Inspection on 08/04/09 for Elmlea

This inspection was carried out on 8th April 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elmlea 02/04/08

Elmlea 01/05/07

Elmlea 10/10/06

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2009.

Key inspection report CARE HOME ADULTS 18-65 Elmlea 99 London Road Gloucester Glos GL1 3HH Lead Inspector Mr Paul Chapman Key Unannounced Inspection 8th and 16th April 2009 09:00 Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmlea Address 99 London Road Gloucester Glos GL1 3HH 01452 550438 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) www.holmleigh-care.co.uk Holmleigh Care Homes Ltd Manager post vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered provider may provide the following category of service only: Care home providing personal care only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability (Code LD) The maximum number of service users who can be accommodated is 8. Date of last inspection 2nd April 2008 Brief Description of the Service: Elmlea is a detached two storey, Victorian brick built property situated in Gloucester. There is off-road parking and a good-sized garden to the rear of the house. The home provides living accommodation on the ground and first floors. On the ground floor there is a lounge, kitchen, dining room, bathroom and one bedroom. On the first floor there are seven single bedrooms and a bathroom. Elmlea provides accommodation for up to eight people with learning disabilities that may also display behaviour that is challenging. The home is staffed 24 hours a day, seven days a week. The property is one of a group of seven registered care homes in Gloucestershire that are owned by Holmleigh Care. After parking to the rear of the property you enter the property through the front door. The garden has a couple of tables and chairs. The kitchen is a good size and people living at the home have access to it at all times. On leaving the kitchen and entering the rest of the property the door to the staff office is in front of you. Turning left into the rest of the property there is a bedroom on the left of the corridor with doors to the dining room and the lounge further down the corridor. Both the lounge and dining room provide people with substantial shared accommodation. Both rooms have large windows and high ceilings. The first floor is accessed from the stairs at the bottom of this corridor. It is a large, wide staircase that turns to the right as it ascends. At the top of the staircase (to the right) is a long corridor with a high ceiling that all of people’s Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 5 bedrooms and a bathroom are accessed from. The home has a Statement of Purpose and Service User Guide. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. This inspection site visit was completed over 2 days, the 8th and 16th April 2009. The acting manager was present at both of these visits. Before completing the site visit we received the completed AQAA (Annual Quality Assurance Assessment) from the acting manager. The AQAA asks a service provider to identify how they believe the service performs against the National Minimum Standards and how they evidence this. It also asks them to identify how the service has improved since the previous inspection, and their planned improvements for the coming 12 months. We review this information along with any other information we have collated about the service since the previous inspection was completed. This enables us to develop a hypothesis for the inspection site visit. On arrival at the home we were met by the care staff on duty, the acting manager arrived within 20 minutes. Whilst waiting for the acting manager we spent time in the communal areas observing what people were doing, and their relationships with the staff that support them. This showed people going about their day–to–day lives and preparing to go out. Relationships were seen to be positive and respectful with staff supporting them to make drinks and breakfast. The morning was spent with the acting manager and a senior support worker discussing staffing and the care of people in the home. During the afternoon we completed a tour of the home with a senior support worker and spoke to a new member of staff about their recruitment and training. At our 2nd visit we spoke to 3 staff speaking to about a range of subjects including activities people complete, how they safeguard people and the training that is offered by the organisation. What the service does well: The acting manager has introduced activity sheets for each of the people living in the home to identify what they wish to do and staff sign to confirm that the activity has taken place. This provided good evidence of people completing a wide range of activities. The senior support worker has developed an activities folder with brochures and leaflets of local attractions which supports people to make decisions about where they would like to go. The folder also asks staff to make comments on trips when they have been completed. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 7 Medication administration is thorough and minimises the potential risks to people in the home. All staff have received training in safeguarding vulnerable adults since the previous inspection was completed. The property provides people with a homely, comfortable and friendly environment that meets their current needs. The acting manager shows a good awareness of the needs of people with communication difficulties and is adapting practices and systems to meet people’s needs. People are able to choose what they would like to eat and the use of pictures enables people with communication difficulties to make choices. Peoples health needs are identified in their health booklets and this minimises the risk of peoples needs not being met. Staff training records are well-organised and show that as well as staff receiving training in aspects of health and safety they also receive training to meet the specialist needs of people living in the home. Health and safety records are comprehensive and show that people are not being put at unnecessary risk. What has improved since the last inspection? What they could do better: There are a wide range of care plans in place that provide staff with a good level of detail about peoples needs but due to them not being reviewed in 8 months it is impossible to confirm that they accurately reflect peoples current needs. The acting manager stated that they plan to review and re-write care plans. All the people living in the home have a wide range of risk assessments in place that minimise potential risks. As with peoples care plans these are in Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 8 need of review and it was impossible for us to confirm that people were not being put at unnecessary risks. Behaviour management plans must provide a greater level of detail about the actions taken when supporting a person whose behaviour may challenge. The acting manager should monitor the staff checking of fire safety equipment to ensure they are checking it as required. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 2 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service has an admissions policy which should ensure that any future admissions are managed consistently. EVIDENCE: There have not been any admissions to the service since the previous inspection was completed. The organisation has an admissions policy which was reviewed in October 2008. At the previous inspection we identified that the admissions policy did not accurately reflect the organisation’s management structure. This has been addressed as part of the review. As there have not been any admissions to the service it is impossible to make a judgement based on practice, but with a policy in place this should mean that future admissions are managed consistently. The manager explained that the Service User Guide will be updated and pictures added. The aim is to make this document more user friendly for people with communication difficulties. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are a wide range of care plans that are detailed but unfortunately they have not been reviewed since August 2008 and this makes it impossible to confirm they accurately reflect people’s current needs. People are supported to make choices and further planned developments in the home will increase the amount of choice available to people. Due to risk assessments not being reviewed since August 2008 it is impossible to confirm that people are not being put at unnecessary risks. EVIDENCE: We examined care plans for 3 of the people living in the home. The care plans we examined covered the following areas: - Communication, safe environment, mobility, eating and drinking, emotional needs, daily living skills, social skills, Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 12 cultural needs, meds, personal hygiene, accommodation requirements, financial, managing behaviour and activities. None of the care plans we examined had been reviewed since August 2008. The acting manager stated that they planned to introduce a new care planning format. They explained that they had looked at the current care plans and felt they provided a good level of detail for staff to follow (a requirement of the previous inspection report was to increase the level of detail in care plans, this was achieved by the previous registered manager). The acting manager explained they aim to introduce a system based on areas identified at present but also add sections on transport and health. A good practice the manager is going to introduce is identifying whether each person has the mental capacity to decide about their care plans. Speaking to the manager we expressed our concern about the care plans not being reviewed for almost 8 months. Our concern was that people’s needs may have changed and that the care plans may not now reflect that. The manager agreed with this and gave her assurances that the new care planning format will be introduced as a matter of urgency. This becomes a requirement of this inspection report. Staff have been working with people completing “Listen to me work books”. These are documents where people have the opportunity to highlight their hopes and dreams for the future. We examined a sample of these documents which showed they were mostly completed and their was clear evidence that staff had been completing them with people. Staff spoke about spending time with people discussing what they would like to do, and showed a good awareness of peoples communication needs. The manager explained that in the future these documents will be supported with pictures to support people with communication difficulties. Whilst examining these documents we identified some shortfalls, these were brought to the attention of the manager. All documents need dating and staff should be careful that the hopes and dreams identified are tangible, not just the day to day things (we saw examples of this). The work books should identify the steps to be taken (or taken) to achieve the long term goal. The acting manager is due to complete training in person centred planning (PCP) in the near future. After they have completed it they plan to cascade this training to senior support staff in the home. People living in the home have communication difficulties and staff are employing different methods to enable people to make decisions. An example of this is the food eaten by people in the home. The manager has recently reintroduced weekly house meetings and this is the place where people are asked what