Inspection on 24/05/05 for Elmhurst Residential Home

This inspection was carried out on 24th May 2005.

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 Residential Home 27/06/07

Elmhurst Residential Home 21/09/06

Elmhurst Residential Home 27/09/05

Elmhurst Residential Home 21/10/04

Elmhurst Residential Home 15/06/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE ELMHURST RESIDENTIAL HOME 81-83 Holden Road Woodside Park London N12 7DP Lead Inspector Tom McKervey Announced 24 May 2005 @ 09.15am 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 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 RESIDENTIAL HOME Version 1.10 Page 3 SERVICE INFORMATION Name of service Elmhurst Residential Home Address 81-83 Holden Road, Woodside Park, London N12 7DP Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8445 6501 020 8446 5419 Bernadette Tisdall Elaine Tisdall PC Care Home only 30 Category(ies) of DE(E) Dementia over 65 registration, with number OP Old Age of places ELMHURST RESIDENTIAL HOME Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 11 May 2005 Brief Description of the Service: Elmhurst is a privately run care home, first registered in 1967 for 30 older people, some of whom may have dementia. The stated aim of the home is to promote the dignity and privacy of service users who are frail and have dementia, thus ensuring their maximum quality of life.The home is a large two storey, detached building. The bedrooms are located on both floors. There are twelve single bedrooms and nine double bedrooms. Three bedrooms have ensuite facilities. A passenger lift provides access to the first floor. The communal lounge, dining area, office, laundry and kitchen are all on the ground floor. At the front of the building there is a large car park, and there is an attractive garden at the rear of the building, which is partly paved and accessible to service users. The home is located in an attractive residential area of North Finchley and close to Woodside Park tube station. It is well served by a variety of shops, restaurants, transport and other community facilities located along Ballards Lane and High Road in North Finchley. ELMHURST RESIDENTIAL HOME Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection had originally been scheduled to take place on the 12 May 2005. However, on the 11 May, a serious anonymous allegation about the conduct of a member of staff was sent to the Commission for Social Care Inspection, which necessitated an immediate investigation. The inspection was therefore, postponed until the 24 May 05. The outcome of the investigation, was that the allegation was not substantiated. This inspection was completed in a period of six-and-a-half hours. The registered manager was present throughout the inspection and fully cooperated in the process. The process consisted of a tour of the home, discussions with the manager and staff, discussions with service users, a relative, and a visiting professional. Service users’ case files and documents pertaining to the running of the home were also examined as part of the inspection process. Prior to the inspection, twenty-four comment cards from service users, fifteen from relatives and eight from healthcare and other professionals who have contact with the home, were sent to the Commission for Social Care Inspection. What the service does well: What has improved since the last inspection? Several areas of the home have been redecorated since the last inspection, and requirements relating to providing a restrictor on a service user’s bedroom window and the need for complete staff’s records, had been complied with. ELMHURST RESIDENTIAL HOME Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. ELMHURST RESIDENTIAL HOME Version 1.10 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 Standards Statutory Requirements Identified During the Inspection ELMHURST RESIDENTIAL HOME Version 1.10 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 standard(s) 2, 3, 5 & 6 There is good information about the service, and prior visits to the home, to enable service users and their representatives to form balanced judgements about their choice of home. EVIDENCE: The records of three new service users contained contracts of terms and conditions. These were signed by service users’ representatives. Comprehensive assessments were recorded in the three case files seen. The home’s assessments were conducted by the manager and the deputy. Care managers’ assessments were also provided, where appropriate. A care review of a service user’s placement six months after admission, was carried out by a care manager. The report stated, “Mr. C’s family and myself are satisfied with the level and standard of care provided. The home offers a warm, sociable, yet professional environment”. One relative who was spoken to, stated that she had visited the home on behalf of the service user, before deciding on the placement. The inspector was informed that a potential new service user had visited the home three times recently. ELMHURST RESIDENTIAL HOME Version 1.10 Page 9 A relative who sent comments to the Commission for Social Care Inspection, stated, “My mother is settled, well cared for and happy. I have real peace of mind knowing she is in safe hands”. Standard 6 does not apply, as the home does not provide intermediate care. ELMHURST RESIDENTIAL HOME Version 1.10 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 standard(s) 7, 8, 9, & 10 The healthcare needs of service users are being met by a full range of healthcare professionals, and there are good systems in place for the safe administration of medicines. However, the privacy of two of the service users is compromised by their room being used for other service users’ medical appointments. EVIDENCE: ELMHURST RESIDENTIAL HOME Version 1.10 Page 11 Four care plans were examined. They were well constructed and clear. The plans were reviewed monthly. The daily records supported the care plans by recording the actions identified in the plans. There were manual handling risk assessments recorded. The files