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Inspection on 21/01/09 for Elmleigh House Care Home

Also see our care home review for Elmleigh House Care Home for more information

This inspection was carried out on 21st January 2009.

CSCI found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

There appeared to be warm relationships between staff and residents and jovial exchanges were observed. Residents had opportunities to go out and attend different activities of their choosing. Residents also enjoyed annual holidays arranged by the home. There was regular contact maintained between residents and their families and friends. Residents spoke positively about being able to have their friends over to visit them. The homes that residents lived in appeared to well maintained and there was a rolling programme in place to ensure any required works were attended to.

What has improved since the last inspection?

There were suitable locks fitted on doors in the home to ensure residents could enjoy privacy as they chose. The flooring in one bedroom had been replaced to ensure it was easy clean. The records of residents monies were accurately maintained however records of valuables were not kept to ensure it was clear what was being safely kept on residents behalf.

What the care home could do better:

There were insufficient assessment processes in place to ensure that care plans were developed to meet all residents needs. There were a range of key deficits including social care, finances, healthcare There was poor recording of care needs in care plans with key areas such as medical conditions not being included and therefore there were no instructions to staff on how residents care need as would be met. Medications were not being stored or documented properly to ensure good practice was in place and two drug errors had occurred. The home is not ensuring that events which affect the well being of residents are being reported to the Commission for Social Care Inspection. Staff had commenced in post with out all required pre employment checks being completed potentially placing residents at risk as staff had worked unsupervised without a Criminal records Bureau check or references being obtained first. There is an inconsistent approach to staff training and some mandatory staff training was overdue at the time of our visit. There has been a poor response to ensuring that the requirements from previous reports have met and as a result we issued a Code B notice under the Police and Criminal Evidence Act to obtain copies of evidence to further consider enforcementwhere compliance has not been achieved.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Elmleigh House Care Home 133 Vernon Road Kirkby in Ashfield Nottinghamshire NG17 8ED     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Bridgette Hill     Date: 2 1 0 1 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 35 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 35 Information about the care home Name of care home: Address: Elmleigh House Care Home 133 Vernon Road Kirkby in Ashfield Nottinghamshire NG17 8ED 01623753837 01623478434 info@elmleighhomes.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Elmleigh Homes Limited Name of registered manager (if applicable) Mrs Susan Jane Beet Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: Elmleigh Homes Limited is registered to provide accommodation and personal care at 131a; 131b and 133 Elmleigh House Care Home for service users of both sexes who primary needs fall within the following categories and numbers: Learning Disabilities (22) Date of last inspection Brief description of the care home The home currently provides care for up to 22 residents who have learning disabilities. Elmleigh house offers accommodation to residents in 4 separate units situated on the same site. The largest unit has 13 bedrooms, one of these is a shared room. There are then 2 houses which offer 4 place in a domestic style house. The last unit is one bedroom unit which has an upstairs bedroom with a kitchenette/lounge on the ground floor. Unless a ground floor bedroom were available the home would not be suitable for people with mobility difficulties as all the properties have stairs. The home sits unobtrusively in a residential street, which is sited close to local shops, transport and other facilities. There is a private car park and a driveway at the property where visitors can park; it is also possible to park on the street. There are pleasant gardens Care Homes for Adults (18-65 years) Page 4 of 35 22 Over 65 0 care home 22 Brief description of the care home surrounding the property. Information about the home can be found in the managers office and the Manager told us each resident has a copy of the Service User Guide. Care Homes for Adults (18-65 years) Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This inspection was an unannounced one. The purpose of this inspection was to assess all key standards and compliance to previously listed requirements. Various records including care planning records were examined the findings are recorded in the body of this report. Discussions were held with residents and staff during the visit. A variety of documentation was also seen, including relevant policies and procedures, staffing files, training records and care records from service users homes. A process of case tracking was used, which involved selecting three service users and tracking the care they receive through review of their records and speaking to staff involved in their Care Homes for Adults (18-65 years) Page 6 of 35 care. An Annual Quality Assurance Assessment was completed by the Manager of the home prior to the visit and where relevant the content has been included in the body of this report. The Manager Sue Beet was on duty shortly after the inspection commenced. Prior to our visit we sent surveys to the home for residents, staff and relatives to tell us about the home. At the time of the inspection visit we had not received any back so arranged to collect some completed ones after our visit. The findings are included in this report. What the care home does well: What has improved since the last