Inspection on 04/04/07 for Elmhurst

This inspection was carried out on 4th April 2007.

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 14/04/08

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 6NF Lead Inspector Jeffrey Orange Unannounced Inspection 4th April 2007 09:05 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 DS0000019335.V335125.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 DS0000019335.V335125.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmhurst Address Windhill Bishops Stortford Hertfordshire CM23 6NF 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 Manager post vacant 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) Elmhurst DS0000019335.V335125.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The DE variation applies to one named service user only. The Commission must be notified when the service user reaches the age of 65 or leaves the service - whichever occurs first. 27th February 2007 Date of last inspection 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 service users. 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 £555 to £650 per week. (Correct at April 2007) 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. Elmhurst DS0000019335.V335125.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over the morning and afternoon and provided an opportunity to speak to service users, staff and visitors to the home, together with the augmented management team that have recently been responsible for the home pending the appointment of a new manager. It was also possible during this visit to inspect key records, including those for staff recruitment, service user care planning and medication and to tour the premises. This inspection has also been informed by any information received by the CSCI since the previous key inspection in February 2007 as well as the ongoing vulnerable adult safeguarding process underway following a serious incident at the home in January. One of the CSCI’s Pharmacy Inspectors accompanied the link inspector for the home during this visit. What the service does well: What has improved since the last inspection? The process of refurbishment, mentioned in the previous report has continued and on the day of this visit, new chairs were being delivered and curtains fitted throughout the home. Most importantly, the standard of medication administration in the home, which recently gave rise to very serious concerns, has been considerably Elmhurst DS0000019335.V335125.R01.S.doc Version 5.2 Page 6 improved. This is as a result of a concerted and focussed effort by the staff team and Quantum Care to address a series of significant failings in good practice. The requirements made following the previous key inspection in respect of healthcare and the dignity and respect of service users have now been met. Although the staff team are obviously still deeply affected by the events of January, in speaking to them there was a very real sense of commitment to improvement and optimism for the future. What they could do better: 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 DS0000019335.V335125.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 DS0000019335.V335125.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): Standards 1 and 3. (Standard 6 does not apply to Elmhurst) Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The information provided for prospective service users is clear and detailed and ensures that a well-informed judgement can be made about the home, what is offered and what the terms and conditions that apply are. The assessment process is through and should ensure that only those whose needs can be appropriately met, are admitted to Elmhurst. EVIDENCE: The Quantum Care “Personal Guide” was read through and found not only to include the minimum required information but also additional detail, all in a very clear and accessible format. Elmhurst DS0000019335.V335125.R01.S.doc Version 5.2 Page 9 A series of assessment files for recently admitted service users were seen and these contained the detailed information that staff would require in order to both identify and meet service user’s needs. Elmhurst DS0000019335.V335125.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7 8 9 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Care plans are adequate but require further development to improve the quality and consistency of the information contained in them to assist staff to be better able to identify and meet service users changing care needs. Service users have access to the community and acute healthcare services they require to meet their changing healthcare needs. Medication is currently being safely administered by staff to service users. Service users’ right to receive care in a dignified and respectful manner is recognised both in theory and practice. EVIDENCE: Following a detailed inspection of medication records by a CSCI pharmacy inspector, no requirements or recommendation have had to be made as Elmhurst DS0000019335.V335125.R01.S.doc Version 5.2 Page 11 satisfactory action has been taken to meet all previous requirements, with a marked improvement in all areas. There were omissions and inconsistencies in some of the care plans seen, these were discussed with the management team and it is understood that action will be taken. Care plans contain evidence of the involvement of a range of healthcare professionals with service users and the home. Service users spoken to confirmed their access to and experience of GP, routine and acute healthcare services. The way that care was observed throughout this inspection visit and talking to staff about care issues, did not give rise to any concerns about how care is provided. Service users were very positive in their comments about the staff. “They look after us very well, even though they are always very busy” was one comment made. Elmhurst DS0000019335.V335125.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users can access a range of varied activities and have a choice of meals and where they eat. Service user contact with friends and families is encouraged and facilitated. One recommendation relating to the wider availability of menus is carried forward from the previous inspection as it is felt that if implemented this would benefit service users. EVIDENCE: On the day of inspection a session of bingo was organised and there were photographs of various recent trips and activities on display throughout the home. The home employs dedicated activities organisers and offers a variety of activities that service users can participate in, either within a group or independently, details of the activities programme is on display in the home. Elmhurst DS0000019335.V335125.R01.S.doc Version 5.2 Page 13 Those service users who wished to were being assisted to attend a celebration of the Eucharist during this visit. Lunch was observed to be undertaken in pleasant surroundings, with staff offering appropriate assistance where required. Elmhurst DS0000019335.V335125.