contained records of healthcare appointments, including visits by the. G..P, and district nurse, and hospital attendance. Other professionals, included opticians and dentists. There was evidence that the weights of the service users were being monitored. None of the service users were self-medicating. The MAR sheets were accurately maintained. Two service users were prescribed Controlled Drugs, which were recorded in a special register. The tablets were counted and tallied with the register. One service user was prescribed insulin, which was administered by the district nurse. The insulin was appropriately stored in the fridge. The temperature of the medication cupboard was being monitored. The inspector was able to converse with four service users. They stated that the staff were very kind and caring and treated them with respect. Through discussion with a relative, and observation of staff/service user interaction, the inspector was able to confirm this. The inspector was concerned to find that a ground-floor double bedroom was being used as a consultation room for all the service users, by G.P’s when they visited the home. This practice is unacceptable, as it prevents access by the two occupants of the room, during G.P sessions. The manager agreed to stop this practice immediately. ELMHURST RESIDENTIAL HOME Version 1.10 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 standard(s) 12, 13, 14 & 15 Service users enjoy a good quality of life in the home, with a good range of appropriate activities, which they can choose to participate in. Service users are provided with sufficient, wholesome and well presented meals. EVIDENCE: There was an activities programme for service users. These included music, exercise and art and craft sessions. An occupational therapy session is held twice a week. The therapist, who conducts sessions on keep-fit, reminiscence and reality orientation, was spoken to during the inspection. A mobile library visits the home and some service users also attend church on Sundays and the “Wednesday Club”, held in the community. The inspector was informed that a religious service is held once a month in the home. ELMHURST RESIDENTIAL HOME Version 1.10 Page 13 The home’s visiting policy is open with relatives able to visit whenever they wish. During the inspection the inspector spoke to a relative and received positive feedback from other relatives/visitors in writing. The visitors book, indicated that there is an open visiting policy. During the inspection, a relative informed the inspector that she was always warmly welcomed by staff with a cup of tea. Other positive feedback was received from relatives/visitors in writing. Service users who were spoken to stated that they were able to rise and go to bed when they preferred. They also stated that they could choose their meals. Some service users preferred not to participate in organised activities and would rather stay in their rooms, reading or watching television. Evidence of choices and decisions was seen in service users’ daily records. The kitchen was clean, well equipped and well stocked. The record of daily fridge and freezer temperatures was satisfactory. There was a record of food served, and the menu was varied and balanced including choices. Service users spoken to, stated that they were generally satisfied with the quality and quantity of food served. The inspector joined a group of service users for lunch. The meals were nutritious, hot and well presented. The inspector observed some service users being supported by staff to eat. This was done in an unhurried and dignified manner. ELMHURST RESIDENTIAL HOME Version 1.10 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 Service users’ best interests and welfare are protected by appropriate procedures, and by staff training. EVIDENCE: The complaints procedure contains the Commission for Social Care Inspection’s contact details and response times for dealing with complaints. There were four complaints logged for the past twelve months. The complaints had been appropriately responded to. Six service users and on relative were spoken to, all of whom stated that they had no complaints, and were happy with the service provided. An anonymous complaint about the conduct of a member of staff had been sent to the Commission for Social Care Inspection. It was also alleged that staff had been warned by managers about what they said to inspectors. Two inspectors carried out an investigation of these allegations, which involved interviewing every member of staff in the home, in private and independently. There was no corroborative evidence found to substantiate the allegations. Another anonymous allegation was made that there is no hot water available, especially on Tuesdays. This inspection, which took place on a Tuesday, included testing the temperature of the water and this complaint was not substantiated. (See Standard 19 below). ELMHURST RESIDENTIAL HOME Version 1.10 Page 15 Service users who were spoken to, stated that they felt safe in the home and that they were treated well. Staff records showed that they had training in adult protection and abuse awareness. Four staff who were spoken to independently, stated that they were aware of their responsibilities on the subject of abuse. ELMHURST RESIDENTIAL HOME Version 1.10 Page 16 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 standard(s) 19, 20, 23, 24 & 26 Service users benefit from living in a generally well-maintained, homely and safe environment. A service user’s comfort is compromised by poor ventilation in their bedroom, and a rug in the lounge is a potential health and safety hazard. EVIDENCE: A tour of the premises was carried out. There is a good standard of internal décor throughout the home. There were attractive hanging flower baskets at the front of the home. The garden looked very attractive and was well maintained. The fire safety equipment had been serviced in the past year, and there were records of weekly fire alarm tests. The furniture and light fittings were domestic in type. The armchairs and