Inspection on 16/06/05 for Elmhurst

This inspection was carried out on 16th June 2005.

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 10/10/06

Elmhurst 08/11/05

Elmhurst 09/12/04

Elmhurst 30/06/04

Similar services:

Abbey The

Snydale Care Home

Hawkhills

Larchfield Manor

Beeches The - North Yorkshire County Council

The Grove Waltham

Staveley Birk Leas Nursing Home

Carentan House

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

CARE HOMES FOR OLDER PEOPLE Elmhurst 69 Pollard Lane Bradford West Yorkhsire BD2 4RW Lead Inspector Sue Dunn Unannounced 16 June 2005 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 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 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Elmhurst Address 69 Pollard Lane, Bradford, West Yorkhsire, BD2 4RW 01274 638151 01274 634890 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) R & N Partners Mrs Deborah Fitzmaurice Care Home 22 Category(ies) of Past or present alcohol dependence (1), registration, with number Dementia - over 65 years of age (7), Old age, of places not falling within any other category (15), Physical disability (2), Physical disability over 65 years of age (7) Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 09/12/04 Brief Description of the Service: Elmhurst is a pair of stone built semi detached Victorian style family houses converted to provide residential accommodation for 22 older people. Changes in legislation concerning multi occupied rooms and minimum space requirements have led to a reduction of occupancy. The home currently has 10 single and 5 double rooms. Only one room, a single, has en-suite facilities.Accommodation is on three floors with access to the first floor by stair lift. The laundry and office are situated in the basement.A small neatly kept garden to the front of the house overlooks the road and offers a sitting area for clients. A conservatory to the rear of the building is used as the designated smoking area. There is no ramped access to the house and parking is on the road.The home is situated in the Bowling area of Bradford within walking distance of local shops, a park and a golf course.The home is one of two in the Bradford area owned by the same proprietors and employing family members. The two homes work closely together and the proprietors take an active interest in the day-to-day activities of the homes. Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection by one inspector which took place between 10.45 and 4.15pm. The purpose of the inspection was to ensure the home was operating and being managed in the best interests of the people living in the home and to meet the National Minimum Standards for a Care Home for Older People. There were 22 people in the home at the time of the inspection. Judgements made during the inspection were based on information from the manager, three care workers, a district nurse and residents. Four care files and a selection of records were examined and routines and practices were observed. What the service does well: What has improved since the last inspection? The manager has returned to the home after a short period of maternity leave. The recording of the care given to each resident on a day to day basis was Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 Page 6 much improved and gave a feeling of the instinctive common sense approach in the way staff were meeting care needs. Suitable door handles and locks have been purchased for bedroom doors. These allow the doors to be locked from either side by each resident but opened easily in the event of an emergency giving people the right to privacy and security in their own rooms. These had been fitted to most of the doors on the first floor and the more independent people had been given keys. There was no odour of cigarette smoke noted in the non smoking areas of the home. What they could do better: There must be evidence to show that all residents have received a contract which explains the terms and conditions of their occupancy. These were only seen for a few people. Pre admission assessments must show before a person is admitted, or re admitted, to the home how the home intends to meet their needs and give assurance that their overall needs can be met. The care plans agreed with each resident must show enough detail to enable any person working a shift in the home to know how each person wishes to be cared for in all aspects of their life. These must be reviewed and amended as needs and circumstances change. Staff should put their training into practice and be aware that the layout of the home can lead to their conversations about peoples care being overheard and compromise privacy and dignity. It is understood that there are plans to improve and enlarge the ground floor toilet arrangements which will benefit residents and staff. In the interests of safety the home must satisfy the requirements of the fire safety officer. Some decorative work is needed in communal areas. The home must notify the CSCI if all attempts to maintain staffing levels have failed for any reason. There must be evidence that CRB checks have been carried out before people are employed. Please contact the provider for advice of actions taken in response to this Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 Page 7 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 The home provides good written information about their services so that anyone going to live in the home can know what to expect. Pre admission assessments do not make it clear how and what resources the home will provide to meet the needs and preferences of different personalities. Despite this, staff had adapted their approach to different people. EVIDENCE: The home has an informative Statement of Purpose and Welcome pack both in large easy to read print. Signed contracts of terms and conditions of occupancy were seen for 12 of the 22 residents. Neither of the 2 more recent people admitted appeared to have a contract. Pre admission assessments were variable One person admitted from hospital had an assessment which gave no personal background information prior to hospital admission. Two assessments of need done by the home were limited in content and one was undated. The assessments did not identify how the home would provide for each persons needs. An example of this being the lack of guidance about the most appropriate communication methods to be used for a person with severe hearing loss. Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 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 standard(s) 7,8,10 There had been an improvement in the content of information written in the daily progress notes to reflect the actual care being given. This helped to fill some of the gaps in the care plans, which were basic and limited in content. Staff were relying on memory and word of mouth to pass on information, which should have been recorded in the care plan. This raised concerns that some care needs may be overlooked. Staff must be aware of their working practices to ensure that the privacy, dignity and rights of residents is not compromised. EVIDENCE: Care plans varied. One gave clear guidance on several aspects of the person’s care but did not include social and recreational needs. A member of staff was able to give a good picture of another person’s interests, which was backed up by a ‘memory book’ from relatives. She acknowledged that none of this was recorded in the care plan. District nurse visits had not been recorded since mid March despite the fact she was said to visit every day. The results of a test carried out in April was not recorded. The person was confined to her room due to mobility Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 Page 11 difficulties and there was no care plan in place to show how to avoid her becoming socially isolated. The only stimulation was the TV which didn’t have a remote control. Staff and the manager were able to provide explanations about how care plans had been followed but this had not been recorded. Review notes showed that one person’s medication had been changed but the health care records and daily progress notes did not record any visit by the GP. The care worker thought a relative was dealing with one aspect of healthcare but this was not recorded in the care plan therefore it looked as though the home was not taking action in the interests of the resident. Another care plan for a person who was clearly unsettled only related to assistance with personal care. This did not include details such a dress and hair care preferences or how to approach situations which could lead to conflict. The daily progress notes however showed that staff had found a glass of sherry or brandy was an acceptable way to placate and reassure. Staff were overheard speaking to a resident and between themselves in a manner which made it clear that the person had been incontinent. The layout of the home is such that extreme discretion is required to preserve peoples’ dignity and privacy. It was said that the ground floor wc area is to be extended to create more space and privacy for people who require assistance. The district nurse were very satisfied with the standard of care in the home and said staff worked cooperatively with them in the interests of the residents. The practice of storing their equipment in a walk in cupboard in a resident’s bedroom is a breach of privacy. The nurse was able to suggest another solution to redress this. Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 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 standard(s) 12,14 The home provides group entertainment and some people go out. However there should be social care plans for people who cannot or don’t choose to join in to ensure that their needs do not get overlooked. People were free to move about within the limits of health and safety. There was no formal care plan for meeting the social and recreational needs of a person temporarily confined to her room EVIDENCE: Care staff were able to display a good knowledge of the interests of each resident though this was not given high priority in the care plan to provide a more focussed approach to meeting social and recreational needs. Entertainers are booked on a regular basis and a previously untried singer was entertaining people in the main lounge. Some joined in, and clearly enjoyed it, others were sleeping. People in the other lounge had either chosen not to listen to the entertainer or were unable to move without staff assistance. All the staff were in the main lounge during the entertainment missing an opportunity for some to spend one to one time with the person in her room and other less able residents. Three of the residents stated they were ‘fed up’. In one of the cases it was because she did not want to be in a care home. A member of staff said that staff play bingo, cards and board games but thought ‘it would be nice if carers could take some people into town’ Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 Page 13 The home has two cockatiels and a dog which is owned by one of the residents. Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 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 standard(s) 16,18 The organisation’s complaints procedures are used to ensure residents are listened to and protected. Staff had an understanding of the subtle ways in which vulnerable people might be abused and were aware that any concerns could be reported to the ‘Care Standards’ EVIDENCE: Everyone is made a ware of the complaints procedure. A recent complaint to the manager was taken seriously and investigated by the proprietor who then informed the CSCI. The complainants were satisfied with the outcome. Staff were able to show a good understanding of behaviours which were abusive. Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 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 standard(s) 19,21,22,24,25,26 The building and facilities would not meet the standards if the home were to be registered today but there is a comfortable, homely atmosphere, which meets the expectations of the people who have made a choice to live in the home. The home must find a solution to meeting fire safety recommendations and which satisfies the fire safety officer. This is a matter of high priority for the safety of the residents The bathing and toilet facilities do not meet the standards for anyone with high physical care needs as the limited space in which to give assistance could place staff at risk and compromises the privacy of residents. The stair lift is only suitable for people with less severe mobility difficulties. These factors have to be considered when assessing if the home can meet needs. The home was clean and comfortable but parts of the home are in need of redecoration. EVIDENCE: Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 Page 16 Locks which can be opened in an emergency, were being fitted to the first floor bedroom doors at the time of the inspection. Some people had their own door key and several rooms were seen to be locked. Some rooms had been made very individual with personal belongings. This was less so in a shared room. The wallpaper on corridors and stairs was starting to show signs of wear and tear. A member of staff said that the ground floor wc area, which is small, and in hearing distance of other communal areas of the home is to be extended to create more space and privacy for people who require assistance. The home had responded to a recent fire officers report by adjusting the door closers so that these closed fully in the event of fire. The practicalities of dealing with other fire safety recommendations are difficult due to the layout of the home. The manager has been asked to write to the CSCI giving details and timescales for compliance with the fire safety officer’s recommendations. The work to fit covers to all the radiators has still to be completed though all the ‘high risk’ areas have been done. Specialist equipment such as pressure relieving cushions mattresses and bed rails are supplied by the district nursing service as required. The home has a stair lift which is not suitable for people with higher care needs. One person had been unable to go downstairs for several weeks due to a leg injury which made it unsafe to use the stair lift. Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29,30 Overall staffing arrangements were satisfactory. However the rotas showed an occasion when there had been insufficient staff for the number of residents. The CSCI had not been notified what arrangements had been made for the welfare of the residents. There must be evidence to show that Criminal Record Bureau checks are carried out on all staff before they are employed, for the protection of residents. Care staff were calm and patient and were generally well informed about the care needs of the people they were caring for. However they could have done more to put their NVQ training into practice as they were carrying out tasks. EVIDENCE: There were three staff including the manager and a work placement trainee to provide care on the morning of the inspection. The work placement trainee is underage therefore not able to give any personal care. Examination of the rota for the week ending 10.06.05 showed that there had only been two care staff on duty on one of the morning shifts that week. If all attempts to meet the staffing levels had failed the CSCI should have been informed as this is a situation which could ‘affect the well being of residents’ The home has a total staff team of fourteen. Three have completed their NVQ award and two are about to start. One person said she had received an induction training when she started working in the home. She said this included an introduction to the residents and other staff, the layout of the home, fire safety instruction, moving and handling and confidentiality. An induction checklist was undated but backed up Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 Page 18 what she said. She had looked at the care plans and was able to describe how she communicated with a new resident and the amount of assistance he needed. Another member of staff said that fire drills and staff meetings were held monthly. Examination of the recruitment and selection file for a recent employee showed no evidence of a CRB check Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,36,38 The manager has a good relationship with residents and staff. She has worked in the home for many years and is supported by the proprietor. However the home would benefit if she were given the opportunity to do training which allows her to make links and share ideas with other managers across the care industry. Satisfactory systems were in place for making and recording Health and Safety checks. The proprietors must inform the CSCI about their intentions for meeting the fire safety recommendations EVIDENCE: The manager has worked in the home for many years. She has been trying to seek advice regarding the City and Guilds Managers award which she completed in 1993 to see if this is an equivalent to the NVQ4 award. She is Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 Page 20 prepared to undertake the Managers award to resolve this matter once a suitable assessor can be found. The manager is included in the staffing numbers on some shifts therefore works alongside staff and can observe practices. A programme of supervision was seen on the office wall and a staff member confirmed that she had supervision with one or other of the senior carers ‘roughly two weekly’. A selection of safety check records was inspected and all were up to date except the emergency lighting checks, carried out two monthly, but last recorded in February. There have been discussions with the fire safety officer about how the home is to meet the recommendations of his report. A solution has not yet been reached. The manager was included on the rota and had to leave before the inspection was completed therefore this area of the inspection will be covered more fully at the announced inspection. Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 2 3 4 x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 x 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 x 14 3 15 x COMPLAINTS AND PROTECTION 2 x 2 2 x 3 3 3 STAFFING Standard No Score 27 2 28 x 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 x x x 3 x 2 Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 Page 22 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. 2. 3. Standard OP2 OP4 OP7,OP12 Regulation 5 14 15 Requirement All residents must have a written contract explaining the terms and conditions of occupancy Pre admission assessments must show before admission how the home will meet peoples needs Care plans must be relevant to the indivduality of each person in the home and provide all staff with guidance on each persons preferences regarding their care. These must be regularly reviewed and amended as care needs change Staff must ensure that their own actions do not affect residents rights to provacy and dignity The home must find a solution to the recommendations of the fire safety officer and inform the CSCI in writing of their proposals, giving time scales for action Lavatories and washing facilities must be of sufficient size to ensure the privacy and dignity of residents is not compromised The home must ensure they have suitable specialist equipment to meet the needs of people living in or returning to Timescale for action 31.08.05 31.08.05 31.09.05 4. 5. OP10, OP19,OP25 ,OP38 12,18 23 Immediate 31.08.05 6. OP21,OP10 12,23 31.03.05 7. OP7,OP22 23 Ongoing with every assessmen t Page 23 Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 the home from hospital 8. OP27 18,37 The home must notify the CSCI of any situations where staffing levels fall below agreed levels for the well being of residents There must be evidence to show that satisfactory CRB checks have been completed before staff come into post 31.08.05 9. OP29 19 31.07.05 10. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard OP19 Good Practice Recommendations The corridor and staircase areas should be redecorated Elmhurst 20050616 Elmhurst UN Stage 4 J52 V230060 S1241.doc Version 1.30 Page 24 Commission for Social Care Inspection Aire House Town Street Rodley Leeds, LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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