they would like to eat. To help make these choices there is a picture menu book (this will be developed by the manager and her staff over the coming months by using photos of the meals actually cooked in the home). People are asked to look at the pictures and show staff what they want as they Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 13 might find it difficult to verbalise what they would like to eat. A similar approach has been taken to enable people in making choices about the activities they wish to take part in. Staff have been collecting leaflets for the various activities and places of interest locally. This will also continue to be developed. There are a wide range of risk assessments in place for each person living in the home. Examining a range of these documents showed that as with the care plans they had not been reviewed since August 2008. The acting manager must take action to address this as people could be placed at unnecessary risk. This becomes a requirement of this inspection report. 2 requirements were made against this outcome group at the previous inspection. The first was to ensure care plans provide staff with sufficient detail to enable them to meet people’s needs consistently. The second was to ensure that each person had comprehensive risk assessments to minimise potential risks in their day-to-day lives. Although we have made requirements against these 2 areas on this occasion the evidence shows that these requirements were met. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): This is what people staying in this care home experience: 12, 13, 15, 16, 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The range of activities available in the home have increased and people living in the home are empowered to make choices about what they would like to do. People living in the home are supported to make choices about what they would like to eat and the menus showed that there are good range of meals made available to people. EVIDENCE: As mentioned earlier in this report one of the senior support staff has created an Activities folder. As well as providing people with pictures/leaflets for activities staff are asked to comment on the activity once they have completed it. This is a good practice and helps in providing good evidence of what the activity was like for people. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 15 Speaking to staff and examining records showed the following. One person gets a paper each day, people go swimming regularly, horse riding, there are day service trips out. In addition to this there are regular activities that are 1 to 1 with staff and whilst we were at the home a person went for lunch at a local pub. People living in the home are encouraged to be involved in chores around the home. Examples of this include staff supporting people to be involved in the house’s grocery shopping, vacuuming, dusting and loading the dishwasher. The AQAA completed by the manager stated that they wished key-workers to be pro-active in identifying the personal interests of people in the home. We asked the manager how this will be achieved. The manager explained that each week key-workers will meet with people and speak to them about activities they can do, and ask them what they would like to do. When speaking to staff they were in agreement that the range of activities available to people has increased recently. There is an aim to develop a storage cupboard in the dining room with games/activities for people to do. Records provided good evidence of peoples relatives and friends being made welcome in the home. At the time of the site visit a relative was being invited for lunch at the weekend. House meetings have been re-introduced recently and we were able to see the minutes for 2 meetings. The minutes provided good evidence of people being asked what activities they would like to take part in. This information was then seen to be transferred to the weekly activity sheets, staff are expected to sign confirming an activity has taken place, and if it has not they must give a reason. In addition to people being asked what they would like to do, they were also asked what they would like to eat. Staff said that up until recently there had been a rolling rota menu, but this needed to be changed to allow people to have own choice. The manager stated that menus were about to be changed to reflect what people have chosen. Notes by staff provided good records of what people have actually eaten. The menu’s we examined showed a good range of meals being provided. Where people have specialist dietary needs we saw good evidence of needs being met, with specialist food being prepared and forward planning so a person could attend a party. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. It is impossible to confirm that peoples personal care needs are being met as the care plans have not been reviewed since August 2008. Peoples health needs have been identified by staff and this minimises the risk of peoples needs not being addressed appropriately. Medication administration is managed effectively minimising potential risks to people living in the home. EVIDENCE: People’s personal care needs are detailed within their care plans. As identified earlier in this report care plans have not been reviewed since August 2008 and it is therefore impossible to confirm whether the care plans accurately reflect peoples current needs. It becomes a requirement of this inspection report that these care plans are reviewed and re-written as required. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 17 Each of the people we case-tracked had a completed Health booklet. This provides other health professionals with detailed information on the person’s needs, their likes and dislikes and any relevant health information. When speaking to staff they spoke about spending time talking to parents about the health booklets, and there was evidence of parents signing the document in agreement with the information. In addition to the health booklet staff also complete a hospital risk assessment. Looking at both of these documents they contain very similar information and we recommend that the hospital risk assessment should be disposed of because the information is already held in the health booklet. We examined the home’s medication administration. All medication is checked by an appropriately qualified member of staff when it enters the home. Any medication that needs to be returned to the pharmacist is recorded in a specified book. The manager explained it is planned that all staff qualified to administer medication will have their competency assessed 6 monthly. A new monthly medication audit form was introduced in the month of this site visit. Records showed that another form of audits had been completed for the last 3 months. Where errors have been identified corrective actions have been taken. All staff complete training in medication administration before they are allowed to administer medication. We spoke to a new member of staff who confirmed this was the practice. The manager stated that although they have already completed medication training, along with one of the senior support workers they will be attending additional medication training at the end of the month. The previous inspection report made a requirement against standard 20. The manager was to update the medication procedure to ensure that staff knew what to do in an emergency. Medication procedures have been reviewed and since the previous inspection was completed and this has now been addressed. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is insufficient detail in the behaviour management plans to enable staff to respond consistently when supporting people whose behaviour may challenge. People’s financial records are comprehensive and minimises potential risks to people living in the home. EVIDENCE: There is a copy of the home’s user friendly complaints procedure on the notice board in the dining room. There has been one complaint made to the manager since the previous inspection was completed and the records we examined showed that it had been dealt with appropriately. As identified earlier in this report people in the home have communication difficulties and when speaking to a member of staff we asked how they could recognise if a person was unhappy if they could not verbalise it. The member of staff’s response showed that they had a good understanding of how someone may display they were unhappy, and the steps they would take to ensure the person was safe. All of the people in the home have behaviour management plans. There is a traffic light system in place that details different indicators for people’s behaviours. There is also a 13 step risk assessment in place that provides more detail. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 19 Looking at the detail in these documents it was agreed with the manager that they need to be reviewed. Current plans do not provide staff with information about how they should react when people’s behaviour becomes challenging and what techniques should be used to maintain the person’s safety. This becomes a requirement of this report. Speaking with the manager they stated they have introduced body map charts that staff are expected to complete when they find a mark/bruise. There is an expectation that staff will follow this process through tracking the improvement of the mark or bruise. This is a good practice and will help to minimise potential risks to people living in the home. Staff receive training in safeguarding adults and each member of staff is given a copy of the alerter’s guide. A copy is also kept on the notice board in the dining room. We examined a sample of records for people’s income and expenditure and the home’s petty cash. These were seen to be clear and precise. All transactions are signed by 2 staff, and all monies are checked 3 times a day by 2 staff to ensure they are correct. We sampled 3 people’s personal financial records and all were seen to be correct at the time of this site visit. The manager showed good awareness of ensuring that people’s monies do not build up and the importance of people being involved in withdrawing or depositing money at the bank. They explained that they plan people will be supported by staff to visit a local bank and be involved in this process. The previous inspection report made two requirements against standard 23. The 1st requirement was to ensure that a sufficient number of staff are trained in Positive Behaviour management (PBM) to enable them to meet people’s needs safely. Training records we examined at this site visit showed that 9 of the staff including the manager have completed PBM training in the past 12 months. The 2nd requirement was to review the system for recording the financial transactions for people living in the home. Examination of records showed that this has been achieved. