Inspection on 19/07/07 for Elmhurst

This inspection was carried out on 19th July 2007.

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 29/09/06

Elmhurst 12/01/06

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 Key Unannounced Inspection 09:30 19th July 2007 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.V337006.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. Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 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 F/P 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.V337006.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 29th September 2006 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. Fees at the home range between £420 and £450. A copy of this report can be requested directly from the home or accessed via the CSCI website (web address on page 2 of this report) Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection took place on 19th July 2007 and lasted five hours. I was assisted throughout the inspection by the acting manager who was open and helpful. I spoke with three staff and seven residents of the home. I inspected the building and examined various care records as well as a number of policies and procedures. All of the residents I spoke with said they were very happy with the care and support they received. One resident told me, “All the carers are very helpful”. What the service does well: What has improved since the last inspection? What they could do better: One requirement has been restated again that the registered provider undertakes regular supervision with the manager and that this supervision is recorded. This will ensure that the manager and the registered provider have a clear document about what needs to be done in the home. Two new requirements have been issued relating to the registration of the manager and the publishing of any quality assurance questionnaires. Three good practice recommendations have been made relating to reviewing risk assessments, reviewing CRB disclosures for staff and undertaking fire drills at night. All these recommendations should ensure the continuing safety of staff and residents at the home. Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 6 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. Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 (6 not applicable) People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home carries out a comprehensive assessment of individual’s needs so that they know that the home is suitable for them before they decide to move in on a trial basis. EVIDENCE: I examined the pre admission assessment for the last person to move into the home. This assessment was detailed and contained good information about the person’s needs. The acting manager told me that the resident visited the home on a number of occasions to see if the home was right from them. This included weekend stays as well as day visits. I spoke with the person concerned and they told me they were happy at the home. I also saw evidence that the cultural needs of this individual were assessed and met by staff at the home. This included revisions to the menu to include culturally appropriate food. Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Care plans clearly set out residents’ health, personal and social care needs so that staff know how best to support everyone at the home. Residents have good access to health care professionals and they are treated with respect. Residents get the medication they require, at the right times and by appropriately trained staff. EVIDENCE: Six care plans were examined. These plans were detailed and set out the plan of care for each individual for staff to follow. The plans set out the health, personal and social needs of residents. Risk assessments had been undertaken for manual handling and pressure care. These assessments were being reviewed on a regular basis. Care plans gave staff a clear understanding of how people wanted their care to be delivered. Staff I interviewed had a good understanding of the use of care plans and the needs of the people in their care. Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 10 There was evidence from care plans that residents can access a range of health care professionals. One person told me, “The world comes to us in here, we have the dentist, chiropodist and optician”. Residents also confirmed the doctor visited the home regularly and staff took them to hospital appointments when required. Satisfactory and accurate records were examined in relation to the receipt, administration and disposal of medication. Residents’ pictures are attached to their medication charts and only those staff who have completed the medication training are permitted to administer medication. Throughout the inspection I saw examples of staff treating people with respect and upholding residents’ privacy. For example staff were seen to be knocking on people’s doors before going in. People I spoke with confirmed that they were treated with dignity and staff upheld their need for privacy. Staff I interviewed were able to give practical examples of when they have upheld peoples’ privacy. Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents can choose from a range of activities at the home and are kept suitably occupied and engaged. Visitors to the home are made to feel welcome and can visit at any reasonable time. Residents are helped to exercise choice and control over their lives. The food provided is of good quality and mealtimes are relaxed and enjoyable. EVIDENCE: A number of activities are available for residents. These include Bingo, puzzles, videos, knitting, feeding gold fish and various board games. Plenty of books were seen to be available. The lounge has a large screen television. People I spoke to said they were happy with the range of activities on offer. One person told me, “Everything’s laid on for you but the carers take you over to Tesco’s if you want”. At the time of inspection a game of Bingo was taking place. People I spoke with said that visitors to the home were welcomed and always offered a cup of tea or coffee. The record of visitors to the home confirmed that they could visit at any reasonable time. Residents confirmed that they were able to have choice and control over their lives at the home. Staff I interviewed were able to give examples of how they Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 12 ensure people are able to exercise choice and control within their daily routines. The kitchen was inspected. The cook on the day of the inspection was aware of individual’s likes and dislikes as well as any special diets people may require. The kitchen was clean and there was a good selection of fresh food. Fridge and freezer temperatures were being monitored and recorded. People I spoke with were positive about the food provided by the home and confirmed that a choice of menu was always available. One resident told me that the food was “Very nice”. Another person said, “There is a good variety of food”. Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Complaints are taken seriously and responded to in a professional manner. Residents are protected from abuse by clear policies and procedures and by an appropriately trained staff team. EVIDENCE: The home has satisfactory policies and procedures in relation to complaints and the protection of residents from abuse. One complaint had been received by the home since the last inspection. Records indicated that the manager dealt with this complaint appropriately. All the residents I spoke with said they had no complaints about the service but were clear that they would say something if they had a concern. The CSCI received a phone call from the manager of the local Tesco store. He was concerned that a resident was visiting the store and looked dishevelled and was walking about in the car park and could present a risk to himself and others. The manager notified the CSCI about this issue and has completed a risk assessment for the individual. This resident enjoys going out of the home and does not like staff being with him. The manager told me that she would try to ensure that a member of staff went out with the individual and followed at a discreet distance to monitor him. I spoke with the resident as the staff at Tesco were concerned about how the staff at the home treated him. He told me that he was looked after well and had no concerns. I asked him if the staff Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 14 were kind to him and he replied, “Of course”. The manager told me she would be monitoring this situation closely. A recommendation has been made that a review of the individual’s risk assessment takes place with the manager of the home and the allocated social worker. Staff were able to describe to me how vulnerable people could be at risk of abuse in a residential care setting. All staff were clear of their responsibility to report any suspicions of abuse to the appropriate authorities. Residents that I spoke to said they felt safe and well supported at the home. One resident told me, “We look well because we don’t have any worries”. Records indicated that most staff have undertaken training in the protection of vulnerable people. The manager told me she was currently organising a refresher course for all staff. Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is safe and cleaned and maintained to a satisfactory standard. EVIDENCE: The premises internally were found to be well maintained and comfortable. There was evidence that resident’s rooms were personalised with photographs and pictures. Rooms were well decorated. People told me they were happy with their rooms and one person said the home was, “Nicely painted”. A requirement issued under health and safety regarding the ramp to the garden has now been complied with. Although the home is relatively small there is a large communal lounge where people can move about freely and watch television or just sit and chat. There is good outside space as well. Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 16 Residents I spoke with said the home was always clean and there were no offensive odours detected throughout the home. There are no domestic staff employed and care workers are expected to clean the home. The manager told me she is currently recruiting fro a domestic worker. This should ensure that care staff have more time to spend with residents. All bathroom and toilets had good supplies of anti-bacterial soap and paper towels. Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. All the staff at the home work very hard to meet the needs of residents and are provided with good training opportunities to further enhance their knowledge and skills. Recruitment practices are sufficiently detailed in order to fully protect residents at the home. EVIDENCE: On the day of the inspection there were nine people resident at the home and two care staff and the manager and cook. The manager told me that there were now always at least three staff on duty for the morning and afternoon shifts and two staff on in the evenings and one waking and one sleeping staff at nights. The rota that I examined confirmed this. A requirement, restated at the last inspection, that staffing numbers must be increased in the day has now been complied with. Residents said they were satisfied with the support they receive from staff. One person told me, “We are very happy here”. Staff told me they were happy working at the home and staff turnover is low. This benefits residents and ensures a consistent approach to care provision. Records indicated that well over 50 of care workers have now completed NVQ level 2 or equivalent. Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 18 Staff were very positive about the training offered to them and individual staff training profiles examined indicated that staff at the home receive the training required to do their jobs effectively. Staff files examined indicated that an appropriate recruitment process had been followed including the completion of application forms, interviews, taking up of references and pursuing Criminal Records Bureau checks. Staff files also included photo identity and evidence of training certificates gained. A good practice recommendation has been issued that CRB disclosures are reviewed fro those staff who have been working at the home for some time. Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The manager of the home knows the residents very well and understands their needs. Residents have opportunities to have a say in how the home is run. Residents’ financial interests are being safeguarded. The health and safety of residents and staff are promoted and protected. EVIDENCE: The acting manager, Jannett Brown has worked at the home for several years and was promoted to her current post on the resignation of the previous registered manager. Both staff and service users commented favourably on Ms Brown’s capabilities and personality. Ms Brown has now completed the Registered manager’s award qualification. It was clear from discussion with the Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 20 manager that she takes her role and responsibilities seriously and works very hard to ensure the home is well run. A requirement has been issued that the manager must apply to the CSCI to become the registered manager. Visits from the registered provider under Regulation 26 of the Care Homes Regulation 2001 are now taking place on a more regular basis and reports of these visits are sent to the CSCI and retained at the home. This was a restated requirement from the last inspection that has now been complied with. Quality assurance questionnaires are sent out to residents, their relatives and other stakeholders on a regular basis. This standard will be fully met when the results of these surveys are published and made available to all interested parties. A requirement has been issued relating to this. The recent round of questionnaires received were all very positive about the standard of care provided by the home. The minutes of the last residents meeting were seen which took place in March of this year. The manager told me that another meeting was due this month. Monies held on behalf of residents were checked during the inspection and were found to be accurate against the records held. All people who live at the home have a lockable facility in their bedrooms. The home had up to date liability insurance certificate. A requirement was restated at the last inspection that the manager receive regular supervision from the registered provider and that these supervision sessions are recorded. The manager told me she does receive regular supervision but for some reason the registered provider is not recording this. The requirement has been restated again. Certificates of safety were seen for fire equipment, gas and electrical installation. COSSH and general risk assessments for areas in the home were seen to be available. The records were examined in relation to fire safety. Although fire drills are taking place on a regular basis it is good practice for night staff to receive fire drills every three months. Staff who work nights often also work day shifts but it is still important to make sure drills happen at night. A recommendation has been made relating to this. The ramp to the garden has been fixed and moss has been removed to ensure that no one slips over. This was a requirement from the previous inspection that has now been complied with. Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 2 X 3 Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP36 Regulation 18(2) Requirement The registered person must ensure that the manager receives regular supervision and that this supervision is recorded. (Timescale of 31/08/05, 1/3/06 and 30/12/06 not met) This requirement is restated. 2. OP31 8(1) The registered person must ensure that the manager applies to the CSCI to become the registered manager of the home. The registered person must ensure that the results of any quality assurance surveys are published and made available to all interested parties. This includes residents and potential residents to the home. 01/10/07 Timescale for action 01/09/07 3. OP33 24(2) 01/10/07 Elmhurst DS0000010671.V337006.R01.S.doc Version 5.2 Page 23 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. 3. Refer to Standard OP18 OP29 OP38 Good Practice Recommendations The registered person should ensure that the resident who enjoys visiting the local Tesco store has their risk assessment reviewed with their allocated social worker. The registered person should ensure that CRB disclosures are reviewed for those staff who have been working at the home for a number of years. The registered person should ensure that fire drills take place at night every three months. 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