Inspection on 26/04/05 for Elms House

This inspection was carried out on 26th April 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elms House 18/10/05

Elms House 27/10/04

Elms House 15/06/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 Elms House 24/26 Woone Lane Clitheroe Lancashire BB7 1BG Lead Inspector Jane Craig Unannounced 26 April 2005 09:00 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Elms House Address 24/26 Woone Lane Clitheroe Lancashire BB7 1BG 01200 424263 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Joanne Brown Care Home only Personal Care 6 Category(ies) of Learning disability (LD) 6 registration, with number of places Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 27/10/04 Brief Description of the Service: Elms House provides care for up to six adults with a learning disability. The home is privately owned by Mrs Joanne Brown, who has responsibility for managing the service on a day to day basis. Elms House is a terraced property in a residential area close to Clitheroe town centre. A bus stop is located near to the home and there are small shops, a church and swimming baths within walking distance. The house has a small front garden with a bench seat, shrubs and flowers. The garden leads directly on to the street at the front of the house, where there is roadside parking. There are two small yards at the rear, with some garden furniture. Access for people using wheelchairs is at the rear of the house. There are four single bedrooms and one shared room. None of the rooms have en-suite facilities but there is a bathroom and WC on both floors. There is a steep staircase to the upper floor. Communal areas on the ground floor include two lounges, a dining room and domestic sized kitchen. Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first unannounced inspection of 2005 and took place over one day. At the time there were 6 residents living in the home. Elms House is one of two homes in a scheme owned by the registered person. Staff are employed to work in both homes and residents spend time together on organised trips and holidays. Residents from West View may also join residents at Elms House for meetings and occasional meals. During the course of the inspection, the inspector met with all of the residents. Some were able to engage in discussions and make verbal comments about the home. The views of others were gained from observation of their reactions and communications with staff. The inspector spoke with two members of staff, the owner (registered person) and a professional visiting the home. A tour of the premises took place and a number of documents and records were viewed. What the service does well: Staff helped residents to find ways to spend their time. Some went out regularly to places in the town, others preferred to do activities in the home. Staff could help residents to find voluntary work if they wanted. Residents had a lot of opportunities to tell staff what they liked or disliked about the home and they felt that staff took notice of them. One resident said “I’m sure that Joanne (the registered person) would always do her best to make things better.” There were good relationships between the residents and staff. Each resident chose their own keyworker to help them with their plans and to talk to if they had problems. One resident said, “I get on with all of the staff, they are all very good.” Another said, “I am very, very happy here.” Residents had health check ups every year with their nurse. Any problems were acted upon. One resident said, “they look after me better here than in hospital.” Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 7 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 Standards Statutory Requirements Identified During the Inspection Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 8 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) EVIDENCE: There had been no new residents admitted since the last inspection, therefore the key standard was not assessed and will be looked at during the next inspection. Other standards have been consistently met during previous inspections to the home. Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 9 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6 and 9 Improvements in the person centred care planning process enabled residents to be involved in goal setting and care planning in accordance with their wishes. The format of new documents had enhanced the systems for reviewing and recording care. The risk assessment and management framework supported residents to take responsible risks. EVIDENCE: New person centred plans had been introduced. The plans included residents’ own thoughts on their strengths, needs and goals. Residents could be as involved in drawing up the plans as they wished. One resident said that he had long talks with his key worker about his likes and dislikes. Another said that he knew a bit about the plan but preferred to let Joanne (his keyworker) do it. 2 of the residents were case tracked and their care plans examined. The plans provided staff with detailed directions to assist residents to meet their daily living needs and work towards longer-term goals. The plans were reviewed every six months following a meeting with the resident and any supporters or other professionals they may wish to be involved. Plans were amended between times if the residents’ needs changed. Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 10 The practice of the home was to support responsible risk taking and policies stated that the role of staff was to facilitate independence. One member of staff said that it was important that risks were thoroughly explained to the resident to help them make choices and then the ways of dealing with risk were a compromise. Detailed risk assessments and management strategies covered activities indoors and in the wider community and were included on residents’ plans. Keeping safe outside the home was the subject of a recent residents discussion group and one resident said that he always carried his identity and phone cards with him in case he had problems when he was out on his own. Another resident said “I can do most things except smoke upstairs because it’s a fire risk”. Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 11 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 and 16 Residents were provided with very good opportunities to engage in a wide range of appropriate activities and were supported to use community facilities. The home’s policies and staff practice ensured residents’ rights were upheld. EVIDENCE: Residents had access to a wide range of activities both inside and outside the home. Person centred plans included a list of activities that the resident thought were essential to them. One resident said he liked going out with one of the others to a lunch club and another talked about going to a music concert. Staff were helping one person to find art classes in the local community so that he could extend his hobby. One resident said “I like being able to go out when I want”. Staff had links with organisations to assist residents to find voluntary work or employment. Several residents were involved in the service user network and one said that he was looking forward to going to the conference next week. Staff supported less able residents to go out or to find interests in the home. There was a resident discussion group every week. The topics were designed to be informative and relevant to the residents at that time, for example, person centred plans, health action plans and the service user network. Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 12 One of the residents talked about his daily life at the home and how he had choice in everything he did. He said, “I’m very, very happy here, the staff are lovely.” On the day of the inspection residents were observed getting up and dressed in their own time, the routines of the day were relaxed and unhurried. Staff were observed speaking to residents in a friendly and respectful way. Residents were given choices at all times and were encouraged rather than pressurised to carry out any tasks. All bedrooms were fitted with locks and staff asked residents’ permission to show the inspector around the home. One of the staff spoken with talked about the importance of upholding residents’ rights to privacy, dignity, independence and choice and how it increased residents’ self esteem and confidence outside the home. Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 20 and 21 Residents’ healthcare needs are identified and met, with evidence of multidisciplinary working. There had been improvements in the management of medication. Policies and practices were robust and protected residents. Staff attitudes, knowledge and skills regarding care of the dying ensure that residents’ wishes will be carried out. EVIDENCE: Residents had access to annual health screening, which was carried out by a practice nurse, a specialist nurse and the registered person. A health action plan was developed following the screening. Any treatment or advice resulting from the action plan was transferred to the residents’ individual plan and referrals made to other specialists as necessary. Staff spoken with were aware of the ongoing health needs of the residents and any care or treatment to be provided. A member of the learning disability outreach team was assessing a resident at the time of the inspection. He told the inspector, “staff acted in (the resident’s) best interests, the referral was appropriate and they have done everything they could.” Where possible residents were encouraged to make their own appointments for chiropody, opticians and dentists and were accompanied by staff if they wished. Residents thought that the staff looked after them very well. One resident who had recently been in hospital said “they look after me better here than in hospital.” Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 14 Residents were assessed as to their ability to control their own medication. All the current residents had consented to staff managing medication on their behalf. Policies and procedures for medicines management had been revised and were complete. Appropriate records of receipt, administration and disposal of medicines were in place. Good systems were in place for communicating changes in medication. The registered person had produced an excellent information leaflet for residents’ families who took responsibility for medicines when the resident was on leave. All staff had received accredited training in handling medication. The policy on the care of dying residents made provision for them to stay at the home for as long as their needs could be met. Staff were sensitive to the changing needs of residents due to the ageing process and illness. One member of staff talked about how a former resident had been cared for at Elms House until their death. She said that she hoped they could do it again for any of the current residents when the time came. Three members of staff had received training in care of the dying person and bereavement. Other staff had received practical training in palliative care from district nurses. Residents’ wishes for care during terminal illness and after death had been sought and were recorded on their plans. One resident said, “ I want to stay here for the rest of my life.” Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Staff had a thorough understanding of adult protection issues ensuring that any allegations would be dealt with appropriately. EVIDENCE: Staff received training in the protection of vulnerable adults. Those spoken to demonstrated a good understanding of their roles and responsibilities in detecting and reporting allegations, including any against senior staff. Written policies and procedures were available for reference. Following a previous recommendation, staff had received training in managing difficult behaviours, including physical interventions. Two residents said that they felt safe at the home. When asked what they would do if someone was being unkind to him, one resident said “no-one here would ever be unkind.” Another said they would “tell Joanne”. Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24 and 30 There had been significant improvements in the standard of décor and furnishings and the home provided a comfortable and homely environment for residents. The standard of cleanliness and hygiene was good. EVIDENCE: Since the last inspection there had been improvements to the décor and furnishings in the home. Other areas for redecoration and refurbishment were included on the development plan. The residents were happy with the home. One resident was very proud when showing off his bedroom; another said that he had been out with Joanne to choose his own carpet, curtains and bedding. External areas were kept tidy and clean and were accessible to residents. The home was clean and tidy at the time of the inspection. Residents’ responsibilities for domestic tasks were included in their individual plans. Staff had been issued with booklets on hygiene and infection control and were awaiting further training. Two members of staff spoken with were aware of safeguards when handling laundry and dealing with spills. Residents were seen to be supervised in the kitchen to maintain good hygiene practices. Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 17 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 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 36 The level of staff supervision provides safeguards for service users. EVIDENCE: Staff said that they received regular one to one supervision from the registered person. One member of staff said that she enjoyed the supervision meetings and found them useful. The sessions provided opportunities for keyworkers to discuss ‘their residents’, ensuring that care practices were monitored and reviewed by the registered person. Staff received annual appraisals of their work. General comments from residents showed that they were happy with staff and were confident in their abilities. One resident said “I get on with all of the staff, they are all very good.” Another said, “we are looked after well here.” Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 18 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 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,39,41 and 42 Policies and practices of the home revolve around the needs of the residents, who are confident that their views are listened to and acted upon. Health and safety training, practices and written procedures safeguard the health, safety and welfare of the residents and staff. EVIDENCE: The registered person took day to day responsibility for the home. Since the last inspection she had completed the Registered Managers Award and was awaiting formal assessment. It was evident that the registered person kept up to date with any new legislation and best practice guidance and ensured that this was put into practice. The staff and residents spoke highly of the registered person and valued her daily involvement. One member of staff said the registered person made sure that anything that was not right was dealt with straight away. A resident said “Joanne is very good, this place runs like clockwork” Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 19 During reviews of their plans, residents’ were asked about their likes and dislikes, including any issues about the home. Residents’ meetings were held every 8 weeks and minutes evidenced that everyone was encouraged to air their views, both positive and negative. Surveys were conducted annually and residents were encouraged to ask anyone of their choice to help them to complete them. Following comments that some residents did not understand the complaints procedure, staff produced a simplified, pictorial version that was displayed on the notice board. Complaints were also on the regular agenda for resident meetings. Residents were confident that any suggestions would be well received. One resident said “I’m sure that Joanne would always do her best to make things better.” From talking to residents and staff, and observation during the inspection, it was apparent that the routines and practices of the home centred on the needs of the residents. Following a previous requirement, each resident had a list of personal furniture and other equipment on their file. Other records required by legislation were in place. The residents spoken with were not generally interested in accessing their records but one person said that if they wanted to they would ask Joanne. Records were held securely and staff were aware of the need for confidentiality. Staff had received training in safe working practice topics to the level necessary for the safety of current residents. Fire drills were carried out regularly and residents were aware of fire safety procedures. Certificates were available to show that installations and equipment in the home were serviced and maintained. Environmental risk assessments had been carried out with particular reference to the current service users. As a result the key pad lock on the front door had been wired to the fire alarm system. Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 20 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x Standard No 22 23 ENVIRONMENT Score x 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x x 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 4 x x x 4 x Standard No 31 32 33 34 35 36 Score x x x x x 3 CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Elms House Score x 4 3 3 Standard No 37 38 39 40 41 42 43 Score 3 x 4 x 3 3 x F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 21 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 Regulation None Requirement Timescale for action 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 None Good Practice Recommendations Elms House F57 F07 S9450 Elms House V222338 260405 Stage 4.doc Version 1.30 Page 22 Commission for Social Care Inspection 1st Floor, Unit 4 Petre Road, Clayton-Le-Moors Accrington Lancashire. BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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