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in a comfortable, homely, clean and well maintained environment that meets their current needs. EVIDENCE: A tour of the premises was completed with the senior support worker. All of the communal areas were seen. The home is decorated to a high standard throughout and has been made to feel very homely by the manager and her staff. There is a separate lounge and dining room. In the lounge there is a range of comfortable furniture, a digital TV, DVD and stereo. In the dining room in addition to the tables where people eat their meals there is a large notice board that is filled with peoples art work, and part of a wall has been made into a chalk board for people to use as they like. The manager explained Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 21 that they would like to develop the dining room to make it into another room where people can sit and relax. To achieve this they plan to purchase some comfortable furniture and a TV, etc. This would be a positive development for the home as it would provide people with more than 1 room with comfortable furniture to relax in. This becomes a recommendation of this report. The home’s kitchen was replaced before we completed the previous site visit. It is maintained to a high standard and was seen to be clean and hygienic on both occasions we visited. A small table has been added in the kitchen and staff spoke how 1 person now sits there to have their breakfast. This is enabling to become more independent in that it allows them to become more involved in getting their own breakfast. The hall and stairway carpet is becoming a little worn in places and should be included in the home’s maintenance programme for replacement. This becomes a recommendation of this report The home has 2 bathrooms. 1 on the ground floor that is a “wet room”, at the previous site visit we noticed there was no lock on this room. This was seen to be addressed at this site visit. The 2nd bathroom is on the 1st floor and was seen to be decorated to a high standard. A requirement of the previous inspection report was for the patio to the rear of the property to be replaced because it was uneven. This has been replaced. 3 people allowed us to see their bedrooms. 1 person’s bedroom had recently been decorated and the other 2 we saw were decorated to a good standard. All of the bedrooms we saw reflected the needs and interests of the people to whom they belonged. The home has a dedicated laundry with industrial standard washing and drying machines. At the time of this site visit the home was clean and hygienic throughout. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home benefit from a team that are regularly supervised and receive training to meet peoples needs and minimise potential risks in the home. EVIDENCE: The staff team consists of 9 staff plus the acting manager. Speaking with the 2 new staff they both confirmed that they had completed application forms and had been interviewed. Staff recruitment records are held centrally at the organisation’s head office with the agreement of the CQC and where not examined on this occasion. Examination of staff training records that showed the following: - Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 23 The manager receives a training matrix each month that highlights what training staff have completed and when they are required to complete refresher training. The sample of staff training records we examined provided good evidence that when new staff start at the home they complete a thorough induction package which includes topics seen as statutory (An introduction into learning disabilities, moving and handling, equality and diversity, first aid, fire awareness, health and safety and food hygiene). We spoke to 2 new members of staff who confirmed that they had completed this training and when they first started they shadowed established staff for a week. Training records for other staff showed that certificates for completed training were available providing good evidence of staff completing a wide range of training. A new supervision format is being introduced. All staff will have a contract of supervision with the manager, there is a set agenda, and the manager informs head office that supervision has been completed. It is aimed that staff will have supervision every 6 to 8 weeks. A sample of staff supervision dates showed that staff have been receiving supervision within these timescales. Staff annual appraisals are in the process of being completed. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 40, 42 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The acting manager is approachable, well-organised and enthusiastic to improve the quality of the service provided at the home. Quality assurance procedures are in place which help to ensure continuous improvement and evidence that the service is led by the needs of the people living in the home. The home’s policies and procedures have been reviewed since the previous site visit and are now being developed to be more user friendly. Health and safety procedures and staff training minimise potential risks to peoples safety in the home. EVIDENCE: Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 25 The acting manager is in the process of applying for registration with the CQC to become a registered manager. Speaking to the personnel manager at the organisation’s head office they stated that they were waiting for 1 document to be returned and hoped the application would be submitted in the week following this site visit. The acting manager has extensive experience of working with this client group and has previously been a registered manager with the CSCI for a similar establishment. Since the manager has been in post they have addressed a number of issues to improve the quality of the service being provided. Examples of this are the ongoing development of person centred plans, Health files, increasing the amount of activities available to people and empowering people to make choices. The AQAA they completed and this site visit provided good evidence of the manager’s good practice and plans for developing the service in the future. It is clear that the manager advocates that the service is led by the needs of the people in the home, and that where ever possible they will be empowered to makes decisions. From conversations with staff during our site visits it was clear that the staff team are enthusiastic to provide a good quality service in