Inspection on 14/04/08 for Elmhurst

This inspection was carried out on 14th April 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elmhurst 04/04/07

Elmhurst 06/02/07

Elmhurst 21/02/06

Elmhurst 19/07/05

Elmhurst 15/03/05

Elmhurst 25/05/04

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

CARE HOMES FOR OLDER PEOPLE Elmhurst Windhill Bishops Stortford Hertfordshire CM23 2NF Lead Inspector Jane Greaves Unannounced Inspection 14th April 2008 09:00 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 DS0000019335.V362382.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. DS0000019335.V362382.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmhurst Address Windhill Bishops Stortford Hertfordshire CM23 2NF 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) 01279 713100 01279 713161 www.quantumcare.co.uk Quantum Care Limited Susan Mary Kent Care Home 61 Category(ies) of Dementia (1), Dementia - over 65 years of age registration, with number (61), Learning disability over 65 years of age of places (61), Old age, not falling within any other category (61) DS0000019335.V362382.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th April 2007 Brief Description of the Service: Operated by Quantum Care Limited, a not for profit organisation, Elmhurst is a care home providing accommodation and personal care for up to 61 elderly people. The home, purpose-built in the late 1990s, is divided into four separate units (one specialising in dementia care) and offers all single bedrooms with en-suite facilities and spacious communal areas in each unit. Elmhurst is situated within walking distance of Bishops Stortford town centre with its mainline railway station and a wide range of shops and other amenities. There is car parking space in front of the building, but as this is shared with a day centre next to the home it can often be full. Elmhurst’s weekly charges range from £420 to £675 per week. (Correct at April 2008) Additional charges apply for personal toiletries, newspapers, hairdressing, chiropody and private dentistry. Quantum Care have a comprehensive Personal Guide which provides very clear information about fees and services and includes contact details for the Commission for Social Care Inspection (CSCI). Copies of the latest inspection report are also made available. DS0000019335.V362382.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This unannounced site visit took place over 6 ¼ hours on 14th April 2008 and a second visit of 1 hour on 16th April 2008. We looked at how the home meets the needs of the people living at Elmhurst. A partial tour of the premises was undertaken and a selection of care records, staff records, medication records and other documentation were assessed. We spoke to some people living at the home, some staff members, some visitors to the home and the management team during the course of the visit and some family members subsequent to the site visit. Prior to the site visit the home had completed their Annual Quality Assurance Assessment (AQAA) and forwarded it to the commission. This provided us with information about how the service feels they are performing against the National Minimum Standards, and how they provide positive outcomes for the people living there. Prior to this visit surveys were sent to the home for residents, relatives and staff members to express their views about the service provided at Elmhurst. Comments from these surveys have been included within this report. What the service does well: People are encouraged to maintain contact with their family and friends and visitors are always made welcome. Relatives felt that staff communicated with them well and kept them up to date with any issues concerning their relative. The service has a good range of information available to help prospective residents make an informed choice about where to live. People surveyed had positive things to say about the care workers at Elmhurst. Comments included “The home staff are excellent”, “Ive always liked the staff from day 1”, “Good basic care and good contact with the permanent long term staff” and “The love and care to all the guests to my way of seeing and thinking under some circumstances to second to none”. Staff were knowledgeable about the needs of the residents and some have got good life and personal histories recorded to help in their care. DS0000019335.V362382.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: The care plans contained some good information about peoples’ health and social history however there is not enough detail around peoples’ care and support needs for care workers to provide personalised care. Care workers need to become comfortable using the care plans as working documents on a day-to-day basis and accurately record how people spend their days. Residents and relatives tell us that they have a big concern about clothing going missing from the laundry and that sometimes residents are not dressed in their own clothes. This does not serve to protect the dignity of the people living at the home. There is an issue regarding the quality of food that has been raised on several occasions by residents and their families that the management of the home still have not resolved. Complaints are generally managed well by the service however when residents, relatives, staff, professionals or any other stakeholders raise verbal complaints or concerns about any aspect of life at Elmhurst these should also be looked at in line with the home’s complaints policies and procedures. This will ensure that each person’s voice is heard and also identify any trends or patterns that may appear. The service provides care workers with training and refresher training in areas including medication administration, safeguarding vulnerable adults and moving and handling to promote the safety and welfare of the people living at the home. Some staff members have not received training or training updates