inspection? What they could do better: There were insufficient assessment processes in place to ensure that care plans were developed to meet all residents needs. There were a range of key deficits including social care, finances, healthcare There was poor recording of care needs in care plans with key areas such as medical conditions not being included and therefore there were no instructions to staff on how residents care need as would be met. Medications were not being stored or documented properly to ensure good practice was in place and two drug errors had occurred. The home is not ensuring that events which affect the well being of residents are being reported to the Commission for Social Care Inspection. Staff had commenced in post with out all required pre employment checks being completed potentially placing residents at risk as staff had worked unsupervised without a Criminal records Bureau check or references being obtained first. There is an inconsistent approach to staff training and some mandatory staff training was overdue at the time of our visit. There has been a poor response to ensuring that the requirements from previous reports have met and as a result we issued a Code B notice under the Police and Criminal Evidence Act to obtain copies of evidence to further consider enforcement Care Homes for Adults (18-65 years) Page 8 of 35 where compliance has not been achieved. 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 set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 9 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 10 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are insufficient needs assessments completed by the home and subsequently care plans and care delivery is not in place to meet all of the residents needs. Evidence: The Annual Quality Assurance Assessment completed by the Manager for this section did not give us the required information about how the home met standards in terms of the admission procedure in place or how service users were given information about the home. In the past year there have been two new admissions to the home. We looked at and discussed the assessment processes with the Manager. The surveys we received back were all ticked to say residents had been asked if they wanted to move into the home and that they had received enough information about the home. Few comments were recorded but one resident told us they had no concerns. The Manager told us they did not always assess the service users prior to admission Care Homes for Adults (18-65 years) Page 11 of 35 Evidence: but gathered information from Care Managers or other professionals as was had taken place in the care file we looked at. Upon admission to the home there was a long term needs assessment form which was completed. In the file we looked at this had not wholly been completed and significant gaps were evident on this such as the eating and drinking section did not record the special diet the resident requires for medical reasons. The dietary needs are included in the Social Services assessment. Other aspects where the resident had needs were also not completed such as vision and personal safety and risk. The needs identified were also documented in the communication records we looked at. We talked to one resident about their admission to the home and they told us they had visited prior to moving in. The Manager told us that residents were able to visit and have a meal at the home before being admitted. The Manager told us that residents had a copy of the Service User Guide in their bedrooms. We looked at a copy of the Service User Guide as part of our inspection. This included some pictures of the home and whilst it was well-detailed may not suitable for most residents as we were informed that the majority of residents had limited literacy skills. The office copy did not however include the range of charges that residents paid to receive a service. We were told that for each resident a copy is completed on admission which included details relevent to the individual resident. Care Homes for Adults (18-65 years) Page 12 of 35 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are significant deficits in risk assessments and the planning of care therefore residents needs may be unmet. Evidence: We looked at the care files of three residents during our visit to make an assessment of how needs were assessed, recorded and met. As part of planning prior to the visit we were aware that there had been significant deficits at our last visit on 4th September 2007 and at the visit made on 6th November 2006 where care plans and risk assessments were not in place. At the visit when it was apparent that this requirement was unmet. A Code B notice was issued under the Police and Criminal Evidence Act during the visit to remove some copies of care records. The Annual Quality Assurance Assessment told us that there were individual person centred plans to record peoples wishes on preferences of how they are cared for. Service users have the choice of when to bathe and go to bed and are given advice Care Homes for Adults (18-65 years) Page 13 of 35 Evidence: and support on any personal and/or hygiene care should they need it. They choose their own clothes, and get involved with all aspects of health care. We found that two different care plan formats were in place both appeared to be in use at the same time. This was potentially confusing to staff. One was a personal support plan which was being developed. This was aimed to be written in a style which was easy for the resident to read. This document tended to be well written in describing the residents hygiene needs and personal preferences. It was also established that despite two care documents in place none contained a full plan of care for all identified needs and the risk assessments that were needed. The records where residents had conditions such as diabetes or epilepsy did not include any risk assessments or care plans which detailed what action should take in medical emergencies. The Annual Quality Assurance Assessment completed by the manager told us that nutritional assessments were completed on residents. However we did not see any that had been