Inspection on 06/02/07 for Elmhurst

This inspection was carried out on 6th February 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 14/04/08

Elmhurst 04/04/07

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 Angela Dalton Unannounced Inspection 6th February 2007 10:15 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.V330120.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.V330120.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.V330120.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. 21st February 2006 Date of last inspection Brief Description of the Service: Operated by Quantum Care Limited, the voluntary organisation that is the provider with the largest number of care homes in Hertfordshire, 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 that has a mainline railway station and a wide range of shops and other amenities. There is adequate car parking space in front of the building but this is shared with a day centre next to the home and often full. Elmhurst’s weekly charges range from £440 to £620 per week Elmhurst DS0000019335.V330120.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was conducted by two inspectors on 6th February 2007. Inspectors spoke with service users, staff and relatives and toured the building. Service users spoke highly of the care they received and staff had a good rapport with individuals which was evident in the conversations overheard. Staff morale has been affected by a recent adult protection incident (which was still undergoing investigation on the day of inspection) but recovery is underway as the team are working together to overcome this recent challenge. The home is currently being managed by two Operational Managers in the absence of a registered manager. This post is currently being advertised. Medication was not inspected on this occasion as the pharmacy inspector employed by the Commission has recently visited the home and will review the requirements made during their visit. The requirements will be included within this report. An action plan has been received but an additional visit by the pharmacy inspector has not yet taken place to review this response. What the service does well: What has improved since the last inspection? A maintenance programme is ongoing: new carpets have been fitted, new curtains are on order and redecoration has occurred or is planned. Armchairs are being replaced which will more appropriately meet service users’ needs. Elmhurst has implemented a no smoking policy for staff and the staff smoking room has been converted into a clinical/medication room. Elmhurst DS0000019335.V330120.R01.S.doc Version 5.2 Page 6 Staffing levels have been reviewed during the day to enable the activities coordinator to be better supported and ensure service users receive a consistent level of care. The operational managers have identified areas within the home that require improvement. The recently devised Quantum Care document mirrored inspectors’ findings during the site visit. 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.V330120.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.V330120.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 Standard 6 is not applicable. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are assessed prior to their admission to ensure that the home will be able to meet their needs. EVIDENCE: Assessments form the foundation for care plans and are conducted by members of the management team. This ensures that the home is able to meet service users’ needs. All service users will be assessed prior to admission to the home but some have additional assessments conducted if funded by Social Services. Assessments are held separately from the care plan but are available for reference if required. Elmhurst DS0000019335.V330120.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): 7,8,10 Standard 9 has not been inspected on this occasion but requirements from pharmacy inspection are incorporated. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans require a little development to illustrate how health care needs are met. Dignity of service users must be better observed. EVIDENCE: Care plans are descriptive and informative but some areas require expansion. This would better illustrate the in depth knowledge and high quality care that is delivered by staff. Examples of areas that require expansion are management of oedema, catheter care (including fluid intake), pain management, palliative care and management of digestive disorders such as diverticulitis. Improvement is needed in meeting some individual care needs: one service user who has a catheter fitted was not receiving adequate fluids and had no drinks in their room for staff to offer whenever they were passing. Two hourly gaps were evident on the fluid monitoring chart and it was apparent that they were passing very little urine. Some service users had swollen legs and feet Elmhurst DS0000019335.V330120.R01.S.doc Version 5.2 Page 10 but had no way of elevating their legs, as footstools were not readily available. A number of female service users were not wearing tights or stockings despite the weather being cold. One toilet had no toilet paper or hand towels available (some sheets of toilet paper had been place on a high shelf) as a service user reportedly emptied containers repeatedly. Call bells continually sounded throughout the home and are heard in every unit even if it does not relate to that area. There is no way to differentiate between floors. It is recommended that this be reviewed. Call bells were not identifiable as being in use in the lounges to enable staff assistance to be summoned if required. Elmhurst DS0000019335.V330120.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): 12,13,14,15 Quality in this outcome area is good – an exception to this is a recommendation made relating to the availability of menus. This judgement has been made using available evidence including a visit to this service. Service users have access to a variety of internal and external activities. A choice of meals is available. Flexible contact with friends and family is maintained. EVIDENCE: An activities co-ordinator offers a variety of activities that service users can participate in, either within a group or independently. Records are kept to identify which activities have been popular and those that have been unsuccessful. Plans are underway to transform the ‘dayroom’ into an activities room. This will provide a designated area for service users to participate in a range of leisure pursuits together rather than just in individual units. Relatives whom inspectors spoke with confirmed that they were made to feel welcome within the home and that visiting times were flexible. Lunch was sampled and found to be hot and tasty; a choice of two dishes was available. Staff supported service users appropriately and service users who were sat together at a table were served as a group (as opposed to individual service users sat separately which detracts from the meal as a social event as people finish at different times). Condiments were available and second Elmhurst DS0000019335.V330120.R01.S.doc Version 5.2 Page 12 helpings were offered. Staff assisted those who required help in a gentle and patient manner and were sat next to the service user as opposed to standing over them. Menus were not available to assist staff to inform service users the choices available for lunch: options are advertised the previous day. A recommendation has been made to have menus available in a service user format. This would be a valuable opportunity as Quantum Care operates a four week rolling menu (with seasonal alterations). Elmhurst DS0000019335.V330120.