CARE HOME ADULTS 18-65
Elms Park Care Home 11 Elms Park Ruddington Nottingham NG11 6NU Lead Inspector
Meryl Bailey Unannounced Inspection 14th December 2005 02:10 Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Elms Park Care Home Address 11 Elms Park Ruddington Nottingham NG11 6NU 0115 945 6323 0115 945 6323 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) H4037@mencap.org.uk Royal Mencap Society Manager post vacant Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 2nd August 2005 Brief Description of the Service: Elms Park is a care home providing personal care and accommodation for up to 8 adults with a learning disability. Care and support is provided by Mencap, though the building is owned by Nottingham Community Housing Association. The home is located in the village of Ruddington with easy access to the village centre. All bedrooms are single and on the ground and first floor. There is no lift, but the ground floor has level access. There is a garden to the rear of the house, which has seating for service users. Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and conducted by one inspector during one late afternoon. All service users were seen as some were at home during the day and others arrived home after attending day activities. Some were able to contribute their views. Two staff (including the acting manager) were seen and their comments and views have been incorporated into this report. Information has also been taken from records. The communal areas of the home were inspected and three bedrooms were viewed on this occasion. What the service does well: What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office.
Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 6 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 Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 7 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 the following standard(s): There had been no new service users since the last inspection and these standards were not assessed. EVIDENCE: Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 8 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 the following standard(s): 6 and 7 Individual plans are created with service users to agree the support required. However, some updating is needed as existing plans are not all sufficient for meeting all support needs. EVIDENCE: The individual plans of two service users were examined. Both were comprehensive and detailed the support required to meet needs. There were some relevant risk assessments linked with planning support. All staff had signed a sheet in each file to show that they had read the plans. One of these indicated rapidly changing needs and had been updated on a monthly basis. The second one had not been reviewed since April 2005 although daily notes and discussion with the manager indicated that needs had changed. All plans must be kept under review and it is recommended that this be done at least every six months, aswell as when needs change. Each of the service users had a copy of their own individual plan within their own room. Two of those spoken with were aware of the content and had signed agreements. Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 9 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 the following standard(s): 13 and 15 There is involvement with the local community and relationships with family and friends are encouraged. EVIDENCE: The service users used local shopping and library facilities within Ruddington and were planning to take part in Line Dancing locally. All service users were planning to spend Christmas with their own families and there was evidence of family members and friends visiting the home. Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 19 and 20 Health needs are monitored, but needs relating to deteriorating conditions are not met by the staffing levels. Medication is organised. EVIDENCE: Within the two service users’ files examined there were copies of assessments carried out by health professionals and records of appointments. The need for nursing had been identified for one person and a suitable placement was being arranged. A temporary arrangement of 1:1 staffing had been provided for the previous week, but these needs were not being met currently, due to insufficient staffing (as evidenced under Standard 33). All medication was held securely in a small locked cupboard on behalf of service users. Storage had been better organised since the last inspection, but would be improved by providing a larger cupboard. Medicine Administration Record sheets were well maintained. Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 11 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 the following standard(s): 22 and 23 There is a clear complaints procedure and service users are protected by procedures in place. EVIDENCE: There were no recorded complaints and none had been received at the Commission. The complaints procedure was displayed appropriately in the dining room. Service users said that they speak to key workers when they have any concerns. There was a copy of the Nottinghamshire Committee for the Protection of Vulnerable Adults policy and procedures, which was available to staff, but the acting manager was not immediately aware of its location. There had been no known reason to implement the procedures. There were risk assessments on service users files, with appropriate action taken to minimise risks and protect service users from harm. Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 12 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 the following standard(s): 26 and 30 The physical layout of bedrooms suit individual needs, but the lack of call alarms makes it difficult for individuals to get support during the night. Further support may be needed with keeping bedrooms tidy. Otherwise, the home is well maintained and clean. EVIDENCE: Three bedrooms were seen during this inspection. They were individualised to reflect individual interests and choices. One of these rooms was well maintained by staff. One resident said that her family help her to clean her room when they visited, but she was expected to keep it clean and tidy herself. It was clear that there was a belief in promoting independence, but some service users may require more support to enable them to organise their belongings. The lounge and dining room were found to be very clean, well maintained, comfortable and homely. There was no call alarm system to all rooms, but one individual was monitored with an individual listening device. Another resident said that there used to be a call alarm, but it was broken. This resident was not confident to leave her bedroom at night to get help. The acting manager said that a portable alarm was no longer working, as a new battery was needed. Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 35 Staffing availability does not always meet proposed staffing levels and there is a danger that needs are not appropriately met raising the level of risks to service users. Staff were suitably trained to work with people with learning disabilities. EVIDENCE: As at the last inspection only one member of staff was present at the commencement of this inspection. There were four service users on the premises, including one who had been assessed as requiring nursing and was awaiting a move to another home. On the file for this person there was an assessment identifying the need for additional 1:1 support for this person. The acting manager stated that the funding for this had run out for the current week. A blank proposed rota submitted to the Commission in August 2005 showed two staff working from 7am and 10pm, but the current rota did not cover all these hours. It was also not up to date as the staff person actually commencing at 3pm was on the rota to commence at 2pm on the day of inspection. The staff member on duty was the acting manager. Another staff member had reportedly been on duty until 1.45pm. During the afternoon the second member of staff commenced at 3pm and then supported a resident on a shopping trip, which again left the acting manager with the remaining service users. Numbers of service users increased as they returned from day services
Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 14 and at the end of the inspection there were seven service users with the acting manager. Several were requesting support with preparing their individual meals. The rota showed that one member of staff slept on the premises and for the following day, there was just that one staff on the rota until 9.30am. The acting manager believed this was sufficient to meet needs. Staff had received Foundation Training with Mencap. This is comprehensive and accredited within the Learning Disability Award Framework. Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37 39 and 42 There is no current registered manager. The quality of the service is monitored. Safety on the premises is promoted. EVIDENCE: There was an acting manager who was going through the assessment procedure with the Commission to determine if registration was appropriate. During this inspection she was not able to concentrate solely on management tasks, due to no other staff being present. The service was monitored by senior management within Mencap and a service review took place in April 2005. Service users views were taken into account at that time and continuously through house meetings. Since the last inspection the opening of the lounge window had been restricted as a security precaution. The acting manager reported that all external doors are alarmed at night, though this was not tested during inspection. All staff had been trained in safe working practices, including Health & Safety, First Aid and Basic Food Hygiene. Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 16 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 X 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 3 ENVIRONMENT Standard No Score 24 X 25 X 26 2 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 X 33 1 34 X 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 3 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X 2 3 X 2 X 3 X X 3 X Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 17 Are there any outstanding requirements from the last inspection? Yes 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. 2. Standard YA6 YA19 Regulation 15(2) 18(1)(a) Requirement Individual Support Plans must be kept under review and updated as needs change. Ensure there are sufficient staff to provide 1:1 support where this has been determined by assessment of need. Ensure there are sufficient staff to meet the needs of all service users at all times. Timescale for action 31/01/06 14/12/05 3. YA33 18(1)(a) 14/12/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard YA26 YA26 Good Practice Recommendations Review needs for support with cleaning and tidying rooms. Replace the battery in the portable call alarm and make an alarm available to all service users. Elms Park Care Home DS0000008672.V273338.R01.S.doc Version 5.1 Page 18 Commission for Social Care Inspection Nottingham Area Office Edgeley House Riverside Business Park Tottle Road Nottingham NG2 1RT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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