competed despite one resident having a significant weight loss which was not fully being monitored. There were a range of areas where the care records we looked at did not contain informationon or consider the risks that were evident. This included where residents smoked, where residents were living supported at a distance from staff in adjacent properties, some risk assessment formats for Moving and handling, dependency, nutrition and falls. Ongoing communication records were kept by staff to record residents progress. These tended to be well-kept and informative however it was apparent from the content of these that GP visits, tests at hospitals and other healthcare needs were evident which did not form part of the residents plan of care. The storage of records was also fragmented with information being kept in different areas and folders about the same person. This may have contributed to poor recording and identifying of needs. None of the three care files we looked at considered or recorded residents abilities to deal with their own finances. Some monies were kept safely on residents behalf. These were found to be secure and correctly documented. There were also some documents which were kept safely on the residents behalf however there was not a record of what was being kept safely so it was not possible to establish if all the documents handed over by the resident were in fact there. Whilst some staff in the home had completed training on the Mental Capacity Act there Care Homes for Adults (18-65 years) Page 14 of 35 Evidence: were no records to indicate that assessments of residents capacity had been completed. We discussed this with the Manager who had completed training and had a trainers pack available but they were unsure if forms to complete this were included in the pack. Care Homes for Adults (18-65 years) Page 15 of 35 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents accessed a range of different activities in and out of the home according to their individual preferences and interests. Residents were able to maintain fulfilling relationships with friends and families. Evidence: All the residents at the home attended some day activities outside of the home. The home has minibus transport available that residents use to get out and about. All of the residents attended day centres, these were different according to the residents choices. One resident told us they enjoyed the Full Bloom project very much. Other day centres were used as well as voluntary work placement schemes for different residents with varying abilities and needs. Care Homes for Adults (18-65 years) Page 16 of 35 Evidence: The residents told us they had enjoyed holidays in the past whilst accompanied by staff from the home. These had been to different places. Some residents also enjoyed holidays with friends. Staffing at the home was available in the day time should a resident have alternative appointments or not be well enough to attend the day centres. Some residents had regular contact with families by visits out or with relatives visiting the home. We talked to residents who told us about the time they spent with family and friends in and out of the home and how they enjoyed this. One survey from a resident told how they liked visits with mum and dad. The communication logs we looked at recorded what contact residents had with families and friends. All residents we spoke with told the food was good and they had a choice. Meals were prepared in three of the properties for the residents. One resident told us they could make themselves a drink or snack when they liked as they had access and ability to do this. We talked to staff about special diets and they gave a good account of what diets residents required. They also told about how they described to residents with visual impairment about how the food was placed on their plates for examples your vegetables are at 12 oclock however this it was not included in this residents care plan that there visual impairment problems that affected the residents independence. Care Homes for Adults (18-65 years) Page 17 of 35 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is insufficient assessment, recording, and planning in place to ensure that service users healthcare needs met. Poor medicines management was evident which may impact adversely on the treatment service users receive. Evidence: We examined three care files to examine how residents healthcare needs were being met. From Social Services assessment information, communication and discussions with staff it was apparent that some residents had significant healthcare needs such as diabetes, weight loss, epilepsy and other serious illnesses that required medication and monitoring. Whilst the personal support plan for one person identified all the medical problems there was insufficient detail on how these were to be monitored. Another record for the resident indicated infrequent blood sugar level checks were being completed. Whilst the residents right to refuse was being respected there was not a plan in place to try to monitor the levels. Staff told us they tried to take blood sugar levels but did not record their attempts. Care Homes for Adults (18-65 years) Page 18 of 35 Evidence: We looked at the medicines management in the home. A monitored dosage system was in use. There was dedicated secure storage in place for medicines in 3 of the properties on site. One site had secure controlled drug storage. We looked at records for the controlled drugs and found that whilst some were on site they had not been entered into the controlled drug register. Throughout the day of the visit from arrival until it was discussed some drugs were left out on the desk in the office. The majority of drugs was recorded and checked in however there were some drugs where they were no ordered by the home and a supply was provided to the home by families where there were no records of what had been received. There were records of returns to pharmacy in a book. Inconsistent practices were observed for handwritten medication administration records as some had been checked and signed by two staff members - others had not. Since our last visit there has been