sofas in the communal lounge were comfortable and in a good state of repair However, the window frames at the front of the building need repainting, and there was a cracked windowpane in room 18. ELMHURST RESIDENTIAL HOME Version 1.10 Page 17 A large rug in the communal lounge was frayed in places and needs to be repaired or disposed of. There is a well-equipped and spacious laundry, which was very clean and tidy at the time of the inspection. Three single and two double bedrooms were visited. They were attractively decorated and there was evidence of personal possessions. There were portable screens in the double rooms to ensure privacy. In room 18, only one window could be opened, which did not allow for adequate ventilation. A requirement was made to allow for at least one other window to be opened. The hot water was found to be 44 degrees centigrade, which was slightly too hot. This was immediately adjusted by the maintenance person, to 43C, which is the standard maximum requirement. At the time of the inspection, the home was clean and tidy and there were no unpleasant odours. There is a control of infection policy in place and disposable aprons and gloves are provided for staff. ELMHURST RESIDENTIAL HOME Version 1.10 Page 18 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Service users needs are being met by sufficient numbers of staff who are properly recruited and trained. EVIDENCE: The staff rota was examined. There are two deputy managers in post. The rota showed that six care staff are normally on duty during the daytime, and three waking night staff. Care staff are supported by cooks, cleaners and a laundry worker. The manager stated that when there are no vacancies, care staff levels are increased to seven per shift. The records of four most recently recruited staff were examined. The records contained satisfactory proof of identity and CRB/POVA clearances. Four staff were spoken to independently. They were able to describe their roles and were aware of their responsibilities. There was evidence in staff records and in discussion with the inspector, that new staff are appropriately inducted on the home’s policies and procedures. There were records of training in the care of people with dementia TOPPS induction and foundation programmes are provided, and several staff are on the NVQ programme. ELMHURST RESIDENTIAL HOME Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 32, 33, 36, 37 & 38 EVIDENCE: The manager is a qualified nurse and has extensive experience of running the home. She is supported by two deputy managers who take responsibility for specific areas such as medication, staff management and induction, care planning and record keeping. The manager stated that she was undertaking training on NVQ 4 this year. Service users, a relative, and staff who were spoken to, stated that the manager was very approachable and sensitive to their needs. Confidence in the competence of the manager was expressed and there were efficient lines of accountability. The inspector was shown completed questionnaires from service users and relatives, which had recently been undertaken as an audit of the quality of the ELMHURST RESIDENTIAL HOME Version 1.10 Page 20 service. However, this had not been summarised and an action plan made, based on the outcome of the survey. The inspector noted that staff supervision took the form of staff being observed performing particular tasks, e.g., supporting a service user taking a bath. However, formal supervision as outlined in Standard 36.3, does not take place. A good standard of record keeping was noted. Records were well structured, up to date and clear. Important documents were securely stored, and a current certificate of employer’s liability was on display. COSHH substances were stored securely, there were records of fire drills, and the fire alarms were tested weekly, The water storage tanks had been cleaned and tested for legionella. A satisfactory safety test had been conducted on all portable electrical appliances in the home. There were safety certificates for gas and electrical appliances. Recommendations by the environmental health officer had been complied with. The lift had been serviced within the past year. ELMHURST RESIDENTIAL HOME Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 2 x x 3 3 x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 3 3 2 x x 2 3 3 ELMHURST RESIDENTIAL HOME Version 1.10 Page 22 Yes 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 10 Regulation 12(4)(A) Requirement Timescale for action 31/5/05 2. 19 13(4) & 23(2)(b) The registered person must ensure that serice users are attended to in their own rooms by health professionals, or a separate medical room is provided. 31/7/05 The registered person must ensure that: 1.The rug in the lounge is disposed of. 2. The woodwork at the front of the building is repainted. 3. temperature of the hot water in the bedrooms does not exceed 43C. 4. The windowpane in Room 18 is replaced and at least two windows in that room can be opened. The registered person must complete the audit of the quality of the service and send the results of the survey to the CSCI. The previous timescale for this requirement, was 31/12/04. This requirement has been restated. The registered person must prepare a business and Version 1.10 3. 33 24(1)(2) 31/7/05 4. 33 25 31/7/05 ELMHURST RESIDENTIAL HOME Page 23 5. 36 18(2) development plan for the home, a copy of which, must be sent to the CSCI. The previous timescale for this requirement, was 31/12/04. This requirement has been restated. The registered person must ensure that staff receive at least six formal supervision sessions per year, as outlined in Standard 36.3 31/7/05 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. Refer to Standard Good Practice Recommendations ELMHURST RESIDENTIAL HOME Version 1.10 Page 24 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate London N14 6HA National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI ELMHURST RESIDENTIAL HOME Version 1.10 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!