the home, this is part is down to the acting manager’s approach. Team members spoke about the manager being approachable and “really good”. Other comments included “staff morale is really good”. Where a service provider is not in day to day charge of the service the regulations state that an unannounced visit must be completed monthly by a representative of the provider. Records seen by us showed that these visits are being completed monthly by a consultant employed by the organisation. These visits are unannounced. The reports provide good detail of what was seen and sets targets for manager to achieve. Evidence seen during this inspection showed that these targets being achieved. Other quality assurance procedures were not examined in detail on this occasion. The manager’s plans for a system of auditing outcomes for people in the future should provide good evidence supporting the quality of the service being provided. As highlighted earlier in this report (evidence seen about choosing activities and food) are good examples of the service being led by the needs/wishes of people in the home. This will form an important part of evidencing the service’s quality in the future. The AQAA highlighted that all policies were reviewed in January 2009. On the 2nd day of our site visit a number of policies and documents had been reviewed and made more user friendly with the addition of pictures and symbols. Speaking to the manager it was agreed that in addition to adding pictures and symbols to the documents the wording should be reviewed making them more precise and shorter. All staff are asked to sign a document confirming they have read the policies. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 26 The acting manager has set up a new maintenance file containing all of the contact details for contracted engineers used by the home. This will minimise the risk of maintenance issues being delayed due to the manager not being on duty. In the week before this site visit the home was visited by an Environmental Health officer. One shortfall was identified, and this had been addressed by the time we completed our site visit. We examined fire safety equipment checks completed by the staff. Records showed that the equipment had not been checked in the past 2 weeks. The manager was unaware of this but explained that up until the week before this inspection 1 member of staff had been tasked with completing checks weekly, but this had now been increased to 2. The manager should monitor this to ensure that future checks are completed. There are detailed risk assessments in place to cover the use of cleaning products in the home. These are supported by data sheets. The manager has completed a wide range of environmental risk assessments to cover potential risks to people around the home. These assessments also highlight strategies for minimising potential risks. In addition to risk assessments, health and safety procedures and training the following regular checks are completed: - Fridge and freezer temperatures are recorded twice daily, a food probe is used to test cooked meats and hot water outlets are tested regularly. Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 2 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 2 2 2 X 3 X 3 3 X 3 X Version 5.2 Page 28 Elmlea DS0000067437.V375100.R01.S.doc No 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 YA6 Regulation 15(2)b Requirement Care plans must be reviewed to ensure that they accurately reflect peoples current needs. Failure to review peoples care plans increases the risk of their needs not being met. 2. YA9 13(4)b, c Risk assessments must be reviewed to ensure that they identify current potential risks and the strategies to minimise those potential risks. Failure to review peoples risk assessments may put people at unacceptable risks. 3. YA18 15(2)b Care plans to address peoples personal care needs must be reviewed to ensure that they accurately reflect current needs. Failure to review peoples care plans increases the risk of their needs not being met. 4. YA23 13(4)c, (7) Behaviour management plans must be reviewed to ensure that they provide staff with the DS0000067437.V375100.R01.S.doc Timescale for action 19/06/09 29/05/09 19/06/09 29/05/09 Elmlea Version 5.2 Page 29 following information: Guidelines must be in place to show how staff are expected to react when people’s behaviour becomes challenging. Guidelines must be in place detailing what techniques should be used to maintain the person’s safety (and staffs) when a person’s behaviour becomes challenging. 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 YA6 Good Practice Recommendations The “Listen to me” workbooks should be dated when they are updated/completed. The hopes and dream identified in the documents should be tangible and not just day to day activities they occur regularly. Staff should record the steps they take on the way to achieving the goal. The information contained in the hospital risk assessment in duplicated in the home’s health booklet. The home should dispose with the hospital risk assessment. A new carpet for the stairs and landing should be included as part of the home’s maintenance programme. New furniture should be purchased for the dining room to provide people with another comfortable area to relax if they wish. When making policies and procedures more user friendly with the addition of pictures the text should also be reviewed to ensure it is plain English. The manager should monitor the fire safety checks completed by the staff to ensure they are completed regularly. 2. 3. 4. 5. 6. YA19 YA24 YA24 YA40 YA42 Elmlea DS0000067437.V375100.R01.S.doc Version 5.2 Page 30 Care Quality Commission South West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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