Inspection on 03/04/06 for Elmglade

This inspection was carried out on 3rd April 2006.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Elmglade 19/06/07

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 Deborah Yapicioz Unannounced Inspection 3rd April 2006 10:30 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.V287694.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V287694.R01.S.doc Version 5.1 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 20 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (10) of places Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 15th November 2005 Brief Description of the Service: Elmglade is owned and managed by both Mr and Mrs Atapattu. The home is now registered with the Commission to provide personal care and support for up to ten older people, not falling within any other category, and ten older people with associated dementia/cognitive impairments. The home itself is a large detached property (formally two houses joined together) situated in a residential area of North Cheam. Built over two floors it comprises of sixteen single and two double bedrooms. There are two separate dinning areas/open plan lounges on the ground floor and sufficient numbers of bathroom and toilet facilities are conveniently located throughout the home. The kitchen and laundry facilities are well equipped and clean. The home also has a well-maintained garden with a fishpond. There is ample space for parking vehicles in the front drive. ` Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place on the morning of 3RD April 2006. The home was inspected under the National Minimum Standards Care Homes for Older People. Methods of inspection included meeting with the service users, a tour of the premises, and observation of contact between staff and service users and meeting the home manager. Records examined included service user plans, staff files, medication records and fire records. The inspector would like to thank the service users, the manager and the staff team for their help in facilitating the inspection The home currently has sixteen single rooms and two doubles. The homeowner is in the process of adding three ground floor bedrooms in a ground floor extension. The homes foundations have recently been “underpinned” following a period of monitoring by the insurance company. The home manager is reminded that risk assessments must be completed to reflect the building worked taking place in the back garden. What the service does well: What has improved since the last inspection? Since the last inspection there has been an improvement in the quality of recording on the service users care plans. The files sampled contained more consistent and informative recording. The medication cabinet has been moved to the general office area. The home manager explained that this was done so that the staff team would have fewer distractions when giving out the medications. The staff team at the home all have signed contracts on their files and signed copies of the working time directives were also seen on the files reviewed. Also the staff team now all have criminal records checks, which are kept, on staff files. Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 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. Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 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.V287694.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,6 The home provides information and introduction opportunities for prospective service users and their families to make a choice about moving to the home. A needs assessment must be completed for every service users prior to admission to ensure service users care needs can be met by the home. EVIDENCE: The home has a statement of purpose and a separate service user guide in place. Both documents were viewed during the inspection and contained all the information required under the Care Standards Act. Service users spoken to during the inspection said that they had been given copies of the service users guide. Any prospective service user and their family is invited to visit the home prior to moving in and service users have a trail period of residency when they first move to the home. The home manager stated that a needs assessment is requested from the referring care manager to ensure that the home is suitable and the service users needs can be met. The home also completes an in house assessment and would visit service users prior to offering a placement at the home.The home manager stated that any cultural issues are identified at the point of the initial Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 9 assessments. However during the inspection it was noted that a needs assessment was not available for the homes most recent admission. The home manager must ensure that a comprehensive needs assessment is received from the service users care manager prior to them moving into the home so that the staff team at the home can be clear as to weather they can meet the needs of any new service user. This home does not offer intermediate care therefore standard six does not apply. Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10 The service users have individual care plans, which are regularly updated to ensure the service users changing needs are met. Medication records at the home are not filled in correctly which could potentially place service users at risk. EVIDENCE: The home manager stated that issues of respect and how to treat service users with dignity is incorporated into the induction training of new staff. During the inspection staff were observed to be treating service users in a pleasant, friendly manner. Service users spoken to during the inspection felt that the staff team are nice to them and treated them well. The home has a policy on the receipt, recording, storage, handling, administration and disposal of medication. It is the homes policy that all medicines administered are recorded on Medicine Administration Record Sheets. On the day of the inspection the medication records were incomplete. This was a requirement of the previous inspection and will be monitored at the next inspection. Since the last inspection the medication cabinet has been moved to the general office area. The home manager explained that there were fewer distractions when giving out the medications and the room was cooler. Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 11 The home has care plans in place that carries on from the original care plan and assessment. The care plans are known as “Assessment for Care Planning” and daily entries are made on a “Kardex” system. Cultural needs and requirements are recorded on the assessments and on the individual persons Kardex. The staff team at the make regular entries to record daily activities and any areas of concern. Since the last inspection there has been an improvement in the quality of recording on the service users care plans. The files sampled contained more consistent and informative recording. The service users are all registered with a local General Practitioner and the home manager informed the inspector that service users have the opportunity to see other medical professionals including district nurses. Any visits from medical professionals are recorded on service users files. Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 12 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 The service users at the home are offered a limited activities that satisfy their social, cultural, religious and recreational interests and needs although the home needs to further the develop the way in which service users are enabled to exercise choice and control over their lives. The home has an open visitors policy to ensure family links are maintained. EVIDENCE: The home has a limited activities programme on offer. The home manager stated that they are usually held in the afternoons and include Bingo, remenisance sessions, chair exercises and listening to music. The library visits the home and large print books are supplied. The home manager informed the inspector that representatives from local churches are encouraged to call at the home. At the last service users meeting it was requested that an outing is planned and their suggestions were put forward for activities/celebrations. The home uses service users meetings as a way of enabling service users to make choices and involve them in the decision making process. However the meetings are not taking place as often as they should and only two meetings have taken place over the previous twelve months. This is not enough to reflect the service users wishes. The meetings need to increase in frequency and the notes should show the action taken by the staff team to address the issues raised at the previous meeting. There is an open visitors policy and families are welcome to visit at any time, although the service users can choose who they wish to see. The visitor’s Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 13 policy is included in the service user guide. Visitors can be seen in any part of the home including bedrooms. Service users spoken to during the inspection said their relatives could visit at a convenient time for them for example when they had finished work. Personal items including furniture can be brought into the home if service users wish (and if it is appropriate). A record of any furniture brought into the home is recorded on the service users file. Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 14 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 There is complaints policy and procedure, which facilitates access to the complaints system for the residents, their family or their representatives. The home has the appropriate adult protection policies in place although the staff team must all receive training on these issues to ensure the protection of vulnerable service users. EVIDENCE: Elmglade has a complaints procedure, which outlines how a complaint is dealt with and timescales for action. The complaints procedure is included in the service uses guide. The home keeps a record of any comments or complaints made about the service. The home has a vulnerable adults policy and the home manager stated that any concerns would be referred in line with the Vulnerable Adults Procedure. However the records held at the home demonstrated that not all staff at the home has received training in this area. This was discussed with the home manager who will arrange training as soon as possible. It was also suggested that the homes deputy manager should attend the local authority training course on vulnerable adults for managers. Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Generally the home provides a safe environment for service users to live in. The general décor of the home is satisfactory providing a comfortable environment for service users to live in. EVIDENCE: The home was originally two semi-detached houses that have been joined together. Accommodation is provided over two floors and there is no lift. Access to the second floor for service users unable to use the stairs is via a stair lift fitted to the staircase nearest the kitchen. The home has two large lounge/dinning areas on the ground floor, which are suitable for the range of interests and activities preferred by service users. Communal areas appeared comfortable, and furnished appropriately to a satisfactory standard with adequate facilities for service users and their visitors to meet in private. The homes foundations have recently been “underpinned” following a period of monitoring by the insurance company. The home currently has sixteen single rooms and two doubles. The homeowner is in the process of adding three ground floor bedrooms in a ground floor extension. The home manager is reminded that risk assessments must be Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 16 completed to reflect the building worked taking place in the back garden. Copies of the risk assessments should be sent to the Commission for Social Care Inspection, Croydon office. Since the last inspection the home manager has developed a “locked door “ policy. The home manager stated that the policy would be reviewed on a regular basis. The home has a separate laundry section to the rear of the property and there are cleaning schedules in place. On the morning of the unannounced inspection the home was warm and clean. Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The staff team have now all had Criminal Records Checks, as a safeguard to offer protection to the home’s service users. However other pre employment checks are not always in place and this may put residents at risk from employees who are unsuitable to work with vulnerable adults. EVIDENCE: Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 18 There were twenty service users in residence on the day of the inspection. The home manager confirmed that there is always a minimum of three care staff on duty during the day at the home. The home also employs a handyman, cook and cleaners. The staff team at the home have now all got signed contracts on their files and signed copies of the working time directives were also seen on the files viewed. A check of the staff records held at the home demonstrated that criminal records checks are now in place for the whole staff team. However the home manager has not always taken up two references for the staff team at the home. The home manager must ensure that pre employment checks also include requesting at least two references and copies of the references should be kept on file. Staff files at the home are still not kept in good order, which made it difficult to ascertain the training courses attended by the staff team. This was discussed with the home manager at the time of the inspection and he has agreed to compile a training needs assessment which will enable the management team at the home to keep a track on the courses that have been attended and when a staff member may need a “refresher” The staff members spoken to during the inspection made positive comments on their experience of working at the home. The service users spoken to during the inspection said that the staff team treated them well. Observations of the contact between the staff team and service users confirmed this. Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 38 Although the management style of the home appears open with clear lines of accountability. Record keeping and admininistation at the home is poor thus making it difficult to ascertain that service users needs are being met. Staff supervisions are spasmodic and appear to be on an “Adhoc basis”, which could have an adverse effect on the service users care. EVIDENCE: Elmgalde is owned and managed by Mr Atapattu who is a psychiatric nurse. Staff members spoken to during the inspection were clear about the line of management in the home and were to go if they needed help or direction. However at previous inspections it was noted that staff supervisions are not being carried out as often as required. This has still not been complied with despite a generous time frame for completion. Annual appraisals have not been completed. The recorded supervision sessions should cover all aspects of practice; philosophy of care in the home, and career development needs of the staff. It was suggested at the previous inspection that it would be easier to keep the level of supervisions up to date if other senior staff were trained to Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 20 carry out supervisions. This was discussed with the manager who has agreed to arrange training for senior staff. Administration is not of a good standard, as service users information is not held on one file and several files had to be looked at to ascertain the necessary evidence. Staff files are also difficult to read, as they are not put into an organised format. Staff meetings are not held on a regular basis and only two have taken place in the last twelve months. The home has a health and safety policy in place. The staff team receive training on health and safety issues. Fire drills are completed in accordance with the standards and the home manager has completed a fire risk assessment. Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 21 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 2 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X 2 X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 2 3 X X 1 2 3 Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 22 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 OP24 Regulation 13. (4)(c) Requirement Timescale for action 03/04/06 2. OP36 18(2) The home manager must ensure that risk assessments are completed to reflect the building worked taking place in the back garden. Copies of the risk assessments should be sent to the Commission for Social Care Inspection, Croydon office. The home manager must ensure 15/07/06 that all staff receives regular supervision. The registered person must ensure that recorded supervisions are kept in greater detail and cover all aspects of practice; philosophy of care in the home, and career development needs of the staff Staff files must contain all the information required under schedule two of the care standards act including two references. The homeowner must ensure that all prospective service users receive a care needs assessment completed by their care manager prior to moving to the home. DS0000007141.V287694.R01.S.doc 3. OP29 17(2) 2, 4. 15/07/06 4. OP3 14. (1)(a) 03/04/06 Elmglade Version 5.1 Page 23 5. OP9 17(1) 33. (I) 12. -(2) (5)(a) 13. -(6) 18. -(1) (c)(1) 12. - (5) (a)(b) The home manager must ensure all medication records are correctly filled in at all times The home owner must ensure that regular service users meetings take place The homeowner must ensure that all staff attends training on Vulnerable adults issues. The homeowner must ensure that all staff receives an annual appraisal. The home manager must ensure that monthly staff meetings take place. 03/04/06 6 7 8 9 OP14 OP18 OP18 OP31 15/07/06 15/07/06 15/07/06 15/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP32 Good Practice Recommendations Staff files at the home are not kept in good order, which made it difficult to ascertain if the correct information is on file. The home manager should ensure all staff records at the home are kept in a more orderly manner. The inspector recommends that the registered person should consider training sufficient numbers of the senior staff team carry out supervisions to ensure each member of staff receives at least six a year The inspector strongly recommends that the homeowner complete a training needs assessment for the staff team at the home. 2. OP37 3 OP30 Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 24 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elmglade DS0000007141.V287694.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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