a Safeguarding Adults strategy meeting held regarding medications being not being changed according to the Doctors instructions. One drug error had also been recorded where poor practice had occurred with staff administering two residents medication at the same time had been distracted and one resident had taken a different residents medication in error. This was against the practice which was described in the homes polices and procedures. This had not been reported to Commission for Social Care Inspection as is required by regulation 37. Staff had consulted NHS Direct about what action to take. We spoke to staff about medications training and was told that some in house training had been done on induction which was 5 years ago. The Manager also acknowledged that medications training for staff was due. We were told that one resident self-administered a medication prepared by the District Nurse and we asked to see the risk assessment in place for this. We were given a file with a care plan but no documented assessment of risk for the self-administration of medicines. Another care file we looked had a medication administration records that indicated one item was self administered. In the care file the manager could not provide us with a care plan which described why the treatment was prescribed, a care plan or risk assessment for the self administration. It was clear from the weight records we saw that the residents weight had dropped significantly over a 3 month period but that the weight of the resident had not checked since to ascertain if there had been any change over the past 3 months. According to the records no GP or dietitian referral had been made for an assessment of the weight loss. Some communication records also Care Homes for Adults (18-65 years) Page 19 of 35 Evidence: indicated that there was little monitoring of dietary intake. The appointment register for this resident was also not well kept with communication logs containing records of GP visits that were clearly documented on the appointments log. A review record we looked at which took place in August 2008 indicated that the resident had broken their glasses. On a board on the wall there a note to say the resident needed an optician appointment. We asked the manager if it had been completed and was told the appointment had not yet been made but would be made this week. The outcome for the resident is that they have been without glasses for an extended period as prompt action has not been taken by the home. There were also residents whose care we examined who had significant sensory impairments and healthcare conditions such as epilepsy, diabetes and other which were potentially life threatening. For these residents there was no risk assessments in place and care plans did not record how the needs were to be met. Outpatient appointments for tests were recorded in the communication logs and we discussed these with the Manager who was unable to tell us what the results from the tests were. Since our inspection we have received a letter from the Manager of the home to tell us that they are implementing a more robust procedure to ascertain our service users healthcare needs and assess any risks. The home tells us they are arranging GP appointments for check ups prioritizing those with greater identified health needs. Care Homes for Adults (18-65 years) Page 20 of 35 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Systems for managing complaints and allegations were in place so that the safety and interests of both service users and staff are satisfactorily promoted. Evidence: The Annual Quality Assurance Assessment completed by the Manager told us there is a clear and concise complaints policy and procedure of which everyone, staff, service users and families are aware. A complex picture format was also available although this was detailed and lengthy and no residents routinely used pictures as a way of communicating. The Annual Quality Assurance Assessment also recorded no complaints or Safeguarding Adults referrals in the past 12 months. Since the Annual Quality Assurance Assessment had been completed no complaints had been received but one Safeguarding Adults referral and investigation had taken place. This was regarding a medication that had been reviewed in an outpatient clinic but the new dosage of a drug; a reduction, had not been implemented. Letters detailing the change had been received by the home and GP but not actioned. It was recorded that the home had changed procedures since this occurrence to ensure this could not happen again. We discussed with the Manager the required reporting of events affecting the well being of residents to the Commission for Social Care Inspection as our planning Care Homes for Adults (18-65 years) Page 21 of 35 Evidence: indicated we were not aware of the safeguarding adult referral described above. The manager told us a form had not been completed. No regulation 37 form reporting of this or the medication error. This requirement is therefore unmet. Staff were able to tell us an appropriate account of what they would do if they suspected a residents was being abused and their training records included the dates they had completed training. Staff were able to vaguely tell about the whistle blowing procedure but were not wholly clear about this. When we looked at the whistle blowing policy it was included as part of the staff disciplinary procedure so is not wholly clear in the message it is giving to staff. Care Homes for Adults (18-65 years) Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this 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 home was found to be generally well maintained and provided a comfortable home for residents to live in. Evidence: The home is arranged in four separate units. The largest provides 13 places all with 11 individual bedrooms and one shared bedroom for residents and a range of lounges available. Two 4 bedded units are available in adjacent properties; one provides care for men the other for ladies. The final property is a small self-contained one-bedroom house with an open plan lounge/kitchen. All parts of the home were clean and tidy. The bedroom where there had been