Inspection on 23/10/07 for Elmsfield House Limited

This inspection was carried out on 23rd October 2007.

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

Elmsfield House Limited 09/10/09

Elmsfield House Limited 16/08/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

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

CARE HOMES FOR OLDER PEOPLE Elmsfield House Limited Elmsfield House Limited Elmsfield House Holme Via Carnforth Lancs LA6 1RJ Lead Inspector Mrs Margaret Drury Unannounced Inspection 23rd October 2007 09:45 X10015.doc Version 1.40 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 Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 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 Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmsfield House Limited Address Elmsfield House Limited Elmsfield House Holme Via Carnforth Lancs LA6 1RJ 01539 563896 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) Elmsfield House Limited Mr Christopher Wilson Care Home 20 Category(ies) of Dementia - over 65 years of age (8), Old age, registration, with number not falling within any other category (20) of places Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 20 service users to include: up to 20 service users in the category of OP (old age, not falling within any other category) up to 8 service users in the category of DE(E) (Dementia over 65 years of age) The service should at all times employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 16th August 2006 2. Date of last inspection Brief Description of the Service: Elmsfield House is registered to provide care and accommodation for up to 20 older people, five of whom may have varying forms of dementia. Mr Christopher Wilson is the registered manager and the head of care is Mrs Ann Thompson. Elmsfield House is set in a rural location close to the village of Holme and three miles from Milnthorpe. There are extensive views over the open countryside of the South Lake District. The home is a Georgian property that has been extended and adapted for its present use as a care home. There are gardens on all sides of the property, part of which have been landscaped and provide a pleasant area for the residents to sit in during the summer months. Accommodation for residents is over two floors, the upper being served by a stair lift. There are eighteen single rooms and one double although currently all rooms are used for single occupancy. Nine of them have en-suite facilities. There are two lounges and a separate dining room, which give ample communal space for the residents to meet with visitors, enjoy activities or watch television. The fees for this service are from £372.00 to £434.00 per week with extra charges for newspapers, magazines, hairdressing, chiropody and some personal toiletries. This service does not provide intermediate care. Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This site visit that forms part of the key inspection took place over two days and we were in the home for a total of 7 and a half hours. Information about the service was gathered in different ways: • Annual Quality Assurance Assessment document completed by the manager • Survey questionnaires returned by residents. • The service history • Interviews with residents, visitors and staff on the day of the visit. We looked at care planning documentation to ensure the level of care provided met the needs of those living in the home and a tour of the building to inspect the environmental standards was undertaken. Staff personnel files were examined. We also looked at the plans for the new extension that is planned for early in the new year and discussed the work to be undertaken to ensure there would be a minimum of disruption to the lives of the residents. What the service does well: Feedback from residents and staff about this service was very positive. Comments such as “ I could not live anywhere better” and “ I am very happy with the care I receive” were made. Relatives were also very complementary about the care received by the residents, with comments such as “the staff are wonderful” and “the staff are very kind and nothing is any trouble”. There is a stable staff team that promotes and encourages the residents to remain as independent as possible and to exercise choice and control over their lives as far as they are able. Some activities are made available to residents if they wish to join in and the manager is looking at ways to improve the range of activities already on offer. Care plans are in place to ensure the staff have the information to meet the assessed needs. Residents are provided with a safe, clean, and comfortable place to live. Meals served at the home are of a very good standard. Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 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. The summary of this inspection report can be made available in other formats on request. Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This service provides prospective residents and/or their representatives with the information needed to choose a home that will meet their needs. EVIDENCE: We looked at the statement of purpose and the manager explained that this document is in the process of being updated so that it properly reflects the facilities on offer when the extension to the home is complete. The current Statement of Purpose is on display in the entrance porch, together with a copy of the resident’s guide and the last inspection report. During the visit we were able to speak to the manager and the residents about the way in which people are admitted to this home. The residents agreed that their admission was made easy because “the care manager and staff were so Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 9 kind and made me feel welcome”. Some residents had chosen their room but if this was not possible relatives had made the choice on their behalf. We spoke to visitors who said they had visited other homes when looking for the right one for their family member. They all agreed that they had made the right choice in Elmsfield House. They also confirmed that they were always made very welcome when they visited the home. The residents we spoke to said they had visited the home and “enjoyed a cup of coffee with the staff” when they were looking for accommodation. The manager completes a needs assessment before any resident is admitted to ensure the home can meet their needs. Details from these assessments are used when the care plans are prepared. Some details of the initial assessments were not on the care plans but this will be amended in the future. Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. Privacy and dignity are respected at all times. EVIDENCE: Each resident has a plan of care that is drawn up from the initial assessment of needs and capabilities. During the visit we looked at a sample of four and found them to be basic, in that the information documented was limited. There was evidence in the care plans and daily notes of health care treatment and intervention and, generally, an outline of the care required to meet the residents’ needs. We found some gaps in the information recorded but during discussions with the staff on duty it was evident that they knew the residents well and were able to identify and meet their needs in a personal and caring manner. The monthly reviews were not all up to date and the manager agreed to ensure this would be rectified as soon as possible. He also confirmed that Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 11 arrangements were in hand to introduce a new care planning system using a different format. We looked at a sample, which showed that much more detailed information and past history would be included, making the plans more person-centred and individual to the resident. A recommendation was made that this task be completed as soon as possible. Residents are weighed on a regular basis to ensure their nutritional intake is sufficient. The care manager told us the residents are always weighed when they return to the home after a stay in hospital. Healthcare needs are met by the local doctor’s surgery and the care manager told us that the home receives excellent support from the doctors and the district nurses attached to the practice. Nurses visit the home on most days and the care manager told us that they are always happy to give support and advice. We looked at the medication procedures and found that the residents are protected by safe systems for handling medication and record keeping was completed in an appropriate manner. The pharmacist has provided training for the staff in safe handling of medicines and the care manager conducts regular audits of the procedures and records. We observed, during the visit, the interaction between the staff and those living in the home. This was very positive and it was evident that the staff knew the residents very well indeed. The staff were very polite when speaking to the residents and ensured all personal care was given in he privacy of their bedroom. Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are able to make choices about their lifestyle and are supported to maintain their independence. The dietary needs of the residents are well catered for. EVIDENCE: The routines in Elmsfield house are very flexible and generally meet the needs of those living there. Residents get up and retire whenever they wish and the care manager confirmed that some residents do like a lie in from time to time. There is currently no designated activities organiser but the manager explained to us that he is hoping to appoint one in the near future. In the meantime staff members arrange activities such as dominoes, quizzes and bingo. There is a plentiful supply of video films and a new wall mounted flat screen television has recently been purchased for “afternoon at the movies”. There are music workshops each month and a local instructor who has developed a programme “Tai’chi for the elderly visits the home every couple of months to conduct a class. Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 13 Local ministers visit the home to conduct services and Communion is provided for those who wish to take it. Those who use this service are given every opportunity to maintain important personal and family relationships and visitors are welcome at any time. We were able to speak to some during our time in the home and they all confirmed that they were always made very welcome and enjoyed the refreshments offered. We were able to speak with the cook who has worked at the home for a number of years and knows the residents’ likes and dislikes well. She provides a well-balanced menu with meals that are nutritious and home cooked. Much of the produced is purchased from local suppliers and an inspection of the food store evidenced a well-stocked supply. Visitors and residents were all very complimentary about the meals provide with comments such as, “the home made cakes are lovely” and we have lovely meals”. Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service are able to express their concerns knowing they will be listened to and acted upon. They are safeguarded from abuse by the home’s policies and procedures. EVIDENCE: There are suitable procedures in place for dealing with complaints. The complaints policy and procedure is part of the guide for the people using this service and there was also a copy on display. The manager said that there had been no complaints for some considerable time and The Commission for Social Care Inspection (CSCI) have not received any. We did discuss what should be recorded as “ a complaint” and the manager agreed that, in future, all concerns raised by residents and visitors would be recorded, showing what action was taken and the outcome. The residents and family members we spoke with during the visit were all aware of the procedure to follow should they need to use it. The service has internal policies and procedures for the Protection of Vulnerable Adults (POVA) and a copy of the Local Authority’s procedure was also seen to be available .All staff have enhanced Criminal Records Bureau (CRB) checks before they start work There have been no allegations of abuse. Some staff training in this subject has been completed and the manager is Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 15 hoping to access further training in the future. We discussed adult protection with the staff during the visit and all showed a good understanding of the procedure to follow and the signs to look for. This subject is covered in National Vocational Qualification (NVQ) training and one member of staff we spoke with said she had learnt a lot about adult protection whist completing the course. Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 22, 23, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents enjoy a comfortable and homely living environment. The premises are reasonably well maintained and kept to a good standard of cleanliness. EVIDENCE: Elmsfield House is set in a rural location close to the village of Holme and three miles from Milnthorpe. There are extensive views over the open countryside of the South Lake District. The home has large well-kept grounds that are used by residents when the weather allows. Internally the home is well decorated and furnished to a high standard. There are plans in hand for work to start on the alterations and extension Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 17 immediately after Christmas. The current building will be upgraded also to ensure the environmental standards are the same throughout. There are two lounges and a dining room, which is due to be extended to accommodate the increase in resident numbers. There is also a small seating area on the first floor that can be used by residents if they wish. We conducted a tour of the building and found residents’ rooms well furnished and personalised with pictures, photographs and ornaments. There are sufficient bathroom and toilet facilities to meet the needs of the residents and nine rooms have en-suite toilets. The home employs domestic staff to ensure the cleanliness of the building is kept to a high standard. It was very clean on the day of the visit. Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People using this service are protected by robust recruiting procedures. Trained and experienced staff ensure all residents are supported and cared for. EVIDENCE: We looked at the staffing levels and found them to be adequate and satisfactory. There are generally 3 care staff plus the manager on duty in the morning and, wherever possible, 3 care staff on during the afternoon. There have been some staff shortages recently due to staff leaving and delays in the completion of the Criminal Record Bureau (CRB) checks. However, new staff gave recently been appointed and will start work as soon as the legal checks are complete. A check on staff files confirmed that there is a thorough recruitment process in place with references, application forms and enhanced CRB checks in place. New staff shadow more experienced staff until the care manager is satisfied with the level of competency achieved. We observed staff dealing with residents and found a caring, sensitive and respectful approach with all personal care given in private. Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 19 There is a training programme with details kept on the home’s computer. We did suggest that a visible record is kept on display in the office. Training recently completed includes, health and safety, food hygiene and fire safety. Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People who use this service live in a home that is safe, well managed and run in their best interests. EVIDENCE: The manager is registered with the Commission for Social Care Inspection and has completed the registered manager’s award. He has worked at the home for many years and has recently, together with his brother, taken over the running of the home from his parents. He is in the home every day and the residents and visitors confirmed that he was “very approachable”. The home also employs a care manager who is responsible for the social and personal care of Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 21 the residents. Discussions with the manager and senior staff confirmed that all who work at Elmsfield House see the care of the residents as top priority and ensure that the home is run in the best interests of those living there. The home does not hold any personal allowance monies on behalf of the residents. Any expenditure is claimed back from the families or advocates via a monthly account. We discussed staff supervision, which is completed by the senior staff with records kept on file. The manager conducts annual appraisals. The manager acts as health and safety officer for the home and ensures all the necessary training is up to date. Regular fire training is completed and we were able to check the records to confirm this. All fire equipment is service under contracts and all other equipment is serviced under annual service level agreements. Risk assessments are in place and reviewed regularly. Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. 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 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X 3 3 3 X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? NO 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. Standard Regulation 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 2 Refer to Standard OP3 OP7 Good Practice Recommendations A copy of the initial assessment should be kept in the care plan. The upgrading of the care plans should be completed as soon as possible Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Eamont House Penrith 40 Business Park Gillan Way Penrith Cumbria CA11 9BP National Enquiry Line: 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 © 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 Elmsfield House Limited DS0000065671.V353091.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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