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Procedures are in place to safeguard service users. There is a comprehensive complaints protocol in place which service users and staff appear comfortable about using. EVIDENCE: The complaints protocol is well publicised and accessible. There are regular service user meetings and forums held where service users and their relatives can raise any issues of concern. Relatives spoken with confirmed that they knew about the complaints procedure and what to do if they needed to make a complaint, and all said that they felt confident that they could raise any matter with the manager or staff at any time. Quantum Care are fully co-operating with an ongoing investigation currently being undertaken under Hertfordshire County Council’s safeguarding procedure. Elmhurst DS0000019335.V335125.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): Standards 19 20 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users live in a comfortable, clean and safe environment. EVIDENCE: There were no problems with unpleasant odour on the day of this visit and the home was found to be clean and tidy. New furniture has been provided including lounge chairs that were being delivered on the day of the visit. New curtains were also being fitted and these helped make the communal areas appear bright and well co-ordinated. Lighting in the corridors has also been improved. Elmhurst DS0000019335.V335125.R01.S.doc Version 5.2 Page 16 The home has addressed the concerns previously expressed about hygiene in the laundry and there were appropriate hand washing materials available in all bathrooms and toilets seen throughout the home. Elmhurst DS0000019335.V335125.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): Standards 27 28 29 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The numbers and quality of staff are such as to provide a good level of care and to adequately meet service user’s needs at most times. Call bell response times are already monitored, this should be reviewed to ensure that everything that can be done is being done to reduce these as far as is possible. The recruitment system in place provides confidence to service users that they are being appropriately safeguarded from the employment of unsuitable individuals to care for them. EVIDENCE: Staff recruitment files were seen for recently employed staff and were found to contain the necessary documentation and evidence of a robust system of preemployment checks being undertaken. Staff training schedules were seen and members of the staff team were spoken with and this confirmed that a comprehensive range of training is available to staff, including NVQ and dementia care training, as well as the routine training and updating of training to ensure that staff have the skills they require to enable them to appropriately meet the needs of service users at all times. Elmhurst DS0000019335.V335125.R01.S.doc Version 5.2 Page 18 During this visit some call bell response times were longer than what is understood to be the target time. As call bells on each floor can be heard on all floors, prolonged response times can be particularly disturbing for service users. Following a review of staffing levels at night, the home feel that these remain adequate. Staffing is maintained at previously accepted levels. However one service user noted that “They are always running, they don’t have enough time”. Nonetheless, the majority of service users spoken to were very appreciative of the way that their care was delivered. Several members of staff were looking forward to the recruitment of more permanent staff to fill existing vacancies. This will provide greater consistency for service users although agency staff, when used, are often familiar with the home and its routines. Staff morale appeared to be recovering from the understandable knock it took after a recent incident in the home. Those members of staff spoken with had an impressive commitment to personal improvement and development and to providing a high standard of personal care for service users. Elmhurst DS0000019335.V335125.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): Standards 31 33 35 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. With the recent appointment of an experienced manager to the home and with the continued input for the time being from the operational management team, the home appears to be well managed and throughout recent challenges and difficulties. The well being of service users has been central to decisions made. EVIDENCE: Quantum Care have made use of a pharmacy consultant to help improve medication practice in the home. Elmhurst DS0000019335.V335125.R01.S.doc Version 5.2 Page 20 The new manager has not yet completed the application process for registration with the CSCI as manager for Elmhurst, although she has considerable experience in managing care homes and has previously been registered with the CSCI. Although only recently taking up her new post she has already built good relationships with both service users and staff and several positive comments from both groups were received during this inspection. Previous issues with health and safety have been satisfactorily addressed. Staff spoken with confirmed that supervision takes place and that they feel well supported by the management team. Elmhurst DS0000019335.V335125.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 4 X 3 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 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 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 2 X 3 X 3 X X 3 Elmhurst DS0000019335.V335125.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 OP7 Regulation 12 Requirement Care plans must consistently reflect how service users’ health needs are identified, reviewed and met. This requirement has not yet been fully met and is carried forward with a revised timescale. Once a manager has been appointed an application to register with the Commission for Social Care Inspection must be made. This requirement has not yet been met and is carried forward with a revised timescale. Timescale for action 31/07/07 2. OP31 8 31/07/07 Elmhurst DS0000019335.V335125.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. Refer to Standard OP15 Good Practice Recommendations Menus should be displayed to orientate service users and staff to meal options available. This recommendation has been carried forward from the last inspection. The manager should review the monitoring of call bell response times to identify if any action can be taken to reduce these where it is possible to do so. 2 OP27 Elmhurst DS0000019335.V335125.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Hertfordshire Area 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. 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