odours at the last visit had been fitted with new flooring which was easier to clean. A full time handyman is employed who was doing some decorating on the day we visited. The training matrix given to us indicated that some fire safety training had been completed but this was now due for updating. There were records of the fire checks that had been completed and servicing of the alarm and equipment was up to date. The Providers son told us that some new fire doors were on order to improve fire resistance of doors. In some of the houses the fire alarm consisted of domestic type smoke alarms, these appeared to be functioning but there was no records of any checks being completed on Care Homes for Adults (18-65 years) Page 23 of 35 Evidence: these. We were also told that there was not currently a fire risk assessment in place which was required by law and this was currently being organised. Residents told us they liked their bedrooms and had some of their own possessions in them. The residents were proud to show us the photographs of family and friends. Some residents had their own televisions and a range of videos that they liked. Bedrooms were personalised to each residents preferences. There were laundry facilities in each of the properties. These were large domestic style washers and dryers considered suitable for the number of residents. Care Homes for Adults (18-65 years) Page 24 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment practices do not ensure staff are safely recruited and suitable to work with vulnerable adults. Evidence: The home comprises of a complex of four separate buildings where residents are cared for. We looked at the staffing rotas and spoke to the Manager about staffing arrangements. Staffing levels appeared to be basic with 2 staff on duty during the day to care for residents who were not at day centres. In the afternoons from 3.00pm onwards until 9.00pm there were 4 staff, after 9.00pm there 3 staff who slept in at three of the properties. For the fourth property there was not any staff available unless they left an adjacent property unstaffed. We spoke to residents who told us they knew how to alert staff if they needed them and were happy with the arrangements in place. The care files however did not contain any risk assessments for a resident effectively living alone on site. The fire alarm was also not connected to the main property which meant should a fire break out staff could potentially be unaware of this. The rotas we looked at indicated that some staff were working excessively long continuous hours. One staff member was scheduled to work continuously from a Monday at 3.00pm to the Thursday at 9.00am. This was discussed with the Manager who said that as the working hours covered some sleeping time they considered this acceptable and the Care Homes for Adults (18-65 years) Page 25 of 35 Evidence: staff to be fit to work these hours. They also added that they were in the process of recruiting which should alleviate the need for staff to work such long hours. We looked at how the recruitment process was implemented and if this safeguarded the residents at the home. Two were of more recent employees. Both of these contained Criminal records Bureau and Pova first checks, completed application forms and references. The dates of the return of the references when checked against start dates on the staff rotas indicated that staff had commenced in post prior to some of the references being received back. For one staff member they had completed one shift induction then on the second shift on the rota worked as part of the usual numbers sleeping in one property in an unsupervised capacity, this was prior to any of the two references. The Pova first check had been received but the full Criminal records Bureau check hadnt. We discussed training with the Manager and looked a training matrix that was supplied to us. There were training records available for each staff member and a training matrix of what had been completed. Some staff mandatory training updates was overdue this included Moving and handling and fire safety. Some residents did use an over bath hoist to help them bathe. A skill-based induction record was available however the full workbook was not available in the home. The Manager told us that this was downloaded as required for staff to work through and that one staff member was currently in the process of completing this. The Annual Quality Assurance Assessment told us our staff are competent and more than 50 are trained to at least NVQ level 2 in health and social care, some higher and all staff attend courses and updates in all specific and mandatory areas of training. There were 8 care staff employed at the home of these there were 6 who had achieved a National Vocational Qualification to enable them to care for residents. This meets the National Minimum Standard of 50 of staff who are suitably qualified. We received one staff survey back that told us that staff received training. The staff member told us that what they considered the service did well was genuinely care about the service users who live at Elmleigh, peoples care and well being is a priority at Elmleigh always. Care Homes for Adults (18-65 years) Page 26 of 35 Care Homes for Adults (18-65 years) Page 27 of 35 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The deficits in the homes management systems directly affect the care and support residents receive and they may not have all their care needs met. Evidence: The Registered manager of the home has since our last visit completed a suitable managerial qualification. The Manager has worked at the home for 13 years, 10 of these as Manager. Staff told us they were approachable. It was evident from the observations of interactions with residents that there was a warm and positive relationship between residents and the manager. Residents appeared to be open and good-humoured conversations were held. This report has identified a range of areas where there is insufficient including the assessment process, risk assessment, care planning, medications and recruitment practices. Some of the shortcomings have been identified at the last 2 previous visits. Feedback