in these areas, this means that they may not have the skills necessary to keep DS0000019335.V362382.R01.S.doc Version 5.2 Page 7 the people using the service safe. The service has not achieved the recommended ratio of care workers trained to a minimum of NVQ level 2. Residents said they sometimes have to wait for assistance in the early morning, as there are just four staff members on duty overnight. Peoples’ needs vary throughout the night and early morning and they need to be confident that there are enough staff on duty to be able to provide the help needed. Record keeping at the home does not always demonstrate the efficient running of the service. Recruitment records, staff training and development records, supervision records and care plan recording need to have a more consistent approach so that the people living at the home can be assured the home is run with their health, safety and well being at its’ core. 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. DS0000019335.V362382.R01.S.doc Version 5.2 Page 8 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 DS0000019335.V362382.R01.S.doc Version 5.2 Page 9 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): 3. Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. People were given the information needed to make a choice about where to live and could be confident that the service could meet their needs EVIDENCE: The Quantum Care “Personal Guide” provided all the required information to enable people considering making Elmhurst their permanent home to make an informed decision. Quantum Care also has a web site that provides information about the services and facilities provided. We spoke to two people who had recently moved into Elmhurst. They said they were happy with the arrangements that had been made for them and that the other residents and staff had made them feel welcome. Together with their family they had been involved in putting together a plan of care that said how they wished to be looked after and how staff were going to meet their daily needs. DS0000019335.V362382.R01.S.doc Version 5.2 Page 10 The service undertook a thorough assessment of needs for each person considering making Elmhurst their home. This means any prospective residents and their families could be assured that the service understood their needs and would be able to meet them. Elmhurst does not provide intermediate care. DS0000019335.V362382.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Elmhurst receive appropriate care, although this may not always be documented appropriately and could possibly place people at risk. EVIDENCE: The organisation is currently reviewing care plans and risk assessments to provide a more user friendly format for care staff to follow and to use as working documents ensuring that the people living at the home receive care that is individual and personal to them with minimal risk. The registered manager agreed further work was necessary and said “ they seem to have got very messy, they need to have information that is more user friendly. The aim of the new care plans is to upgrade standard of recording”. The plans contained good information about peoples’ personal history and medical conditions, but daily records included little information about how individuals chose to spend their day and what they felt about life unless something out of the ordinary had happened. “Ate and drank well” was the DS0000019335.V362382.R01.S.doc Version 5.2 Page 12 only entry for one shift, the quality of recording varied from one care plan to another. Minutes from the recent Elmhurst Home’s Forum showed that the organisation’s Director of Care and Development had explained to family members the importance of a care plan and encouraged families to write in it and read it regularly. It was explained to the relatives how a care plan must be present at any review or assessment of peoples’ needs and it details the changes that take place. The home manager reported to the Forum that the service is in the process of updating their care plans. A relative consulted confirmed that she had been encouraged to attend a review meeting held at the home with social worker present. People living at the home praised the staff for the care provided and said overall they felt that the care delivery protected their dignity and privacy. One healthcare professional responding via survey commented ‘Treat their residents as individuals and go out of their way to help them.’ A family member reported, “Nothing is too much for them to do” and “The love and care to all the guests to my way of seeing and thinking under some circumstances to second to none”. One person living at the home has specific moving and handling needs, all care workers have received training updates to ensure this person’s safety is promoted and protected. Care workers attend a one-hour training session with training co-ordinator; this person has not been formally trained to deliver medication training. Training is delivered by means of a slide show with a questionnaire at the end. Care workers then undergo a minimum of 4 practical assessments and once Care Team Managers are confident in the care worker’s ability to safely administer medication to the residents they sign the care worker as fit to administer medications. Minutes from Elmhurst Home Forum held on 8th April indicated that staff members do not always ensure residents had taken their medication even though they had signed to say they had administered it to the resident. Manager’s response was that staff would be retrained on medication. There has been some pharmacy led training provided for approximately 20 staff in December 2007. A discussion was held with the training co-ordinator about providing this external training for the remainder of the staff team. The staff team were observed interacting positively with people during the course of this visit and people spoken with all confirmed that care