Inspection on 24/04/07 for Elmside

This inspection was carried out on 24th April 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

Elmside 16/02/09

Elmside 31/10/05

Elmside 12/04/05

Elmside 05/11/04

Elmside 09/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

Henrietta House

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

CARE HOMES FOR OLDER PEOPLE Elmside Elmside Walk Hitchin Hertfordshire SG5 1HB Lead Inspector Jeffrey Orange Unannounced Inspection 08:40 24th April 2007 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 Elmside DS0000019334.V336868.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. Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmside Address Elmside Walk Hitchin Hertfordshire SG5 1HB 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) 01462 451737 01462 454298 home.fxg@mha.org.uk Methodist Homes for the Aged Manager post vacant Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home may accommodate four additional older people over the age of 65 years for the purpose of respite care. The manager must inform the CSCI when these rooms have been closed and building work on the extension has commenced. 31st October 2005 Date of last inspection Brief Description of the Service: Elmside is a care home providing personal care and accommodation for 42 older people. It is owned by Methodist Homes for the Aged, which is a voluntary organisation. The home is located in a quiet cul-de-sac in the centre of Hitchin, close to town centre shops, churches, the post office and other amenities. The home was opened in 1985 and consists of a two-storey building with parking to the front and a large garden to the rear. All the homes bedrooms are single, and three of the bedrooms have en-suite facilities. There is a passenger lift. The existing building is due for demolition sometime after June 2007, when the current residents will, (Subject to registration of the new building by the Commission for Social Care Inspection (CSCI) ) move into a new, purpose built home, currently nearing completion, which is being built adjacent to the existing home. The home has a Service User Guide, which gives contact details for the CSCI, and copies of the latest inspection report are available in the home. Current fees range from £484 to £609 per week. They include hotel services and personal care but exclude newspapers, hairdressing, chiropody and personal toiletries, which are provided at additional cost. These details were correct at April 2007. Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over approximately six hours, during which time it was possible to speak to people who live in the home, to members of the staff team on duty both in the morning and afternoon and to the duty senior member of staff. Although the manager was not in the home during the inspection, it was possible to speak with her on the telephone during this visit. Key records, including those for medication, staff recruitment and care planning were also examined. This report takes into account any information received by the CSCI since the previous inspection in October 2005 and the ongoing inspection process for the home will be updated in line with any information received from the home or as a result of surveys undertaken by the CSCI of people who live in the home, their relatives and health/social care professionals associated with the home. The inspection visit was made in the context of the imminent move of the residents and staff into the new home, currently nearing completion, which has been built adjacent to the existing building. This move, whilst potentially exciting and beneficial for both residents and staff, is a natural cause of anxiety for residents, as it unavoidably involves some disruption and upheaval. What the service does well: What has improved since the last inspection? There were no requirements or recommendations made following the last inspection of October 2005. Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 6 Under the circumstances, the maintenance of previous good standard of care throughout the changes outlined above, is in itself an achievement. 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. Elmside DS0000019334.V336868.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 Elmside DS0000019334.V336868.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): Standards 1 3 5 (Standard 6 does not apply to Elmside) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The information provided to people considering making Elmside their home is comprehensive and clear, including details of fees and what is included in them. This means that a well- informed and balanced decision can be made. People thinking about making Elmside their home can visit prior to making that decision including if they require a short-term period of residence. This should ensure that they can judge if the home will meet their needs in a way that they are comfortable with. A very full process of assessment of potential resident’s needs is undertaken before they move into Elmside, to make sure that their care needs are fully identified and can be appropriately met. Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 9 EVIDENCE: Care plans seen for people who have recently moved into Elmside were seen to include a robust and thorough process of assessment, involving the potential resident, their families and other health and social care professionals as relevant. One person living in the home described how her family arranged for her to have a trial period of residence before she decided if Elmside was a place she could be happy; “Which was very helpful and sensible” she noted. The information provided to potential residents about fees was seen to be both comprehensive and transparent, dealing explicitly with the position where the full costs of care are not covered by any Local Authority contribution. Elmside DS0000019334.V336868.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): Standards 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. People living in Elmside have access to the healthcare services they need both within the home and in the local community. Health needs are monitored and appropriate action taken and care plans contain a record of general healthcare information. Elmside has a comprehensive medication policy and procedures are generally well carried out. Where people who live in the home self medicate, there are risk assessments in place. Where errors in medication administration do occur they are identified promptly and appropriate action, including additional staff training, takes place. This means that people living in Elmside can be confident that their health and safety is being promoted and safeguarded. People who live in Elmside are treated with respect and their dignity is protected whilst personal care is being provided. Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 11 EVIDENCE: Throughout this inspection visit staff were seen to be interacting with people who live in Elmside in an appropriate and respectful way, for example when assisting them at mealtimes or given them medication. “I can only speak very highly of the care we are given” one person living in the home remarked. The care planning format is currently being changed and in the short-term this had led to some lack of consistency whilst the two systems operate together, however once the process of change has been completed the new format will represent an improvement and will help staff to better monitor and meet the care needs of people living in Elmside. The standard of medication records found was generally acceptable, although there were two errors found and the last report from the home’s pharmacy also found some gaps in administration records. However there is a very robust error reporting system in use, that ensures that where errors do occur, they are promptly and appropriately addressed and action taken. Elmside DS0000019334.V336868.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): Standards 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 live in Elmside are able to develop and maintain important personal and family relationships and to take part in a range of social and spiritual activities in line with their individual interests, beliefs and capabilities. People who live in Elmside have a variety of ways to influence the way that the home operates and to exercise choice in their lives, including in respect of meals and mealtimes. The quality of the food provided is the subject of differences of opinion between residents, with some being more positive about it than others. EVIDENCE: There was a morning service taking place in the home during this inspection visit and both that and an afternoon session of activities were quite well attended. People who live in the home can receive visitors readily and several were seen during this visit, often taking people out of the home for short trips. Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 13 At least two residents were seen leaving the home to go to local shops or for a walk, they each notified staff of their intentions and in one case were provided with a pendant call alert device. The activities co-ordinator described a basic framework of activities together with details of regular trips out of the home, available to residents. Activities programmes were on display in the home. One resident explained that they are “wheeled round” for church services if they choose to go and there are very full minutes available in the home of residents and friends meetings at which it is clear that any matters of concern can be raised. Mealtimes appeared to be pleasant and sociable occasions, with tables appropriately set out with cloths and cutlery, plenty of drinks available and meals attractively presented. The quality of the food was the subject of some contention, with comments varying from “good” to “rough”. Food is raised as an issue at most resident’s meetings and the catering staff do seem to attempt to canvass the views of people living in the home and act on them. Elmside DS0000019334.V336868.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): Standards 16 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Elmside has an open culture that encourages people who live there to express their views and concerns. Advocacy services are available locally and are well publicised in the home and this together with considerable external involvement in the home by local churches and other community organisations provides many opportunities for the wellbeing of people living in the home to be regularly assessed by interested, independent people. The policies and procedures for safeguarding adults are comprehensive and give clear and specific guidance to those using them. Staff receive appropriate training and know when incidents need to be reported and what action to take to do so. EVIDENCE: Age Concern advocacy service details are prominently displayed in the home. Complaints policies and procedures are well publicised and full records were seen of a small number of complaints made, with details of the action taken to address them. Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 15 A series of residents’, friends’ and relative meetings and surveys take place to ensure that any concerns or grievances can be freely aired. Comments from people living in the home and letters seen from relatives, confirm that people feel able to approach the manager and her staff freely with any concerns. Staff training includes issues around safeguarding, what constitutes abuse, how it can be recognised and what action to take if it is seen or suspected and the appropriate Hertfordshire County Council policy is displayed on the main notice board. Elmside DS0000019334.V336868.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): Standards 19 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite the imminence of the move from the current building, the home continues to provide a safe and well maintained environment in which to live and work and although the new, purpose built home may be an improvement in many ways, all residents spoken to were sorry to be leaving the current building and regarded it with great affection. EVIDENCE: The home was clean and free from any unpleasant smells throughout this visit. The home’s maintenance staff were seen to be very active during this inspection visit addressing any problems identified. A maintenance request log was available in the office and was evidently well used by residents and staff to address minor issues as they arose. Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 17 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): Standards 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 who live in Elmside can have confidence in the staff that care for them. There are consistently sufficient numbers of staff on duty, with the necessary skills and qualifications to meet the care needs of people living in the home. MHA has a good system of staff recruitment and the checks made and information received should provide people living in the home with the confidence that unsuitable people will not be employed to care for them. Staff meetings take place regularly as dose staff supervision, both of which offer support to the staff team and help to promote and monitor good care outcomes for those living in the home and receiving care. EVIDENCE: All of the many residents spoken to during this inspection visit were positive about the staff in Elmside and the standard of care they receive from them. “This is a wonderful home, with excellent girls (sic)” All of the staff team spoken to confirmed the support and training that they received and indicated that they could approach the management team of the home at any time. Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 18 Staff training records are well maintained and provide evidence that the basic skills level of staff is maintained and that at least 50 of current staff have or are obtaining NVQ qualifications at least at level 2, with some staff holding level 3 or above. Additional dementia care training from a variety of sources is underway, including “Food for thought” for catering staff providing information about dementia care and nutrition, an intermediate course in reflexology for one staff member and “The final lap” training in issues around death and dying. Staff felt overall that numbers were adequate and no adverse comments were received from people living in the home about lack of carers at key times. Staffing numbers will of course have to be kept under review and revised as necessary when the move to the new home takes place. Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 19 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): Standards 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. The home appears well managed and seeks to ensure that its administrative and care practices provide satisfactory outcomes for those living and working in the home, however the manager has not yet been assessed as fit by the CSCI through the registration process. Health and safety are given an appropriately high priority so as to protect those living and working in the home at the same time as recognising and encouraging people who live in the home to exercise judgement and choice about risks within a robust risk assessment framework. Although the current system for the recording of resident’s money held by the home is robust and efficient, it might benefit from the added rigour of more frequent independent audit. Staff receive regular supervision that provides them with the support they need to provide a good standard of care outcomes for those living in Elmside. Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 20 EVIDENCE: The current manager has not yet completed the registration process with the CSCI although it understood that this is in hand. Staff, relatives and people living in the service were very positive about the manager and her recent contribution to the home. The administrative support provided to people who live and work in the home is efficient and very much part of the caring ethos of Elmside. The standard of record keeping is essentially satisfactory, medication records, because of their key importance must be maintained at a consistently high level at all times. Consideration should be given to an increased frequency of independent audit of resident’s money held by the home. This does not imply that the current system is operated in other than an appropriate manner including safeguards for residents, but recognises that the transparency of the system could be improved if audit checks were carried out more frequently by people not directly involved with making the entries to be checked. Staff spoken to and record seen provide evidence that a system of routine and regular supervision is in place. Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 21 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 3 8 3 9 2 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 X X X 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 2 X 3 X 2 3 X 3 Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? There were none. 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 OP9 Regulation 13(2) Requirement Staff involved in the administration of medication must ensure that records are fully completed and accurate at all times. Timescale for action 24/04/07 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 OP35 Good Practice Recommendations Consideration should be given to an increased frequency of independent audit of resident’s money held by the home. Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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 Elmside DS0000019334.V336868.R01.S.doc Version 5.2 Page 24 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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