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): 16,18 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 protect service users from abuse. A complaints protocol is implemented and service users and staff feel comfortable to use this where necessary. EVIDENCE: A protocol for recording and effectively dealing with complaints is in place. Paperwork is currently being updated to reflect the Commission’s correct details owing to a recent change of address. Service users confirmed that they were aware of the process as did relatives and stated they were confident to use it. Service users were aware of recent changes within the management team and knew who the acting managers were and said they had found them approachable. Service users have regular meetings where concerns can be shared. Regular relatives forums are also held to ensure that family and friends are able to meet with members of the home management team and senior management within Quantum Care. The home has recent experience of an adult protection issue which was handled appropriately. Staff are aware of the local inter agency protocol should Elmhurst DS0000019335.V330120.R01.S.doc Version 5.2 Page 14 they have any concerns. The company Whistleblowing procedure supports staff to raise any concerns that they may have about the care of a service user. Elmhurst DS0000019335.V330120.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): 19,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. An ongoing maintenance programme is ensuring that service users live in a well maintained environment. Improvements are needed to protect service users and staff from poor infection control issues. EVIDENCE: A maintenance programme is being implemented. New carpets have been fitted and armchairs are being replaced. New curtains are on order and redecoration is taking place or planned for the near future depending on the location of the unit. The home was odour free and found to be clean and tidy with the exception of a smeared television screen in one of the lounges. The operational managers have consulted with service users and staff regarding the home improvements that are being introduced. Elmhurst DS0000019335.V330120.R01.S.doc Version 5.2 Page 16 Some infection control issues require attention: the sealant strip over a join in the laundry floor is missing and poses a cross infection risk, especially as the washing machine is currently leaking. As discussed earlier one toilet has no hand towels available and it is not evident how staff or service users are able to dry their hands. On one of the units the dishwasher was not working effectively and the table has been laid with unclean cutlery and glassware. Elmhurst DS0000019335.V330120.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): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate staffing numbers ensure that service users’ needs are met during the day but levels should be reviewed at night. A solid recruitment process ensures the safety of service users. Regular training equips staff to meet the needs of service users. EVIDENCE: Adequate numbers of staff are employed during the day and staff are focused upon meeting the needs of service users. Positive interaction was observed on each unit and staff know service users’ individual requirements. One staff member brought the unit’s cat over to a service user which gave them a great deal of pleasure. Staff were also observed to be completing paperwork sitting with service users as opposed to out in the corridor which enabled them to continue to engage with each other. A recruitment programme is currently underway to fill staff vacancies: a number of staff are ‘pending’ whilst employment checks are made. Regular agency staff are employed to cover the current vacancies. Recruitment documentation was examined and found to be in good order. Regular training ensures that staff are equipped to meet the needs of service users and 60 of staff have achieved an NVQ (National Vocation Award) level 2 or above. Elmhurst DS0000019335.V330120.R01.S.doc Version 5.2 Page 18 A recommendation has been made to review staff numbers at night – currently only four staff members cover the whole home: one for each unit (including a manager). This results in levels dropping when a member of staff takes their break or goes to the assistance of a colleague. Some care plans identify that service users require two members of staff to assist with hoisting or to meet other needs (such as supervision) and it appears that staff are often required to work in pairs. Elmhurst DS0000019335.V330120.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): 31,33,35,38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Adequate short term management cover is being provided in the absence of a registered manager. Some attention is required to health and safety to ensure the protection of service users and staff. EVIDENCE: The home is currently without a registered manager but this post is being advertised. Quantum Care have a history of ensuring registration is applied for on the employment of a manager. Two Operational Managers are currently overseeing management responsibilities and monitoring the ongoing adult protection issue. As stated earlier service users, relatives and staff could Elmhurst DS0000019335.V330120.R01.S.doc Version 5.2 Page 20 identify the acting managers and felt comfortable in raising concerns with them. Some attention is required to health and safety to ensure the protection of service users and staff. As already reported earlier the laundry floor sealant is missing and this poses both a trip hazard and a risk to infection control. The washing machine is leaking and although an engineer visited during the course of the inspection he is not due to return for six days and meanwhile the machine continues to leak. Aditionally there was no evidence of water temperature checks available during the inspection: although the temperature of hot water was within the safe range it was far lower in one part of the building for those wanting a warmer bath or shower. Emergency lighting checks had not been conducted since October 2006 and this must be addressed. Two doors in the kitchen were held open with door wedges whilst a dining room door on one of the units was held open with a chair. This practice must ceaseas it presents a fire risk. Elmhurst DS0000019335.V330120.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 2 8 2 9 X 10 2 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 X X X X X X 2 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 2 Elmhurst DS0000019335.V330120.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. 2. 3. Standard OP7 OP8 OP9 Regulation 12 12 17(1)(a) Sch 3 Requirement Care plans must reflect how service users’ health needs are identified and met. The health requirements of all service users must be monitored and managed. The requirements made as a result of the pharmacy inspector’s visit on 11th January 2007 must be met. The dignity of all service users must be observed and assured. Infection control measures must protect staff and service users. Once a manager has been appointed an application to register with the commission for Social Care inspection must be applied for. The health and safety of staff and service users must be assured. Timescale for action 31/05/07 31/03/07 28/02/07 4. 5. 6. OP10 OP26 OP31 12 13(3) 8 28/03/07 28/02/07 31/05/07 7. OP38 13(4) 31/03/07 Elmhurst DS0000019335.V330120.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. Refer to Standard OP15 OP27 Good Practice Recommendations Menus should be displayed to orientate service users and staff to meal options available. The staffing levels available at night should be reviewed. Elmhurst DS0000019335.V330120.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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