workers always knocked before entering personal rooms. One person reported that a fellow resident had entered their bedroom without knocking and this had made them feel very uncomfortable. Family members reported via surveys and through conversation with us that they sometimes found their relatives wearing clothes that did not belong to them and that this did not support individuals’ dignity. One person said, “When DS0000019335.V362382.R01.S.doc Version 5.2 Page 13 returning clean laundry please make sure it is returned to correct person. They seem to mislay various items of laundry”. DS0000019335.V362382.R01.S.doc Version 5.2 Page 14 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): 12, 13, 14 and 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home do not always feel the food and range of activities meet their expectations. EVIDENCE: One activity person employed to work at Elmhurst is currently on long-term leave meaning that the activity provision for 61 residents has reduced to 25 hours per week over four days. The registered manager reported that a 2nd person would return in approximately 2 weeks. Activities provided for people include Bingo, skittles, card making and cooking. At our second visit to this home on the 16th April some residents were observed taking part in a game of Bingo in the activities lounge. An external entertainer is brought in monthly to sing and entertain people. A tabletop sale was held a few weeks before this visit to raise money for activities in the home. A “Name the Doll” competition was also being held to raise money. The home is a squared off horseshoe shape and the courtyard had previously contained a raised bed with a tree in it forming a mini roundabout. This not only obscured vision across the courtyard but also posed an accessibility problem for those people using wheelchairs. The area has now been levelled DS0000019335.V362382.R01.S.doc Version 5.2 Page 15 and paved and the manager reported the intention to introduce some bright coloured planting in pots to make the area a pleasant place for people to sit in fine weather. One family member responded via survey “they could benefit from having some facilities for residents to be able to occupy themselves.” People living at the home did not voice any clear opinion about the facilities on offer for recreation, a number of people chose to spend their time in their own rooms reading books, newspapers and watching television, most liked to have the bedroom door left open so they could see who was moving around and what was going on in the home. Visitors were encouraged and made welcome with a cup of tea and biscuit at any time of the day. Some relatives were visiting people at the home on this day and were happy to talk with us. One person praised the home for the way they serve Sunday lunch for those residents with visitors, setting a separate table with a cloth and flowers for them. One relative responding to a survey said, “Always made very welcome on visits and unit manager very informative” Surveys returned to the commission as part of this inspection process indicated that food was an area causing concern for some residents and their families. Comments such as “Food standards have dropped drastically, I find the food on most days disgusting” and “The meals used to be excellent but are very sub standard now. The food really needs to be brought back to the previous standard”. We spoke with people at this visit and some re-iterated complaints about the quality of the food. Comments such as “The food improved briefly because everyone complained but it has become awful again” and “Food always tasteless and appears unappetising.” One person said if they don’t like the food on offer the kitchen is always happy to make them a salad. Some people spoken with were happy with the choice; quality and quantity of the food provided however did say it was sometimes cold by the time it was served to them. A Quantum Care survey had been undertaken with all people living at the home relating to food provided and just four critical comments had been received from the 30 questionnaires returned. Positive comments from this survey included “The food is lovely here, eatable and nice” People on one unit complained that they were not able to have their breakfast until all people living on that unit were up in the morning. The manager reported this is not home policy and that it is more of a care staff culture on this unit that is being changed. Kitchen staff members were consulted at this visit, they reported being comfortable with the quality of provisions they have to work with and reported that the kitchen equipment is maintained in good order. Despite visiting the kitchen during lunchtime preparations it was clean tidy and orderly with just two people to prepare hot meals for 61 residents. The manager reported, and menus and residents confirmed, that fresh vegetables were provided daily and DS0000019335.V362382.R01.S.doc Version 5.2 Page 16 some fresh fruit was seen around the home although the manager reported a delivery was due the following day. There was no record of nutritional intake within the care plans. The registered manager reported that the kitchen would have records of who had chosen what to eat however these did not seem to be linked in any way to ascertain how much people had eaten of what food and if they had enjoyed it. Menus viewed included offer of a cooked breakfast upon request, a choice from 2 main dishes or salad for lunch, and two choices of ‘high tea’ or salad with home made cake provided daily. The registered manager reported that the food budget had been increased to £18 per person per week from £16.50. The previous two inspection reports included a good practice recommendation that ‘Menus should be displayed to orientate service users and staff to meal options available’. The registered manager reported her view that this was not appropriate, as a