. Staff are aware of the complaints procedure. However the complaint procedure needs to be brought up to date and to more accurately reflect the avenues open to residents or their representatives; for example, they might use the internal complaints process, or refer to their Local Authority Care Manager or inform the Commission that a complaint is not being addressed effectively and in a timely manner if that were the case. Complaints from individuals do appear to be fully recorded and those we examined appeared to have been dealt with in a timely, outcomes and actions not being properly logged. It is not always the case however that complaints can be fully resolved to everyone’s satisfaction and this appears to have been the case in one of the very few complaints dealt with by the home. Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 16 Policies and procedures for safeguarding residents are in place but the home’ procedures do not reflect the Local Authority’s procedures for “Safeguarding Vulnerable Adults”. For example the home’s procedures refer to investigation allegations of abuse but make no reference to informing the local authority before doing so, so as to ensure an effective and coordinated approach is taken to the investigation. Staff are not be familiar with the guidance nor did the have access to the latest guidance on dealing with allegations of abuse. Staff did however know that any concerns of this nature should be reported either to the manager, owner or to a relevant outside body such as the Social Service or Commission. So in practice staff know what to do – but the procedures need to be brought up to date. Staff are being booked onto relevant training courses as required by the Commission but not all staff have undergone this training as it relies upon training opportunities being available. Despite some shortcomings residents able to express an opinion say that they are satisfied with the care in the home and feel safe and several visitors agreed that they feel their mother/father is being cared for in a safe and comfortable manner. Areas of strength are the willingness of the acting manger to listen to concerns and deal with them in a very positive manner, staff are also aware of the need to deal with complaints and allegations of abuse in a timely and effective way and some information is available but it is limited and out of date. Some but not all staff have been trained in the procedures for dealing with allegations of abuse and the home needs to acquire the latest copy of the local authority’s procedures and give each member of staff of summary. So this section, about complaints and protection is assessed as adequate. Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22 and 26: Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The layout of the home and the manner in which it is being maintained means that this is a reasonably safe, comfortable and suitable environment for the service users. There were however a number of matters requiring attention and they are outlined below. The premises are being kept reasonably clean and hygienic but not entirely free from offensive odours but systems are in place to control the spread of infection. EVIDENCE: To a large extent Elmglade provides a physical environment that meets the needs of the people who live there. The home is comfortable, and has a programme to improve the decoration, fixtures and fittings but there are shortcomings in this home. It has narrow winding corridors and has no passenger lift so moving people with physical disabilities is problematic. There are two chair lifts for residents who can manager this form of aid but we note that they have no safety belt in use. The home has just one lifting hoist (to move residents from bed to chair etcetera) but that is located on the ground floor and can’t be used on the first floor. Ramps are needed to give residents easy and safe access to the garden and main entrance now that the extension Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 18 work is completed. Not all bedrooms meet modern standards although the new bedrooms do and this includes ensuite facilities in each of the newer bedrooms. Some bedrooms, old and new, have a very poor outlook – looking onto a brick wall within about five feet. Some of the older bedrooms are in need of improvement either to the general décor or to the old and worn furniture. Similarly the bathrooms need improvement for example side panels to baths are damaged and unsightly as are some toilet seats. It would appear that maintenance tends to be reactive rather than proactive although the acting manager has now appointed a member of staff to check each room periodically and to report any problems. Residents can personalise their rooms but quite a few were rather bare and without adornment so residents probably need support to personalise their rooms and staff have been directed to help in this. During our inspection we observed that the Elmglade is reasonably clean, warm, well lit and there is sufficient hot water. But there was a slight malodour in some areas – which the acting manager says she is trying to resolve by changing floor coverings. The owner states that the water system has been checked for Water regulation compliance but he has yet to deal with all the recommendations made such as covering and lagging the water tank. Toilets for the use of people using the service are appropriately located within the home, but are not all easily accessible for less mobile residents because of the layout of the home. Residents are not always able to have the option of a single room immediately on admission and may need to share – this would be agreed at the time of admission and would form part of the contractual fee. Elmwood does not have small group living for residents but the acting manager is aware of the benefits of re-arranging accommodation to better meet the needs of the two distinct client groups the home caters (those with and those who do not have dementia). In respect of fire safety the home’s policy, developed by a consultant is now five years old and out of date in that it does not take account of the revised regulations now referred to as the “Fire Safety Reform Order, 2005”. Guidance is available from the Department for Communities and Local Government in their book ‘fire safety risk assessment in residential care premises’ and should be used to develop appropriate risk assessment and to review fire safety in the home. In Elmglade we found a fire door wedged open; final exits with keys; equipment such as wheelchairs chairs and even cupboards (that is, ones that are not fire resistant) on or partially blocking fire exit routes. We have been informed and the home has arranged for staff to undertake training in the control of infection. Hygiene equipment is available but chemicals were seen to have been left in an unlocked cupboard thus posing a potential hazard to residents. There are two reporting systems for recording maintenance problems but neither is fully utilised to best advantage to ensure environmental and health and safety standards are being maintained proactively, for example lagging the water tanks. Areas of strength are the homeliness and higher standards achieved in the new extension; matters requiring improvement include the view from bedroom windows; fire safety, chemical storage; décor and furniture; malodour; accessibility - so this section, about the environment, is assessed as adequate. Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27 to 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number of staff employed and their skill mix are appropriate to the assessed needs of the current service users in this home – so this will ensure that their needs are being met. The required procedures are in place to ensure recruitment of staff protects service users. The home has a staff induction, training, support and supervision regime in place so service users can be assured that staff are competent in their jobs. The recruitment, training and support of staff will ensure service users are ‘safe in their hands’. EVIDENCE: Residents have confidence in the staff that care for them and some said so during the inspection; staff were described as kind and helpful. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the residents. Staff members undertake external qualifications including general certificates such as NVQ [National Vocational Qualification] and more specific ones such as dementia care, infection control, and protection of vulnerable adults, etcetera. The acting manager encourages and enables this and recognises the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. The acting manager is designating roles for her staff such as ‘activity leader’ and ‘health & safety monitoring’ and so forth. There are contingency plans for cover for vacancies and sickness and there is little use of any agency or temporary staff. Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 20 The service has improved recruitment procedures but the staff files need to be better organised so that in each case the manager can see clearly that the correct process has been followed. A simple checklist would help. The acting manager does however recognise the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Residents are not involved in the recruitment process and as a result we noted that several staff including care and ancillary staff do not have English as their first language so communication between staff and between staff and residents is sometimes inhibited we were told. Involving residents more in the recruitment process may help to identify those staff with good or at least adequate communication skills. The acting manager recognises this issue and has arranged for staff to attend ‘English as second language’ class. The staff we interviewed confirm that the service was clear about what was involved at all stages of recruitment and that it was robust in the following of its procedure for example in the supply of documentation such as passports to confirm legal status and identity. We checked a sample of staff records and confirmed police checks [CRB] were in place for these staff and the manager states that all staff have had this check and in addition for some staff this was preceded by a ‘POVA’ check [Protection of Vulnerable Adults list]. However, we identified that some of the older staff files were not well presented; documents such as the application form were not fully completed by applicants for example several did not include full work history as regulations now require and the references offered were not clear as to source. So a recommendation is made to improve future practice and ensure all staff files are clearly laid out and indexed. Evidence of staff annual appraisals are now in place along with two-monthly supervision notes. Staff meetings are now taking place regularly and this was confirmed by the written minutes and staff themselves. Individual staff supervision sessions or meetings are now also in place - and will need to be held at least six times each year. The home has no suitable staff room but does have a few lockers. Areas of strength include the positive and professional attitude of staff, improved training opportunities, improved staff meetings and supervision regime, and matters requiring improvement include the need to ensure staff have an adequate use of spoken and written English as well as reasonable understanding of the residents’ cultural background. The home also needs to improve staff recruitment files and this may mean improving documentation such as the application form to ensure all required information is both requested by the home and supplied in full by all applicants for jobs in the home. There is no suitable staff room. However, this section, about staffing, is assessed overall as good. Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 33, 36, 37 and 38: Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. The manager is registered with the CSCI as a person competent to run this home in accordance with its stated aims and objectives and so in the best interests of the service users. The home is well managed, including finances, and is safe for service users. EVIDENCE: The manager of the home is also an owner and he is registered with the Commission and is qualified to run the home but he now employs an acting manager who will, we are advised, apply for registration shortly. Meanwhile the owner has on office on-site to oversee the day-to-day running of the home. The position of manager is therefore not consolidated at this point. Staff recruitment, training, development and supervision has been inconsistent and poor at times but is now improving. Policies and procedures are in place, but they are dated September 202 when a consultant introduced a range of procedures; they have not all been reviewed or kept up to date, and quality Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 22 assurance monitoring is not in place other than informal consultation with residents and visitors. Staff are not always aware of the homes’ policies and procedures, which are not easily accessible and are not always complete and update to date - the procedures for protecting vulnerable adults and fire safety are two examples. Equal opportunities or an appreciation of diversity and person-centred care is thought to be important by the manager and owner and the very good care planning documentation supports this but the booklets used for recording individual resident’s wishes and aspirations are not always used to best effect - particularly when reviewing care needs. The home has a health and safety policy (but dated 2002) and there is no evidence of a high number of accidents and incidents