was given after the inspection to the Providers son by telephone and in person. Assurances were given that requirements would be worked on and there was a Care Homes for Adults (18-65 years) Page 28 of 35 Evidence: willingness expressed to improve the level of record keeping that was in place. The Annual Quality Assurance Assessment received which the manager completed did not acknowledge the previously listed requirements or inform us what action had been taken to ensure the previous requirements were met. The Annual Quality Assurance Assessment told us that service users have regular meetings both individually and group to make choices about their lives e.g. where to go on holiday how they may want their bedroom decorating. The evidence at the home however was that one service user meeting had been held in the past year which was in January 2008. Surveys of residents and relatives had also been completed with positive feedback on the home being given. Some of the surveys were in a simplistic form but with words to describe what the resident was giving their opinion on. Regular monthly visits were made by the Providers son to monitor quality at the home. The notes on these were brief and whilst residents were spoken with the content of the conversations or topics discussed were not recorded. A limited range of records was also examined at each visit. The Manager told us the owner and his sons took an active role in the running of the home and were present for part of the inspection visit. Health and Safety records examined on the day were kept to demonstrate satisfactory management of Health and Safety, these included fire safety records, accident, incident, water outlet temperatures where full body immersion was possible, electrical circuit testing, portable electrical appliance testing and the gas safety certificate. Window restrictors were fitted on windows to prevent falls and radiators in the home were largely fitted with covers to prevent burns. Care Homes for Adults (18-65 years) Page 29 of 35 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 (4) (c) The registered person must 05/10/2007 ensure that risk assessments are completed on service users medical conditions and behaviour and indicate action to be taken by staff This requirement had a timescalec of 30/12/06 & 5/10/07, which has not been met. Enforcement action is now being considered. 2 18 15 (1) Care plans must be 05/10/2007 implemented as specified, as to how the service users needs in respect of his health and welfare are to be met. Priority areas are as follows: Pressure Area/tissue viability Management of Diabetes Dementia Care Epilepsy Management of Continence Mental Health needs Older persons needs . Challenging behaviour Care Homes for Adults (18-65 years) Page 30 of 35 This requirement had a timescalec of 30/12/06 & 5/10/07, which has not been met. Enforcement action is now being considered. 3 23 17,37 Ensure notifications are made as required by regulation 37 and safeguarding referrals to ensure service users are protected from harm. This requirement had a timescalec of 5/11/07, which has not been met. Enforcement action is now being considered. 05/11/2007 Care Homes for Adults (18-65 years) Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 2 14 There must be 27/02/2009 comprehensive assessments of prospective residents in place This is to ensure the home can meet the residents needs and a plan of care can be developed which meets all assessed needs 2 19 14 All residents healthcare 30/04/2009 needs must be assessed and plans of care and risks assessments be in place./ This is to ensure residents healthcare needs are met 3 20 13 All medications in the home must be stored securely. This is to ensure safe storage which limits the risk of theft, accidental ingestion or tampering of medications. 27/02/2009 4 20 13 All drugs received into the home, including controlled drugs must be recorded in and managed according to 27/02/2009 Care Homes for Adults (18-65 years) Page 32 of 35 Royal pharmaceutical Society Guidance This is to ensure robust auditing of medications can be implemented 5 24 23 All requirements described by the fire officers report must be met this must include a workplace fire risk assessment To ensure fire safety in the home is robustly managed 6 34 19 Staff must be robustly recruited and all required checks be in place before they work with residents This is to ensure the staff in post are suitable persons to work with vulnerable adults 7 35 18 All staff must receive a mandatory level of training to include moving and handling and fire safety This is to ensure they are competent and able to meet residents needs 27/03/2009 27/02/2009 31/07/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 1 The Statement of Purpose and Service Users Guide should be developed to provide it in a format which is suitable for the residents being cared for and should include the range of charges The Mental Capacity of residents should be assessed routinely and the care planning process should take into Page 33 of 35 2 9 Care Homes for Adults (18-65 years) account the decision making capacity of residents 3 20 For handwriiten medication records systems must be in place to ensure these are checked, signed and doubly checked to ensure accuracy A complaints procedure in a simple format should be developed to ensure it is accessible to residents who are not able to read. The whistle blowing procedure should not be presented to staff as part of the disciplinary procedure and should be a policy in its own right which informs staff of what they should do and the protection afforded to them for good faith whistle blowing reports they may make Checks of the smoke detectors should be recorded to evidence they are fully functioning Consideration should be given to the length of hours worked by some staff to ensure they are fit to work the long hours as indicated on the rota 4 22 5 23 6 7 24 32 Care Homes for Adults (18-65 years) Page 34 of 35 Helpline: 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 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) Commission for Social Care Inspection (CSCI). 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