CARE HOMES FOR OLDER PEOPLE
Elmhurst 69 Pollard Lane Bradford West Yorkhsire BD2 4RW Lead Inspector
Sue Dunn Announced Inspection 8th November 2005 09:30 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 DS0000001241.V250476.R01.S.doc Version 5.0 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 DS0000001241.V250476.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Elmhurst Address 69 Pollard Lane Bradford West Yorkhsire BD2 4RW 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) 01274 638151 01274 634890 R & N Partners Mrs Deborah Fitzmaurice Care Home 22 Category(ies) of Past or present alcohol dependence (1), registration, with number Dementia - over 65 years of age (7), Old age, of places not falling within any other category (15), Physical disability (2), Physical disability over 65 years of age (7) Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 16 June 2005 Brief Description of the Service: Elmhurst is a pair of stone built Victorian style family houses converted to provide residential accommodation for 20 older people. The home has 10 single and 5 double rooms. Only one room, a single, has en-suite facilities. Accommodation is on three floors with access to the first floor by stair lift. The laundry and office are situated in the basement. A small neatly kept garden to the front of the house overlooks the road and offers a sitting area for clients. A conservatory to the rear of the building is used as the designated smoking area. The home is situated in the Bowling area of Bradford within walking distance of local shops, a park and a golf course. Parking is on the road. The home is one of two in the Bradford area owned by the same proprietors and employing family members. The two homes work closely together and the proprietors take an active interest in the day-to-day activities of the homes. Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector undertook the inspection, which was announced. The inspection started at 9.50am and finished at 5.15pm. The purpose of the inspection was to ensure the home was operating and being managed for the benefit and well being of the residents. There were 17 people in residence on the day of the inspection and two in hospital. A pre inspection questionnaire and comment cards were sent to the home before the inspection. Four residents, one relative and two professional visitors returned completed comment cards. All expressed satisfaction with the standard of care. Issues raised by an anonymous complainant prior to the inspection were investigated as part of the inspection process. The complaint was not upheld. What the service does well: What has improved since the last inspection? Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 6 All residents have an information booklet in their room, which informs them of the facilities, and services they can expect to receive. The assessments carried out by the home to see if they can meet the identified needs are more detailed therefore show the reasons why the home may have to refuse a person whose care needs they are unable to meet. More work is being done to obtain some background history of each person to help staff provide a more personal approach to care. The content of recording in the daily notes had improved and showed an understanding of the plan of care. A plan of care for a person who was unable to access the communal areas gave clear direction to show how social and emotional support was to be provided. All bedroom doors have been fitted with handles and locks, which provide security and privacy but can be opened quickly by each resident or a member of staff in an emergency. All the fire safety work has been completed to a satisfactory standard. The ground floor toilet has been enlarged making a great improvement to the facilities. The work has been completed to a high standard. 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. Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 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 DS0000001241.V250476.R01.S.doc Version 5.0 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): 1,2,3,4 People are able to make an informed decision about the home from the written information they receive and what they see when they visit the home. The home must first receiving a summary of the Care Management assessment and a copy of the Care Management Plan carried out by relevant professionals before admitting new service users EVIDENCE: A copy of the home’s welcome pack explaining what the home provides was seen in those bedrooms inspected. There was evidence to show that all residents now have a contract showing the terms and conditions of residency. One person had been admitted to the home without any information showing an assessment had been undertaken by a relevant professional, though the home had received assurances of short term funding. The manager was still trying to obtain this information. The home had carried out an assessment prior to admission to establish that they were able to meet the person’s needs. The content of home’s pre admission assessments had improved since the last inspection. The manager makes efforts to obtain more background information
Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 9 about people in order to meet needs other than basic health and personal care needs. Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Residents were satisfied that their health and social care needs were met and care plans provided clear and detailed instructions for staff to follow. Residents were treated with respect and their privacy was upheld. Staff had a good understanding of each person’s preferences. Some medication practices need closer scrutiny to avoid opportunity for potential error EVIDENCE: The written care plans showed a marked improvement with daily records showing evidence that the care plans were being followed. All the staff spoken with had good knowledge of personal preferences and routines and respected individual choices, giving people the opportunity to make decisions about their personal care on a day-to-day basis. One particularly good care plan had been developed to reduce the possibility of one person becoming socially isolated. Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 11 Residents who were spoken with and others who completed comment cards felt the food was good and they were safe and well cared for. Several people used the keys to their bedroom doors for security and privacy. Accident records were well recorded and showed the action taken. It is recommended that staff record how people have been raised from the floor after a fall The medication system was inspected and showed some areas in the recording systems, which needed improvement. For example as some records had been archived there was no record readily available to show when a GP had changed medication because the professional visitors contact sheet had not been completed. A subtraction error in the controlled medication book had not been picked up despite two staff signing over a period of time that they had checked the balance. The manager investigated the discrepancy and notified the CSCI inspector of her findings within hours of the inspection. Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Residents are encouraged to be part of the decision making process and make choices about their lifestyle. They are supported to maintain contact with family and friends and visitors are welcomed at the home. A good, varied and nutritious diet taking into account individual choices is provided at the home. EVIDENCE: The manager felt that there had been a very positive response from people who had attended the last residents meeting with suggestions made for colouring, jigsaws and making Christmas tags. The manager provides materials and equipment if people express an interest in particular activities. The social activity record showed a range of activities such as outings, domestic tasks, visitors and chatting and a good level of interaction was observed between residents and residents and staff. The dog and two birds provide interest and stimulation. The cook who has worked as a care worker in the home is familiar with the likes and dislikes of the residents. She was enthusiastic about food and had a range of cookery books, which she uses for inspiration and to offer variety. The lunch, which was sampled, was of a good standard, well cooked and tasty. The home has a monitoring form for those people who have poor appetites. To be effective the records should show how much has been eaten rather than what has been served.
Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 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): 16,17,18 Residents and their relatives have their views listened to, taken seriously and action is taken to resolve issues. Residents can be sure that their rights are protected and that they are safe from abuse. EVIDENCE: The home has a complaints procedure, takes any complaints seriously and if required will use the disciplinary procedure. A book is used to log any complaints. This should include any complaints investigated by the proprietor or the CSCI and give details of how they are handled. An anonymous complaint was investigated as part of the inspection process. The complaint was as follows:Residents were not given choice whether to have a bath or shower Staff were getting residents up at 5am Incorrect moving and handling Overseas staff made to sign long contracts. All the staff on duty were interviewed separately. Staff were able to name residents who had particular preferences for bath or shower including those who like both and will make a decision at the time of bathing. Staff were able to identify a small number of residents who wake very early and those who like to stay in bed until mid morning. They all stated that the
Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 14 early risers will be encouraged to return to bed after a cup of tea but this is not always successful. Each member of staff interviewed was able to describe how to use the moving and handling equipment and the circumstances when it was used. All had received moving and handling training. Overseas staff are employed through a recruitment agency and have work permits, which are specific to the company and on fixed term contracts of two years. Some staff have chosen to extend their contracts after agreement with the Home Office. None of the complaints was upheld. As the polling station has moved residents now use postal votes. A local candidate visited the home before the last election leaving leaflets for the residents. All the staff were spoken with and confirmed they had had in house training and a training booklet about adult protection. Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,22,23,24,25,26 The home offers a well-maintained environment, which provides a comfortable ‘homely’ atmosphere for the residents. Work has been undertaken to improve the toilet facilities. The home has limited bathing facilities but can offer choice of bath or shower. EVIDENCE: Work recommended by the fire safety officer had been completed to provided compartmentalised escape routes. Bedrooms were nicely personalised and bedroom doors had been fitted with new door handles and locks. Several residents had chosen to hold a key and locked their doors for security and privacy. All radiators, apart from those behind hand washbasins, had been fitted with covers. The proprietor is considering fitting low surface temperature radiators to the remaining few, which currently pose very little risk.
Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 16 The ground floor wc has been enlarged to create an accessible toilet, which allows sufficient space for staff to assist those people who need extra help with personal care. All areas affected by the refurbishment work have been made good and blend in well with the existing décor. The home was clean and warm but lacked soap and towels in the communal toilet areas on the first floor. This was brought to the attention of the cleaner who was working at the time of the inspection. The seat of a plastic wheeled chair on the first floor corridor was cracked and roughly repaired with parcel tape. This could pose a risk for anyone using it and should be repaired properly or removed from circulation. Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 The numbers and skill mix of staff were sufficient to meet the needs of the service users. Recruitment procedures are in place to protect service users but more could be done to provide evidence of a selection process, which provides equality of opportunity for candidates. Staff are trained and competent to do their jobs and showed a genuine interest in the well being of residents. EVIDENCE: The home has a stable core group of staff. All the staff on duty at the time of the inspection were interviewed individually. All displayed a good understanding of the residents, their routines and preferences and explained how they offered choice. All explained what had been covered in their fire, adult protection and moving and handling training and were able to describe how they would use equipment safely to assist in moving and handling. The recruitment and selection documentation was inspected for two relatively new members of staff. The selection process did not provide evidence to show that gaps in employment had been checked. It is recommended that there is more than one interviewer and notes be kept of questions and responses to ensure equality of opportunity and a robust selection procedure. Criminal Record Bureau checks are carried out on all staff before they are employed. The records showed the home provides sound induction training for new staff.
Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 18 Overseas staff are employed by the company on fixed term contracts. Work permits issued by the Home Office allow them to work only for the organisation. Staff are given the opportunity to extend their contracts, which one person had chosen to do. Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,32,33,34,38 The home is well managed and the manager is well able to discharge her responsibilities. She offers good leadership to the staff and ensures the residents are protected and cared for in a correct manner. EVIDENCE: The manager completed a City and Guilds managers’ award several years ago but is looking at the options of a suitable NVQ provider to enable her to do the NVQ4 award in Management. All the staff spoke highly of her leadership style finding her fair and sympathetic to personal circumstances. Staff said they had been invited to special events within her family circle. One person stated the manager would not allow standards of care to be compromised and would ‘come down hard’ if standards slipped.
Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 20 The home does not manage any residents finances but ensures those people handling finances provide residents with sufficient to meet their needs. The proprietors have carried out work in the home to improve the fire safety precautions. Systems are in place for carrying out and recording safety checks. Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 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 3 3 2 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 18 3 3 3 3 2 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 3 x x x 3 Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP3 Regulation 14 Requirement The home must first receive a summary of the Care Management assessment and a copy of the Care Management Plan carried out by relevant professionals before admitting new service users The manager must make satisfactory arrangements to ensure staff follow the procedures for safe handling of medication The bathing chair used to assist residents must not be used unless it is in a satisfactory state of repair Timescale for action 31/12/05 2 OP9 13 31/12/05 3 OP22 23 31/12/05 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
Elmhurst Refer to Standard 8 Good Practice Recommendations Accident record should show how staff raise people from
DS0000001241.V250476.R01.S.doc Version 5.0 Page 23 2 3 8,15 29 the floor after a fall. Food intake monitoring records should show the amount of food and fluid taken at each meal The staff interviews should be conducted in a way which provides evidence to show that the home supports equality of opportunity Elmhurst DS0000001241.V250476.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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