Inspection on 12/01/06 for Elmhurst

This inspection was carried out on 12th January 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

Elmhurst 19/07/07

Elmhurst 29/09/06

Elmhurst 11/07/05

Elmhurst 16/11/04

Elmhurst 29/06/04

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 Elmhurst 7 Queens Road Enfield Middlesex EN1 1NE Lead Inspector Mr David Hastings Unannounced Inspection 12th January 2006 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 Elmhurst DS0000010671.V269915.R01.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 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. Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Elmhurst Address 7 Queens Road Enfield Middlesex EN1 1NE 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 8366 3346 020 8366 3346 Mr Teen Fook Chon Mrs Julie Sooi Yuin Chon Mrs Janet Murphy Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11th July 2005 Brief Description of the Service: Elmhurst is a home for 14 older people. It is owned by Mr & Mrs Teen Fook Chon and is located a short distance from Enfield Town. The home provides a service to older people with a wide range of needs. Some of the older people are very mentally alert and able to maintain their own self-help skills. Some of the other older people have high care needs and require staff support in all aspects of their care. The house is on two levels and there is a lift. There are two shared bedrooms and the others are single. All the rooms have en-suite facilities and there is also one assisted bathroom on the ground floor. There is a large lounge/ dining room at the rear of the house overlooking the garden. This room is comfortable and bright with chairs around the edge of the room in a traditional manner. The stated aims of the service are to provide a secure home in which the service user can express their individuality, to seek the maximum development of each service user within their potential and to promote a feeling of self worth for each service user. Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place on Thursday 12th January 2006 and lasted three hours. The manager was not on duty and the inspector was assisted throughout the inspection by the senior carer. A partial tour of the premises took place and case files were examined. Seven residents and three staff were spoken to independently. All staff working at the home were open and helpful throughout the inspection. What the service does well: What has improved since the last inspection? What they could do better: It is a matter of concern that eight requirements have not been complied with. Many of these requirements have been restated from previous inspections. The registered provider must address this issue as continued failure to comply with these requirements could lead to enforcement action being taken by the CSCI. These restated requirements relate to additional conditions of registration, residents’ likes and dislikes in relation to activities, medication, kitchen Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 6 hygiene, repairs to flooring in the bathroom, monthly monitoring visits by the provider and supervision of the manager. Seven new requirements have been issued as a result of this inspection. This includes one immediate requirement, issued on the day of the inspection that staffing levels are not to be reduced at the home without the agreement from the CSCI. Staff need to record what activities take place at the home, the fly screen in the kitchen must be replaced and a foot pedal bin needs to be purchased. The quality of food provided by the home must improve. The ventilation unit in the bathroom needs repairing. The CSCI needs to receive written confirmation that the requirements from a recent fire officer’s visit have all been complied with. 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. Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 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 Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 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): 3 and 4 Service users have their needs assessed by trained professionals before they move into the home. This ensures that the service user knows the home will be able to meet their needs before they decide to move in. EVIDENCE: Two case files were examined of two service users who have been recently admitted to the home. There was evidence that detailed assessments had been carried out for these two service users before they had moved into the home. The care plans provided evidence that the home was able to meet all the assessed needs of these service users. Service users that the inspector spoke with said that the staff at the home were able to meet their needs. All service users were positive regarding the manager and staff at the home. A requirement issued at the last inspection that the manager apply for a minor variation to allow those service users with dementia to remain at the home has not been complied with and is restated. Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 9 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, 8, 9 and 10 Service users’ health and personal care needs are set out in an individual plan of care and staff work hard to meet these needs while respecting service users’ privacy and dignity. Service users get the medication they have been prescribed at the right times and by properly trained staff. EVIDENCE: Six care plans were examined. There was evidence that plans were being reviewed monthly by staff and yearly by social workers. All plans seen had satisfactory risk assessments in place and detailed how the assessed needs of service users were to be met. A requirement was issued at the last inspection that service users’ likes and dislikes in relation to food and activities must be recorded. The inspector saw that service users’ likes and dislikes with regard to food had been recorded and the cook was aware of service users’ preferences. However the likes and dislikes in relation to activities was not always being recorded. The requirement has been amended and restated. Plans recorded good access to health care professionals such as doctors, dentists and chiropodists. There was evidence that service users were being weighed on a regular basis. All plans examined contained a pressure sore assessment with Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 10 detailed action described regarding how the risk of developing pressure sores had been reduced. Records in relation to the receipt, administration and disposal of medication were examined. A requirement was issued at the last inspection that medication that needs to be stored in a fridge is stored separately and not in the fridge in the kitchen. The provider has rented a fridge but this does not have a lock on it. The requirement has been restated. Not all medication being received by the home was being recorded. This was a requirement from the last inspection and is restated. Photos of service users with their name recorded were seen on all medication files. This was a requirement from the last inspection that has been complied with. The records in connection with the administration and disposal of medicines were satisfactory. During the course of the inspection staff were observed supporting service users in a respectful manner. Service users confirmed that staff treated them with respect and in a manner that maintained their privacy and dignity. Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 11 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, 14 and 15 The home provides a range of activities for service users including the opportunity to go out to local shops and other outside activities. Staff ensure that service users’ independence is encouraged as much as possible. The registered provider must ensure that good quality food is provided for service users at the home. EVIDENCE: Service users that the inspector spoke with said they were satisfied with range of activities available and had opportunities to go out of the home to the local shops. Staff were seen sitting and chatting with service users and the service users were clearly enjoying the company of the staff. Staff were not always recording the activities undertaken at the home. A requirement relating to this has been made in the relevant section of this report. Service users informed the inspector that call bells were located near their beds at night and staff responded to any calls in a timely manner. This was a requirement from the previous inspection that has been complied with. Service users informed the inspector that they were able to exercise choice and control over their lives at the home and it was clear that staff encouraged service users to do this. The kitchen was inspected and the cook interviewed. The cook told the inspector that she was unhappy with the quality of food purchased by the registered providers and that she did not always receive the Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 12 food requested and so had to make do with what was in the kitchen at the time. On the day of the inspection the menu indicated that lunch should be gammon but no gammon had been obtained and the cook had to make corn beef hash. She told the inspector that this was frustrating and she was sometimes embarrassed by the meals she had to prepare at the home. This is very disappointing as service users have usually been very positive regarding the meals provided. It was clear that the cook was trying her best in very difficult circumstances. A requirement has been made that the registered provider must ensure that the system of food ordering is reviewed so that good quality supplies are obtained and that these match the menus for the home. A requirement was issued at the last inspection relating to the storage of out of date food items. This has been addressed and complied with by the cook. The kitchen was clean however the fly screen needs repairing. The kitchen also needs a foot pedal bin in order to minimise the risk of food contamination. Two requirements relating to these matters have been issued in this report. The kitchen has the appropriate coloured chopping boards. This was a requirement from the last inspection that has been complied with. A requirement that all knives are appropriately stored has not been complied with and is restated. The cook writes the menu for the day on a board in the lounge so the service users know what is for lunch and supper. This was a requirement from the last inspection that has been complied with. Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 13 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 Complaints are taken seriously and investigated effectively. EVIDENCE: The record of complaints was examined. One complaint had been recorded since the last inspection. It was clear that this complaint had been dealt with according to the home’s policy and that an investigation had been carried out. The record of the response to the complainant from the registered provider was detailed and appropriate. Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 14 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 and 26 Service users live in a comfortable, clean, homely and well-maintained environment. EVIDENCE: The premises were inspected. It was noted that the bathroom on the ground floor smelled damp. This may be due to the flooring, which was worn and damaged, allowing water to soak into the floor. A requirement was issued at the last inspection that the flooring must be repaired or replaced. This has not been complied with and is restated. It was also noted that the ventilation unit in this bathroom was very noisy and an additional requirement has been issued that this ventilation unit must be repaired. In general the home was well maintained and decorated to a good standard. The home was clean and tidy and free from offensive odours. The laundry is appropriately equipped. Antibacterial soap was available in all the shared bathrooms and there were adequate supplies of disposables such as wipes, gloves and aprons. Staff have attended infection control training. Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 15 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 and 29 The staff at the home work hard to meet the needs of service users however the registered provider must not reduce staffing levels without authorisation from the CSCI. The home has satisfactory systems in place with relation to staff recruitment practices. EVIDENCE: On the day of the inspection there were nine service users in residence and five vacancies. As a result of the vacancies the registered provider had reduced the staffing levels at the home. On the day of the inspection there were two care staff on duty. The agreed staffing levels are one manager and two care staff or, if the manager is off, three care staff. On top of this no domestic staff are provided and care staff are expected to undertake cleaning duties as well as care for service users. This staff reduction has not been agreed with the CSCI and the registered provider is in breach of the Care Homes regulations 2001. An immediate requirement was issued on the day of the inspection that staffing levels are not reduced without first obtaining written confirmation from the CSCI that any reduction has been agreed. The inspector was very impressed by the commitment of the two care staff on duty and it was clear they were trying their best to meet the needs of service users in their care. Service users were very positive about the staff working in the home. A requirement was issued at the last inspection that all staff must sign their terms and conditions. This requirement was difficult to fully assess as the manager was not present and staff files could not be examined. The senior Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 16 carer on duty informed the inspector that the manager had addressed this matter and confirmed that she had signed the terms and conditions. The other care also confirmed that she had signed her terms and conditions. On this evidence the inspector has judged that this requirement has been complied with. Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 17 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): 33, 35, 36 and 38 The registered provider must undertake regular visits to the home in order to obtain the views of the service users living there. Service users’ finances are safeguarded by clear accounting procedures. Staff at the home are appropriately supervised. Fire safety policies and procedures have improved and both staff and service users are now better protected. EVIDENCE: A requirement was restated from previous inspections that the registered provider carry out monthly visits to the home and provides a written report to the CSCI as required by Regulation 26 of the Care Home Regulations 2001. This requirement has still not been complied with and is restated again. Further non-compliance with this requirement could lead to enforcement action being taken by the CSCI. Most of the service users at the home manage their own finances. One service user is assisted by the manager of the home. Records in relation to this were Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 18 examined and were clear and accurate. All service users have a lockable storage box in their rooms. A requirement was issued at the last inspection that the staff receive regular supervision. The staff on duty confirmed that they do receive supervision from the manager and commented that the manager was very supportive. A requirement was also issued at the last inspection that the manager must receive regular supervision from the registered provider. This requirement was difficult to assess as the manager was not on duty and is restated and will be assessed at the next inspection. The fire records were examined. Three immediate requirements were issued at the last inspection relating to fire risk assessments, fire doors being wedged open and fire alarm and emergency lighting certificates. All of these requirements have now been complied with. Fire door guards have been fitted to all appropriate doors in the home. The senior carer informed the inspector that the fire officer visited the home on 20th July 2005. A requirement has been issued in this report that the manager write to the CSCI to confirm that all the requirements from the fire officers visit have been complied with. Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 19 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 X X 3 2 X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 X 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 X 2 X X X X X X 3 STAFFING Standard No Score 27 1 28 X 29 3 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 3 2 X 2 Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 20 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 OP4 Regulation 12(1)b Requirement The registered provider must apply to the CSCI for minor variation of the conditions of registration for the one service user who has developed dementia at the home. This application must include an up to date assessment of the service user by a person qualified to do so. (Timescale of 31/11/05 not met) This requirement is restated. The registered provider must ensure that all service users likes and dislikes in relation to activities are identified and recorded in their individual plan of care. Timescale for action 01/03/06 2. OP7 12(3) 01/03/06 3. OP9 13(2) (Timescale of 31/10/05 not met) This requirement is restated. The registered provider must 01/03/06 ensure that the medication fridge has a suitable lock fitted. (Timescale of 31/09/05 not met) This requirement is restated. Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 21 4. OP9 13(2) The registered provider must ensure that all medication received by the home is properly recorded. (Timescale of 31/09/05 not met) This requirement is restated. The registered provider must ensure that all knives are properly stored in the kitchen. (Timescale of 31/08/05 not met) This requirement is restated. The registered provider must ensure that the flooring in the ground floor bathroom is either repaired or replaced. (Timescale of 31/11/05 not met) This requirement is restated. The registered provider must ensure that monthly monitoring visits are undertaken and copies of the reports sent to the CSCI (Timescale of 30/08/05 not met) This requirement is restated. The registered provider must ensure that the manager receives regular supervision and that this supervision is recorded. (Timescale of 31/08/05 not met) This requirement is restated. The registered provider must ensure that staff maintain an accurate record of activities and outings undertaken by service users at the home. The registered provider must repair the fly screen in the kitchen. The registered provider must ensure that a foot pedal bin is provided in the kitchen to minimise the risk of cross contamination. DS0000010671.V269915.R01.S.doc 01/03/06 5. OP15 16(2)(g) 01/03/06 6. OP19 23(2)b 01/03/06 7. OP33 26 01/03/06 8. OP36 18(2) 01/03/06 9. OP12 12(3) 01/03/06 10. OP15 13(4) 01/04/06 11. OP15 13(4) 01/04/06 Elmhurst Version 5.0 Page 22 12. OP15 16(2)(j) The registered provider must ensure that the system of food ordering is reviewed so that good quality supplies are obtained and that these match the menus for the home. The registered provider must ensure that staffing levels at the home are not reduced without first obtaining written confirmation from the CSCI that any reduction has been agreed. (Immediate requirement issued) 01/04/06 13. OP27 18 12/01/06 14. OP19 23(2) The registered provider must ensure that the ventilation unit in the ground floor bathroom is repaired. The registered provider must send written confirmation to the CSCI that all requirements of the fire officer’s visit to the home on 20th July 2005 have all been complied with. 01/04/06 15. OP38 23(4) 01/04/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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 Elmhurst DS0000010671.V269915.R01.S.doc Version 5.0 Page 24 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!