Inspection on 10/02/10 for Elmslea

This inspection was carried out on 10th February 2010.

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

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elmslea 28/05/10

Elmslea 18/05/10

Elmslea 27/04/10

Elmslea 15/02/10

Elmslea 13/11/09

Elmslea 17/09/09

Elmslea 27/08/09

Elmslea 02/03/09

Elmslea 17/03/08

Elmslea 13/06/07

Elmslea 11/07/06

Elmslea 04/01/06

Elmslea 22/06/05

Elmslea 22/09/04

Elmslea 23/06/04

Elmslea 19/05/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

Extracts from inspection reports are licensed from CQC, this page was updated on 25/04/2010.

Key inspection report Care homes for adults (18-65 years) Name: Address: Elmslea 34 Dunheved Road Launceston Cornwall PL15 9JQ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Helen Tworkowski     Date: 1 1 0 2 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 39 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 39 Information about the care home Name of care home: Address: Elmslea 34 Dunheved Road Launceston Cornwall PL15 9JQ 01566777661 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Irene Stanbury,Mr Henry Stanbury care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Service users to include up to 15 adults aged 18 - 65 on admission with a mental illness (MD), some of whom may have a secondary minor learning disability. Total number of service users not to exceed a maximum of 15 Date of last inspection Brief description of the care home Elmslea is registered to provide accommodation and personal care for 15 adults with a mental health needs, some of whom may have a secondary minor learning disability. The care home is situated in a quiet residential area of Launceston. The recreation park and leisure centre are nearby and the town centre amenities are a short walking distance. All the bedrooms are single, and all but one have with en suite facilities. There are various communal spaces and garden areas for residents to use. Details of the cost of care, and information about the home (Statement of Purpose and Service User Guide) are available from Mr and Mrs Stanbury. 0 2 0 3 2 0 0 9 15 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 39 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key unannounced inspection that was carried out by two inspectors (Gail Richardson and Helen Tworkowski), and took place over two days 10th and 11th February 2010. The visit on 10th February 2010 started at 9.30 and finished at 5 p.m., whilst on 11th February 2010 the visit started at 10.00 am and finished at 4.30 p.m. An Expert by Experience, also took part in the inspection visit on the first day. An Expert by Experience is someone who because of their experience of a service or particular issue is able to offer an additional insight. We asked the Expert by Experience to particularly focus on the issues of choice and how people spend their time. As part of this inspection we looked in depth at the care of four people. We looked at their records, including care plans, risk assessments and other documents. We looked around the house, including communal areas and bedrooms. We looked at the medication system, at training, and at the way people are kept safe. We also looked at Care Homes for Adults (18-65 years) Page 5 of 39 the management of the home. We spoke to one Social Worker who was visiting the home during the inspection. We sent surveys to a range of health and social care professionals who have contact with the service, two were returned. Care Homes for Adults (18-65 years) Page 6 of 39 What the care home does well: What has improved since the last inspection? What they could do better: We found that there was no evidence that people were being made to attend Church, however we were still concerned that religious attendance appeared still to be a foregone conclusion. It is important that people who may at a particularly vulnerable time in their life, are given the opportunity to maintain their faith, but also not placed in a situation where they feel pressured to conform to religious observance. Care Plans, documents that detail the help and support that people need, had been rewritten, and whilst there was some improvements, such as evidence of people signing their own care plans, they still need to be more comprehensive and detailed. We noted this particularly for one person who had a particular health condition. The information Care Homes for Adults (18-65 years) Page 7 of 39 on the file was inadequate, and this persons health and well being could be placed at risk. We did note on one file that there was information about signs of deterioration, and there was evidence that when the persons health deteriorated appropriate action was taken. Risk assessments, particularly in relation to self-medication remain inadequate, and there was evidence that people were not always getting the medication that is prescribed. We also found that some medication was not properly stored. We consider that the management of this home must be improved. Many of the issues identified in this report have been identified in previous reports. Where concerns had been raised these had not been dealt with in an open or direct manner. Also that various therapies are being provided at or through the service, without any discussion with the Care Manager who has a responsibility in this area. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 39 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 39 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The information about what the home provides is clear and well written, and provides people who are thinking about using the service with the information they need to make an informed choice. No new people have moved to the home so it has not been possible to check if assessments have been done before anyone moves. Evidence: Mr and Mrs Stanbury told us that no new people have move to the home since the last visit. We were therefore unable to look at how in practice they carried out assessments and ensured that any prospective service users needs could be met. A requirement was made at previous inspections in relation to new people moving to the home. As we have not been able to ascertain if it is met, it will remain as a requirement. At previous inspections Mr and Mrs Stanbury have emphasized the importance of people fitting in to the group of people who already live and Elmslea, and therefore it has been important that people who already live at the home are involved. At previous inspection we have required that the Statement of Purpose and Service Care Homes for Adults (18-65 years) Page 10 of 39 Evidence: User Guide be reviewed so that they contain all the elements specified in Regulations. The Commission has received copies of amended documents and has written to Mr and Mrs Stanbury about some areas where amendments are required. We have seen amended copies of these documents. These documents have significantly improved and contain the necessary information that people who use the service may need to know. We will be asking Mr and Mrs Stanbury to ensure that they are made available to everyone who uses or who commissions a service. Care Homes for Adults (18-65 years) Page 11 of 39 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Elmslea cannot be confident that their care needs will be met. Information about the care people receive has improved, however it is still inadequate, being neither sufficiently comprehensive or detailed. Risk assessments are inadequate and do not explain how risks will be managed. The actual care provided does not always reflect the care described in the care plan, and as a consequence people may be being placed at risk. Evidence: As part of this inspection visit we looked at the records and the care relating to four individuals. Each person had a file which contained information about their background, a care plan, and risk assessments. These documents should provide detailed guidance about how care is to be provided, clearly stating where people are able to manage independently or where they might need assistance and how this assistance is to be provided. Risk assessments should identify how risks are to be managed so that people are to be kept safe from unnecessary harm. Care Homes for Adults (18-65 years) Page 12 of 39 Evidence: We asked to see copies of reviews that have been carried out by the organisations purchasing or monitoring the service to each individual. We were unable to identify copies of reviews for each person. In one case we found a review on file, however the Social Worker, who happened to be visiting that day, told us that there had been a more recent review. It was difficult to know whether the lack of reviews on file was because they had not been completed by the relevant organisations, or received by the service or not properly filed. It was also therefore difficult, during the inspection, to ascertain if the Elmslea care plan reflected the service that is being purchased by organisations commissioning or monitoring services. We will be raising this with the people who commission services. Requirements have been made at previous inspections with regard to care planning and risk management. We found that each person did have a care plan- these were usually one page of A4 paper and divided into three columns headed issue, plan and implementation. Some of these documents had been amended, reviewed and updated recently. There was evidence of the people who live at Elmslea agreeing these documents as they contained their signatures. The Care Plans were difficult to follow- as the information did not always read across from one column to the next. The information was very general. For one person it said that they cannot manage feet and then that Chiropody was to be arranged. This is not sufficient information to establish what the need is and that it is being met. On another persons documents we saw that goals had been set for the individual to keep her room clean, by developing a routine and she was going to be taught how to clean and use a vacuum. Another goal was set that she should cook once per week. However, when we asked to see how these goals were actually put into practice- the only evidence we could be shown was a book with recipes cooked and the cost of the meal. We would expect to see a proper teaching plan in such instances, with a record of progress made towards a goal. The Care Plan for another individual with physical health problems indicated that the person needed assistance and monitoring. However, when we asked about the actual care being received the level of assistance and monitoring it was not that which was indicated in the care plan. We contacted the Commissioners of the service, after the completion of the visit, and were advised that Mr and Mrs Stanbury had indicated that they provide a very high level of supervision and monitoring. This was not the level of support actually being provided. This discrepancy meant that not only the individual was not receiving the care that was being purchased and planned, but that they were at risk of suffering harm. An immediate requirement was left in relation to this matter, and contact was made with the relevant professionals to ensure that the individual was kept safe. This issue is considered further under healthcare. Care Homes for Adults (18-65 years) Page 13 of 39 Evidence: The information for a further individual included information about the signs of deterioration in their mental health. We looked at the daily record for this individual and found that when she had deteriorated relevant health care professionals had been contacted. The daily notes showed that the advice given had been taken, and that individuals medication was to be managed by staff rather than by the individual self. For this individual there was evidence that the care plan was followed and that the appropriate actions were taken when the individuals needs changed. There