within the home. Staff have had recent training to enable them to work safely and are aware of policies and procedures that exist but these are not readily accessible to all staff as there is no suitable staff room to lodge policies and guidance for staff. The owner advises us that the home is not in any financial difficulty but is fully extended following the works to enlarge the home. It is evident that the home is struggling to deliver an excellent service, the cramped spaces, older furniture, small offices, small laundry area and the odd layout of communal spaces (lounge/dining) and the lack of a suitable staff-room indicate that this home is stretched to its physical limit. An insurance certificate is in place and up to date. Record keeping was checked including, residents’ case files, staff files, food records, complaints, accidents, fire safety, a sample of policies, medication records, visitors signing-in book and so forth. They are being reasonably well maintained and any shortcomings have been identified in other sections of this report. Areas of strength include the owner’s intention to appoint a registered manager to take over the day to day running of the home, and so the new acting manager, who was the deputy, is now working very creatively and conscientiously to improve standards in all areas. However there are many problems requiring improvement - our findings are that residents are not fully protected in this home. The home needs to bring up to date the fire safety risk assessment in accordance with the new regulations; to risk assess other hazards such as accessibility around the home – here the home may need to restrict the admission of residents with mobility problems to ground floor bedrooms. As many residents have memory and cognitive problems the home also needs to review access to areas that may be hazardous such as bathrooms, kitchen and laundry areas. Chemicals need to be stored safely. Whilst the home cannot realistically complete old application forms it must ensure that in future the whole recruitment process is more effectively managed. None of the problems identified appear to pose an immediate risk to the safety of residents, mainly because all residents are supervised throughout the day, but these matters do require urgent attention and therefore this section, about management and administration, is assessed as only adequate. Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X 2 X X X 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X 2 3 2 Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? Yes 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 OP10 Regulation 12(4)a Requirement Privacy and Dignity: In order to respect the privacy and dignity of residents at all times staff must use suitable table napkins and appropriate language at meal times. Kitchen equipment: crockery and other broken kitchen equipment must be replaced without delay so as to ensure good standards of catering for the safety and well being of residents. Staff training: The homeowner must ensure that all staff attend training on safeguarding vulnerable adults issues so as to ensure that residents are protected by staff trained to deal with allegations of abuse. This requirement remains outstanding from 31/12/06 but is underway. Furniture and fittings: old and worn furniture and fittings such as chairs, toilets seats and bath panels must be repaired or replaced without undue delay. Aids and Adaptations; the home must make clear in its statement of purpose and Guide that there DS0000007141.V337788.R01.S.doc Timescale for action 30/07/07 2 OP15 23(2)c 30/07/07 3 OP18 13(6) 30/08/07 4 OP19 16(2)c 30/09/07 5 OP22 23(2)n 30/07/07 Elmglade Version 5.2 Page 25 6 OP26 16(2)k 7 OP38 23(4)(4A) 8 OP38 23(4)(4A) 9 OP38 13(4)a 10 OP26 13(4)a are limitations in respect of the layout of this home and the lack of a passenger lift that make the home unsuitable for residents with mobility problems for example if they use a wheelchair. Hygiene; The home must ensure it has suitable cleaning programmes in place to keep the home free from malodour. This is to ensure the comfort of residents and visitors. Fire Safety: the fire safety risk assessment must be brought up to date with the revised Fire Reform Order 2005. Fire safety: The entire home must be re-assessed to identify fire hazards such as fire exits with keys, blocked fire escapes, and such hazards dealt with appropriately. Chemical storage: All hazardous chemicals must be held safely under the direct supervision of a member of staff or locked in a suitable cabinet. This is to ensure the safety of residents. Water Regulations: The owner/manager must comply with any requirements of the Water Authority including the covering and lagging of water tanks so as to reduce the risk to residents of Legionellosis. 30/07/07 30/07/07 30/07/07 30/07/07 30/07/07 Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 26 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 OP1 Good Practice Recommendations Statement of purpose and residents’ guide: It is recommended that once the owners have agreed modifications to the registration certificate that these document be updated, in particular that they make clearer the criteria for admission and to confirm that all the matters listed in Standard 1 and Schedule 1 are up to date. This will ensure residents have accurate information when they are admitted to the home. Registration of manager: It is recommended that if the owner/manager is to relinquish day to day management of the home that he applies for the registration of a replacement without undue delay. Care Plan reviews: it is recommended that the current minimal reviews are extended periodically to update each resident’s assessment and care needs and not merely restate out of date information. This will ensure residents’ needs are recorded up to date and reflect their changing needs. Notice boards: The staff team at the home should use the white-boards in the home’s lounge areas to inform service users of the day, date, activities, staff on duty and the day’s menu. This will assist residents with poor recall to have useful information before them each day and thus assist their orientation. Staff files: It is strongly recommended that all staff are collated and indexed so that recruitment in future will follow good practice. Each file will need to contain all the information listed under Schedule 2 of the care Home Regulations. It is further recommended that any gaps in existing staff files are noted by the manager and explained for future reference. This will ensure residents are safeguarded by correct recruitment processes. 2 OP31 3 OP7 4 OP12 5 OP29 Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Elmglade DS0000007141.V337788.R01.S.doc Version 5.2 Page 28 - 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. 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