large notice board would not contribute to making a homely atmosphere for the people living at the home. A restaurant style menu in a folder was ‘work in progress’ at this visit and in the interim staff visited each person living at the home to offer a choice of meals for the following day from the menu. It was also reported that if someone changed his/her mind on the day there was ‘generally’ enough quantity of food available to facilitate. DS0000019335.V362382.R01.S.doc Version 5.2 Page 17 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People can be confident that any concerns they raise will be listened to and dealt with appropriately, however they have not been fully protected by the staff training provision for safeguarding vulnerable adults. EVIDENCE: We spoke with 3 visitors during the visit and 3 relatives by telephone subsequent to the visit. Instances were given where issues had been raised verbally regarding laundry food etc. Records did not indicate that these had been dealt with as complaints. The manager reported that she only considered issues presented in writing as complaints and that where things were brought to her attention verbally she had the opportunity to address them immediately without the need to take a formal approach. Discussion was held around recognising what is a complaint and making provision for these to be recorded to identify trends and highlight where strategies were or were not working. Evidence was available to confirm that where complaints were presented in writing they were recorded appropriately and addressed within timescales as stated in the homes’ policies and procedures. A ‘suggestion’ box had been ordered and delivery was anticipated. The box was to be placed at reception so that people who did not wish to officially make a complaint could had a formal process to make constructive suggestions. DS0000019335.V362382.R01.S.doc Version 5.2 Page 18 Safeguarding vulnerable adults training is provided for the care staff team and is included within induction however evidence showed that some people had not attended this training and some others were overdue to receive refresher training. The training co-ordinator was aware of these gaps and was scheduling some courses to rectify this shortfall. Recruitment records confirmed that staff employed at Elmhurst had all had satisfactory Criminal Record Bureau disclosures before they started to work at the home and that two satisfactory references had been received. DS0000019335.V362382.R01.S.doc Version 5.2 Page 19 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 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home is suitable to meet peoples’ needs but is not always clean and fresh. EVIDENCE: A physical tour of the building was undertaken and all areas appeared to be generally well maintained however an odour was noted in unit 3 on the1st floor; the odour was present first thing on arrival and was still evident at 1500hrs. The rest of the building smelt fresh however there were some areas where cleaning required more attention. A hoist stored in bathroom in unit 4 was dirty, a toilet in one person’s en suite was very dirty and the resident reported that it had been so for two days. Waste bins in one person’s room had not been emptied however a care worker emptied it when the individual asked them to. Dining chairs in unit 4 had a collection of food crumbs at the edge of the cushions. The registered manager reported it was “a bad housekeeping day” as the department was short staffed on this day. However two family members spoken with reported that the standards had fallen in DS0000019335.V362382.R01.S.doc Version 5.2 Page 20 recent months. The roster for the next working day following this visit indicated that 3 housekeeping staff were to be on duty: 0800 to 1500hrs, 1200 to 2030 hrs and 0730 to 1330hrs. One family member said “It always seems to be quite clean when I visit, it looked lovely at Christmas”. A staff survey included the comment “The homes are nicely decorated creating a nice homely atmosphere. On the whole, the homes look clean and do not smell of urine”. The home is a purpose built unit however suffers from a lack of storage for hoists, cleaning carts and wheelchairs. Individuals’ wheelchairs are kept in their own rooms; hoists are stored in communal bathrooms. In two instances it was not possible to access wash hand basin in bathrooms without moving hoists first. In one bathroom on unit 4 it was noted there was no bin to discard used paper towels. The service does not routinely provide infection control training for the care workers, it is offered to staff as an ‘extra’. A discussion took place with the training co-ordinator and the registered manager about the importance of ensuring the staff receive up to date guidance to keep the people living at the home safe from the risk of infection. It was reported that the topic is covered lightly during the company induction. The laundry was well organised and maintained however people reported that items go ‘missing’ and some family members spoken with subsequent to this visit and reported via surveys that residents are sometimes dressed in clothing that was not their own. The subject of missing laundry was brought up at the Home’s Forum of 8th April; family members commented how even though laundry is clearly marked it still goes astray. The service responded that it had tried every way possible to sort out the problem with laundry and it was going to be discussed at the next housekeeping meeting. DS0000019335.V362382.R01.S.doc Version 5.2 Page 21 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): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at Elmhurst can expect to be supported by staff who have a good level of basic training but who may need refresher training to ensure their skills are maintained. People cannot be confident there are always enough Staff members on duty to meet individuals’ needs. EVIDENCE: The service was able to demonstrate that the use of agency staff had reduced as a result of a continuous recruitment drive over recent months. This had a positive impact in that people using the service received care and support from care workers familiar with their needs and preferences. The Annual Quality Assurance Assessment (AQAA) completed by the registered manager prior to this visit indicated a commitment to continue to reduce the amount of agency workers at the home. On the day of this visit eight permanent care workers and two agency staff were on duty. Relatives surveyed reported that one of the things the home could do to improve the service for the people living there was; “More care staff. Be less reliant on agency staff” and “I think it would help them if they had a few more staff, as they do work hard” and residents comments included “In my opinion more staff are needed.” Staffing levels in the home are arranged as follows: DS0000019335.V362382.R01.S.doc Version 5.2 Page 22 Day shifts = 10 care workers plus duty manager from 07:30hrs to 21:30hrs. It was reported that there are times when they are one carer short in the mornings however the duty manager then covers. Night shifts = one duty manager and three care staff from 21:30hrs to 07:30hrs. This means there are 4 care workers to attend the needs of 61 people in a home that is very spread out and arranged in a horseshoe shape over two floors. Residents spoken with reported that they often have to wait for what seems to be a long time if they need help in the morning as there is only one member of staff available to help people on each unit. This is equivalent to 1 carer to 15 residents some with higher dependency levels than others. The manager reported that if there is a specific need, for instance someone needing 1:1 care then an extra person could be rostered on duty, a discussion was held around the potential risks should an incident arise at night. The service employs 49 care staff and 10 care team managers plus catering staff, housekeeping staff, administration staff and a handyman. 18 Care workers had achieved a minimum of NVQ2, five were currently undertaking this qualification and the training co-ordinator reported an expression of interest from a further 4 people. The service has not yet achieved the position where 50 of their staff are trained to NVQ 2 or above as recommended in The National Minimum Standards. The recruitment files for three staff members employed since the previous inspection were looked at: none included a photograph of the care worker; two had a copy of the photo page from a passport providing a very blurred and indistinct image. One file did not contain any identification papers. Evidence was available to show that all staff had completed Criminal Record Bureau (CRB) disclosures. The registered manager assured us that all the relevant information will have been obtained for these employees and it was noted that a CRB could not be undertaken without the relevant identification being provided by the applicant however this standard of record keeping was not sufficient to confirm to the people living at the home that all the relevant checks are being made to ensure the right people are being recruited to promote and protect their safety and welfare. Training records seen on the day of the initial visit to this service were not complete and the training co-ordinator was not on duty. We visited the home two days later to solely assess the training records for the staff team. As already noted, the service does not routinely provide infection control training for the staff team, it is offered to staff as an ‘extra’. A discussion took place with the training co-ordinator about the importance of ensuring the staff receive up to date guidance to keep the people living at the home safe from the risk of infection. It was reported that the topic is covered lightly during the company induction. Safeguarding Vulnerable Adults training is provided and covered within induction however there were some gaps evident where the current provision DS0000019335.V362382.R01.S.doc Version 5.2 Page 23 required refreshing. The training co-ordinator was aware of these gaps and was scheduling some courses. There were a number of gaps indicated in the Moving and Handling training provision, evidence was seen of a course booked in May. A fire-training course had been arranged for 23rd April 2008. 2 dates had been booked in April for all staff members to attend Dementia awareness training. A training course for emergency aid had been booked for 23rd April 2008 and food hygiene was in the process of being booked. These additional training sessions addressed the current shortfalls in the training provision. A discussion took place with the training co-ordinator about ensuring that routine refresher training is provided for the staff team in order to update and maintain their skills so that the people living at Elmhurst can have the confidence that their health, safety and well being are promoted and protected. The AQAA completed by the manager stated in the what we could do better section under this outcome group ‘Maintain an ongoing development programme to ensure staff are trained and competent to carry out their duties’ indicating an awareness of this area of shortfall and an intention to commit resources to improve this area. Not all care workers were wearing name badges. We weren’t able to distinguish who was staff and who was visiting the home. One relative responded by survey, “I just wish all care workers could wear name badges. It is off putting talking to someone, without knowing names”. DS0000019335.V362382.R01.S.doc Version 5.2 Page 24 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): 31, 32, 33, 35, 36, 37 and 38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at Elmhurst and their relatives can be confident that the management at the home is working