Inspection on 29/09/06 for Elmhurst

This inspection was carried out on 29th September 2006.

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

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

Other inspections for this house

Elmhurst 19/07/07

Elmhurst 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 Stephen Boyd Key Unannounced Inspection 11:15 29 September 2006 th 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.V292077.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Elmhurst Address 7 Queens Road Enfield Middlesex EN1 1NE Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8366 3346 020 8366 3346 Mr Teen Fook Chon Mrs Julie Sooi Yuin Chon Mrs Janet Murphy Care Home 14 Category(ies) of Old age, not falling within any other category registration, with number (14) of places Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th January 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 £450 and £500. 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.V292077.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place in one day in September 2006. During the inspection four service users were spoken with, as were two members of staff and a relative. A tour of the premises was undertaken and various records and policies were considered. A total of sixteen comment cards from relatives, visitors and service users were received prior to the inspection. The inspector was assisted throughout the visit by the acting manager, Ms Jannett Brown. What the service does well: What has improved since the last inspection? What they could do better: This inspection lists a number of requirements including the restating of some previously made. The proprietors need to ensure that they make a copy of monthly monitoring visits available in the home for the manager and Inspectors. There is a need to have a copy of the homes policy on adult protection available for staff to consult. Some safety issues need addressing inside and outside the home (see standard nineteen). Most importantly; staffing levels need to be appropriate to the needs of current service users. Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 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. Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users have their needs assessed and are assured these will be met prior to moving into the home. EVIDENCE: The file of a service user admitted since the previous inspection was looked at during the inspection. There was an assessment carried out by the home prior to his admission. The service user’s placing authority had also provided detailed information on his needs. The service user advised the inspector he had visited the home prior to his admission accompanied by his social worker. The home was seen to have a policy and procedure in respect of the admission of new service users. The home does not offer an intermediate care service. Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9 and 10 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users’ health, personal and social care needs are set out in an individual plan of care. Health needs are fully met including being given the right medication at the correct time by trained staff. Service users are treated with respect with their privacy given a good priority. EVIDENCE: Service users all have individual plans of care. These are based on activities of daily living and those sampled were found to have goals with actions detailed on how to meet these. Plans were seen to have been reviewed on a regular monthly basis and there was evidence that the plans are known about and discussed with service users. A requirement of the previous inspection to ensure service users preferences in respect of activities were known and recorded had been met. Service users health care needs were seen to be given a good level of priority both within care plans and in evidence of appointments being made with relevant healthcare professionals such as G.P’s, Dentists, Opticians and Chiropodists. Weight charts are kept for each service user to aid health Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 10 monitoring and risk assessments had been completed on service users covering issues such as moving and handling and also pressure sore risk. The home operates a monitored dosage system of medicine administration. This was checked on the day of inspection and found to be working appropriately. Medication administration record sheets were filled in correctly. Two requirements from the previous inspection regarding ensuring all medicines coming into the home are appropriately recorded and a suitable lock being provided for a fridge holding medication had been complied with. Staff administering medication had received training. In discussion with service users they said they were treated with respect and afforded dignity by the staff working in the home. One comment made by a service user was “ Staff are angels to us” Staff were seen to talk to service users in an appropriate manner and to maintain privacy by knocking on bedroom doors. Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15 Quality in this outcome area is good. This Judgement has been made using available evidence including a visit to this service. Service users enjoy a range of activities and can choose preferences that meet their social and recreational needs. Service users maintain contact with relatives, friends and others as they wish. Service users can have control and choice over their lives. Meals are appealing to service users. EVIDENCE: A number of activities are available for service users. These include Bingo, puzzles, videos, knitting, feeding tropical fish and various board games. Plenty of books were seen to be available. The lounge has a large screen television. Service users spoken with said they were happy with the range of activities on offer. At the time of inspection a game of Bingo was taking place and one service user had gone out for a walk. All of the service users living at the home had some degree of contact with family or friends. Service users confirmed their visitors were free to come to the home at any time. Comment cards received prior to the inspection from visitors and relatives confirmed they could visit at any time and were made to feel welcome. A relative of a service user who had unfortunately recently died at the home, was visiting at the time of the inspection and expressed great satisfaction with the level of care his mother had received at the home. Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 12 Service users said that they could exercise choice and control over their lives. This included issues such as what to wear, where to sit and when to go to bed. They were free to join in activities if they wished. Three requirements were made at the previous inspection regarding food related matters. All of these had been addressed by the time of this inspection. Knives were properly stored, a new fly screen had been fitted and a good quality of food supplies were apparent. Service users were complimentary about the meals at the home, saying they had plenty to eat and drink. The lunchtime meal during the inspection was presented well and was sufficient in quantity. Menus showed variety of meals being available. One issue the home needs to ensure is that a record is kept of what each individual service user eats to aid any health queries that may arise periodically e.g. if a person was ill and the G.P. wanted to know what and how much they had been eating. Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users and their relatives and friends can be confident their complaints would be heard and dealt with appropriately. The registered provider must ensure the homes policies and procedures in respect of protecting service users from abuse are available for staff to consult if necessary. EVIDENCE: The home has a complaints policy and procedure. No complaints had been recorded since the previous inspection. Service users spoken with during the inspection had no complaints or concerns they wished to raise. Comment cards received from relatives and visitors indicated they knew of the homes complaints procedure but had not needed to use it so far. The acting manager, Ms Jannett Brown advised she had been trained by the London Borough of Enfield regarding protection of vulnerable adults and is in the process of cascading training to all staff as a result of this. A number of staff had already undergone training in abuse issues in this or previous jobs. The home had a copy of Enfield policies and procedures regarding the protection of service users from abuse. However, a copy of the homes’ own policies and procedures could not be located during the inspection and clearly needs to be available for staff to consult and use if necessary. Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users live in a pleasant environment. Some issues need to be addressed to increase service user safety in and outside of the building. The home is clean and hygienic. EVIDENCE: Two requirements made at the previous inspection regarding the premises had been complied with by the time of this inspection. These were the repair of flooring and ventilation in the ground floor bathroom. The premises internally were found to be generally well maintained and comfortable. There was evidence that service users rooms were personalised with Photographs and pictures. Rooms were well decorated. Service users said their rooms were comfortable and warm in cool weather. A number of safety issues were seen regarding the premises. Window restrictors were not fitted to service users bedrooms and risk assessments should be carried out regarding the need for these. The rear garden was in need of attention to make it a pleasant area for service users. Grass was overgrown and a lot of weeding and general tidying was needed. The ramp Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 15 leading to the garden was slippery with dirt and moss in places and was in need of a power clean. There was a loose paving slab also in need of fixing. The home internally was clean, pleasant and hygienic. Service users commented on this being the case at all times. The home has a policy on infection control and staff said they always had sufficient supplies of aprons, gloves and anti- bacterial soap. Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 and 30 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. Service users are in safe hands from a staff team recruited in a professional manner who are trained to do their jobs. Staffing numbers need to be enhanced at certain times to fully meet service users needs. EVIDENCE: At the time of inspection there were two care staff on duty and the acting manager. There was also a cook on duty No domestic staff are employed. All staff spoken to during the inspection indicated that staff levels could reduce to two carers only on Tuesdays, Thursdays and at weekends. Given that the home has some service users who require the assistance of two carers for certain care tasks, the level of care staff on all days between 7.00a.m and 3.00p.m must increase to three which may include the acting manager. This would also enhance opportunities for staff to take service users out during these times and give continuity of staff levels at all times. More than fifty percent of the staff working at the home have achieved National Vocational Qualifications at level two or above. The acting manager advised that two staff would be doing their nvq’s at level two shortly. There was evidence that staff had completed various training courses relevant to their work including: first aid, food hygiene, safe handling of medicines and infection control. Planned training in the coming weeks included food hygiene, moving and handling, fire training and infection control. Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 17 The recruitment of staff was evidenced to be carried out in a professional manner. Prospective staff fill in application forms and attend for interviews. If successful, written references are obtained and Criminal Records Bureau checks undertaken. Staff spoken with confirmed these practices and that they receive regular supervision sessions and can share their views on the operation of the home at staff meetings. Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is adequate. This Judgement has been made using available evidence including a visit to this service. The acting manager is liked and respected by service users and staff. The home is generally run in service users best interests. Service users financial interests are safeguarded. The health, safety and welfare of both service users and staff is generally met though some improvements are needed. 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. The Inspector understands an application by the proprietors for Ms Brown to become the homes’ registered manager will shortly be made to the CSCI. Both staff and service users commented favourably on Ms Brown’s capabilities and personality. Ms Brown is due to complete the Registered manager’s award qualification in October of this year. Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 19 An outstanding requirement from the previous inspection is the need for records of monthly monitoring visits by the Providers, Mr and Mrs Chon to be not only sent to the CSCI, but be kept in the home. The visits records for July and August were not available and thus the requirement is restated in this report for a third time. Service users meetings are held in order that residents can share their feelings and views on the operation of the home. Minutes were seen of these. Monies held on behalf of service users were checked during the inspection and were found to be accurate against the records held. All service users have a lockable facility in their bedrooms. The home had up to date liability insurance for the home. The arrangements for the health, safety and welfare of service users were generally acceptable, although, there were safety issues in need of attention as noted under standard nineteen of this report. 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. Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 20 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 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 2 Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 21 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 OP15 Regulation 17 schedule4 (13) 13(6) Requirement The registered proprietors must ensure that a record of food eaten by each service user is kept The registered proprietors must ensure the homes policy and procedure on protection of vulnerable adults is available for inspection and for consultation by staff. The registered proprietors must ensure that the premises are kept in a good state of repair both internally and externally The registered provider must ensure that staffing levels at the home are at an appropriate level for the current needs of service users. (see standard 27). The registered provider must ensure that monthly monitoring visits are undertaken and copies of the reports given to the manager and sent to the CSCI (Timescale of 30/08/05 and 1/3/06 not met) This requirement is restated. The registered provider must ensure that the manager DS0000010671.V292077.R01.S.doc Timescale for action 30/11/06 2. OP18 31/10/06 3. OP38 23 30/11/06 4. OP27 18 31/10/06 5. OP33 26 30/11/06 6. OP36 18(2) 30/11/06 Elmhurst Version 5.1 Page 22 receives regular supervision and that this supervision is recorded. (Timescale of 31/08/05 and 1/3/06 not met) This requirement is restated. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elmhurst DS0000010671.V292077.R01.S.doc Version 5.1 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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