Inspection on 17/01/07 for Elmhurst Private Nursing & Residential Home

This inspection was carried out on 17th January 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elmhurst Private Nursing &... 22/03/10

Elmhurst Private Nursing &... 17/03/09

Elmhurst Private Nursing &... 03/04/07

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Maple Lodge

Heathlands

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Ravenhurst

Bank House

Inspirations

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Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Elmhurst Private Nursing & Residential Home Prees Whitchurch Shropshire SY13 2EN Lead Inspector Mike Moloney Key Unannounced Inspection 17th January 2007 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 Private Nursing & Residential Home DS0000068427.V327871.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 Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmhurst Private Nursing & Residential Home Address Prees Whitchurch Shropshire SY13 2EN 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) 01948 841140 01948 841113 LDCG Limited *** Post Vacant *** Care Home 28 Category(ies) of Past or present drug dependence over 65 years registration, with number of age (6), Old age, not falling within any other of places category (17), Physical disability over 65 years of age (2), Terminally ill over 65 years of age (3) Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The home may accommodate a maximum of 28 older persons, of these a maximum of 6 may be suffering from dementia and a maximum of 3 may have a terminal illness. The home may accommodate up to 2 persons with a physical disability under 65 years of age. There must be at least 1 Registered Mental Nurse employed within the staff team. An application to register a manager must be submitted within 3 months of this certificate. Bedrooms must not accommodate more than 2 persons by end April 2007. This is a new registration. Date of last inspection Brief Description of the Service: Elmhurst is a privately owned care home, situated on the outskirts of the village of Prees in a very rural location with extensive views over farm land. It is registered to provide both personal and nursing care, for a maximum of 28 older people in single, double or four bedded rooms. Many rooms have direct access to the extensive lawned gardens and views of open countryside. The registered managers position is currently vacant but the home is being run by Jane Platt. Fees currently range from £440 a week to £520 a week Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. A range of evidence was used to make judgements about this service. This includes: information from the provider, records kept in the home, medication records, discussions with the staff team, tour of the premises, previous inspection reports and talking with as well as observing the care experienced by people using the service What the service does well: What has improved since the last inspection? 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 Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 6 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elmhurst Private Nursing & Residential Home DS0000068427.V327871.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 Private Nursing & Residential Home DS0000068427.V327871.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 Quality in this outcome area is good. Prospective residents have their needs assessed in a way that should enable the home to develop a full package of care for them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records of a service user recently admitted to the home were looked at and these were seen to contain an assessment of that person’s needs. The areas of potential need that were looked at included such things as communication, orientation, vision, hearing, sleeping, eating, drinking , etc. the assessments also covered areas relating to religious and cultural needs. This information was seen to have been used to create a service user plan and the risk assessments necessary to ensure that the needs of the individual were met. Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. The health and personal care is not always based on the individual needs that have been identified within a care plan. The principles of respect, dignity and privacy are put into practice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records for two service users were looked at. Both people were very poorly and unable to communicate because of this. Of the two files looked at only one was found to contain a care plan. The absence of the care plan was checked and confirmed by the Operations Manager. He went on to explain that this was an area of shortfall identified by the new owners and a new system of care planning had been developed for implementation across the group in the near future. Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 10 Risk assessments for a variety of activities were found within the files looked at. It was explained that these were to be reviewed as part of the introduction of the new care planning system. A visiting health care professional was spoken to during the inspection and he said that, in his experience, the staff at the home carried out any treatments that had been identified as being necessary for the well being of the individual service user. The procedures for managing and storing medication were also looked at. The records that were seen had been maintained accurately. The medication was kept in secure storage with special facilities and records for controlled drugs. The operations manager explained and the visiting GP confirmed that the home was currently reviewing its policies and procedures around medication. During the inspection staff were seen knocking on bedroom doors which were kept closed while personal care was being given. Screens were seen to be available in shared rooms. Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. Residents are not able to choose their social activities but can keep in contact with family and friends. Social, cultural and recreational activities not provided to meet resident’s expectations. Residents receive a healthy, varied diet according to their assessed requirement and choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care plans of the three service user records looked at showed little information about their interests. Their daily records since Christmas showed care needs being met and service users had received visits from their families. During the inspection the inspector was able to talk with two relatives of two different service users. Both said they were happy with the care their mothers receive. The menus for the last three weeks were seen. The meals offered to the service users were seen to be varied and were traditional in nature. The cook explained that she kept a list of peoples likes and dislikes so that she could Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 12 offer an alterative to people if necessary. She also talked knowledgeably about some of the special dietary needs that she had to cater for. Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. Residents do not have access to a robust, effective complaints procedure and are not fully protected from abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Operations Manager confirmed that he was not aware of any complaints having been made. The concerns and complaints book did not contain any. He also said that the Complaints policy was not available on site as all of the home’s policies were being reviewed and updated as a result of the audit carried out after the home had been taken over by the new provider. There had been no allegations referred within the local adult protection procedures. Staff stated that they had not received training in the how the vulnerable adults in their care should be protected from abuse and how they should go about reporting any concerns that they may have in this area. Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. The altering of the layout of the home so that rooms contain a maximum of two service users would help the home to further meet the needs of those living there in a safe, well-maintained and comfortable environment, which encourages independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is in a very rural position. There are good views over the landscape to the rear of the building through a series of ‘french’ windows leading from the lounge. The lounge has two areas that can be kept separate by partitions. There is a separate dining room next to the kitchen. The laundry area was seen to be appropriate. Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 15 The proprietor and his architect were in the home during the inspection and they outlined the plans around how the two four bedded rooms would be changed so that no rooms would accommodate more than two people. Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is good. Staff in the home are trained, skilled but not always in sufficient numbers to fulfil the aims of the home and meet the changing needs of residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The records of a number of the staff were looked at and these showed that background checks that are designed to reduce the chance of unsuitable staff working with vulnerable people had been carried out. Talking with a recently appointed member of staff confirmed that she had received induction training. In a later conversation with a senior member of staff she explained that the homes induction and foundation training had been reviewed and a new programme was about to be implemented. The staffing rota was seen and this showed appropriate staffing levels although on the day of the inspection the home was operating with one less staff than they needed. Staff commented that this had been a common occurrence in recent weeks. NVQ training records were not available on day of inspection but two of the three staff spoken to said that they have achieved NVQ 2 in care. Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33. 35, 36 and 38 Quality in this outcome area is poor. The management and administration of the home can not be said to be fully based on openness and respect as staff do not receive professional recorded supervision, the home does not have effective quality assurance systems as these are still being developed, or a competent professional manager until a nominee has been through the fit person process involved in registration with the Commission for Social Care Inspection. This judgement has been made using available evidence including a visit to this service. EVIDENCE: On the day of the inspection the manager was not available, however, the Operations Manager was present. Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 18 In talking with the staff they all expressed a positive attitude towards the way that the home was being run saying that they find the current manager and her managers approachable, friendly and helpful. Talking with the staff also identified that professional supervision does not take place and no record of any substitute activity could be found by the administrative staff. Staff also said that they have received or are receiving the mandatory safety training. However, later conversations with the senior management of the company confirmed that there was still some way to go in completing this process. The Operations Manager explained that a new quality assurance package is being developed and is to be implemented across the group soon. Staff confirm that Head of Care is a regular visitor. She had carried out a visit that is required under regulation 26 of the Care Homes Regulations 2001 the day before the inspection and the records showed that this was a monthly occurrence. The home does not hold cash for service users. Staff described how they check bath water temperature before bathing the service users. They also said that they were aware that the maintenance staff check the temperatures weekly. The temperature of the water from some of the baths was checked and found to be acceptable. Records that showed that fridge and freezer temperatures were monitored were seen to have been kept on a regular basis. Accident records seen in service user files. The records of fire equipment tests were seen to be up to date. Portable appliance tests were seen to have been carried out. Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 19 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 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 3 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 1 x 3 Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? no 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 15 (1) Requirement The registered person shall prepare a written plan as to how the service user’s needs in respect of health and welfare are to be met. The registered person shall prepare a written plan as to how the service user’s needs in respect of leisure activities The home shall establish a complaints procedure that contains all of the information required by the Care Homes Regulations 2001. The home must ensure that the staff have training in the identification and reporting of adult abuse. The home must ensure that staff are available numbers that are adequate to meet the needs of the service users. The registered person must establish and maintain a system for reviewing at appropriate intervals the quality of care provided at the nursing home. Care staff must receive formal supervision at least six times a DS0000068427.V327871.R01.S.doc Timescale for action 31/03/07 2 OP12 15(1) 31/03/07 3 OP16 22 28/02/07 4 OP18 18(1)c 30/04/07 5 OP27 18(1)a 28/02/07 6 OP33 24(1) 31/03/07 7 OP36 18(2) 28/02/07 Elmhurst Private Nursing & Residential Home Version 5.2 Page 21 year. 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 Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Shrewsbury Local Office 1st Floor, Chapter House South Abbey Lawn Abbey Foregate SHREWSBURY SY2 5DE 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. Extracts may not be used or reproduced without the express permission of CSCI Elmhurst Private Nursing & Residential Home DS0000068427.V327871.R01.S.doc Version 5.2 Page 23 - 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. 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