towards improving the service and will seek their views about the home and the service offered. EVIDENCE: The registered manager has completed the NVQ 4 qualification and the Registered Manager’s Award. During discussion the manager was able to demonstrate that she has attended relevant training to update her skills. She has attended a safeguarding adults training update, a course in promoting practice in social care and appraisal training. The manager is able to describe a clear vision of the home based on the organisation’s values and corporate priorities. The manager communicates a clear sense of direction, is able to evidence a sound understanding and application of ‘best practice’ operational DS0000019335.V362382.R01.S.doc Version 5.2 Page 25 systems, particularly in relation to continuous improvement, customer satisfaction, and quality assurance. A family member responded by survey “The new manager Sue Kent is very approachable and is making a lot of changes in the home for the better”. Quantum Care has a comprehensive Quality Assurance process. Evidence was seen of questionnaires that had been distributed to residents and relatives and the responses received. There is strong evidence that the ethos of the home is open and transparent. The views of people who use the service are listened to, and valued. Both the registered manager and external management have responded to recent concerns about the standard of food provided at the home in an open and timely manner. This shows that the service takes peoples concerns seriously and acts promptly. The home has efficient systems to ensure effective safeguarding and management of residents’ money and valuables, including record keeping. Monies are kept in individual wallets with records and receipts showing when, where and by whom the money was spent. The registered manager undertakes physical spot check checks every 1-month to 6 weeks, a complete check was undertaken in November 2007. People pay for personal items such as hairdressing, chiropody, newspapers, and toiletries. The manager reported that the home’s staff supervision system is getting better, she has done some supervision recently but these have not always been recorded. The manager accepts that this is an area where improvement is necessary. The manager is responsible for the supervision for the senior team (Care team managers, chef manager, senior housekeeper and admin) and Care team managers are responsible for supervision of staff working on individual units. The AQAA lets us know about changes they have made and where they still need to make improvements. It gives some indication how they are going to do this. All sections of the AQAA were completed and the information gives a reasonable picture of the current situation within the service. The evidence to support the comments made is satisfactory, although there are areas where more supporting evidence would have been useful to illustrate what the service has done in the last year, or how it is planning to improve The home has as appropriate, effective and regular support through a named line manager and, as required, access to professional accountancy and business advice. There are clear lines of accountability. Insurance cover ensures that the home or corporate body are fully insured to meet any loss or legal liabilities. Checks show that records are generally up to date although some gaps are found in recording and entries are not always clear. The home’s AQAA stated under the section what we could do better ‘Ensure all information is recorded DS0000019335.V362382.R01.S.doc Version 5.2 Page 26 in all relevant places’. This shows that the manager is aware of this shortfall and is committed to improvement in this area. A communication book was open on a desk in the admin office. This book contained miscellaneous information about various aspects of running the home from maintenance issues to issues affecting the staff rota and which residents needs to see a doctor. It was noted that some residents’ personal healthcare information had been recorded in this book. Discussion was held with the registered manager regarding the appropriateness of having personal information recorded in this manner and the need to consider the protection of peoples’ dignity and privacy. Fire bells are tested weekly to ensure they are in working order. A Fire inspector attended the home towards the end of 2007; no areas of concern were identified at that visit. A fire drill, including evacuation, takes place fortnightly and drills take place whenever bells go off. Risk assessments in pace for those people who are bed bound and advice has been received from the local fire brigade. DS0000019335.V362382.R01.S.doc Version 5.2 Page 27 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 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 2 3 DS0000019335.V362382.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? No 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 OP7 Regulation 15 Requirement Care plans must contain clear detail as to what actions care workers need to take to ensure each person’s needs in respect of his/her health and well being are to be met. The person in charge must make sure that care workers receive training to keep people safe. Specifically refers to the safer administration of medicines, the Protection of Vulnerable Adults and the control of infection. Timescale for action 31/07/08 2 OP18 OP30 18 31/07/08 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 OP27 Good Practice Recommendations The person in charge should review the numbers of staff employed to work at the home at night in line with the needs of the people living at the home. DS0000019335.V362382.R01.S.doc Version 5.2 Page 29 DS0000019335.V362382.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 DS0000019335.V362382.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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