were various documents on files headed risk assessment, however these were not risk assessments- but check lists of issues. They did not identify the nature of the risk and how it was to be managed. Other documents identified a score in relation to issues such as depression or anxiety. However there was no evidence of how any particular score played a part in care planning or in risk management.The affect of this for the people who live at the home is that they may not be receiving the support they need to be safe. Over all whilst the information held on each person had improved from previous inspections however the standard of care planning and risk assessment was still inadequate. Most people at Elmslea manage their own finances, however a few people have money held in the home on their behalf. There are records of this money. Mr Stanbury explained that some people have a power of attorney (POA), and in this instance the home provides a record of spending to the POA along with receipts. We discussed with Mr Stanbury the need to keep a record of all transactions, including payments by for accommodation. We also reminded Mr Stanbury that no monies belonging to an individual should be paid into the homes account, and that suitable accounts should be opened for the individual. Mr Stanbury advised us of how an individual had been given his building society account book, when Mr Stanbury heard that the person was considering moving to more independent accommodation. This had resulted in the individual spending all of their savings. We discussed with Mr Stanbury whether such actions could be seen as undermining the plan for the person to move on, by setting them up to fail. Mr Stanbury disagreed, as he considered that it demonstrated that the individual lacked the necessary skills, particularly as he believed that Social Services had not be up front with him about possible plans for the individual. Care Homes for Adults (18-65 years) Page 14 of 39 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Elmslea are offered the opportunity to engage in a wide range of activities and occupations both at home and in the community. People have choices about how they spend their time however there appears to be a lack of any real choice about religious observance. Meals are well and imaginatively cooked, with fresh ingredients. There is a lack of recording in relation to specific dietary needs. Evidence: An Expert by Experience was involved in this inspection visit. An Expert is someone who because of their experience in a particular area is able to offer particular insight into the experiences of people who use a service.The Expert by Experience at this inspection was asked to look at the the opportunities and choices people at Elmslea have in relation to activities in the home and in the wider community. The Expert spoke with a number of the people about how they spent their time, comments from the Expert included: Care Homes for Adults (18-65 years) Page 15 of 39 Evidence: There was evidence of lots of activities taking place for the service users. P (carer) gave them morning exercise sessions, and the local college came in to give them cookery lessons, plus the ongoing sewing and art sessions. There was also a vegetable garden outside where the residents where encouraged to take part in growing their own food, it wasnt up and running on the day of my visit because it was February. All the service users I met engaged well and were very chatty about their life at Elmslea. I noticed that service users were very active around the home, vacuuming their rooms, cleaning the kitchen, working alongside their carer P, and that there was a lot of laughter and banter as they teased each other about how good they were at cleaning. The carer, P told me they had a lot of fun in the home and that there was a lot of love in the house. She told me she brought her crystals in and gave healing to everyone. I asked one person if she and her friend went out in the evenings, and was there a time she had to be back for. She said if they went out they always went to bed by 10.30 p.m., because they were tired. I asked another person if she could have a lie in if she wanted, and she said that everyone had to be up by 9.00 a.m. for breakfast. If you didnt get up you didnt get breakfast, but you could stay in bed if you wanted. One lady was in bed that morning and came to lunch in her dressing gown. She said she wasnt feeling well. Lunch was freshly cooked and everyone turned up to eat at the same time, except those who were working on the farm. Everyone chatted at lunch around one big table and although there wasnt a choice of menu (baked potatoes) there were various choices of accompaniments e.g. grated cheese, beans, egg mayo, salads and fresh fruit for pud. All the service users helped lay the table and cleared away and washed up together quite willingly with the carer. Once again I noticed lots of banter and laughter as they worked. With so many activities available at Elmslea I was confident that service users were being provided with lots of choices. The level of engagement and interaction was really high and it was obvious that the people living at Elmslea felt valued and inspired by the programmes they were involved with, i.e. dressmaking for African children, baking biscuits for everyone, cooking their boyfriends meal, or working on the farm. We have raised concerns at previous inspections that the people who live at Elmslea have told us that they have to go to Church on a Sunday. Following this visit the Expert by Experience commented on the level of religious observance in the home and Care Homes for Adults (18-65 years) Page 16 of 39 Evidence: noted If the Christian church going is enforced it would be hard to say that it is against anyones will, more a case of a foregone conclusion that people would want to attend. The Expert asked Mrs Stanbury if there was a choice of denominations, she told me that there were various churches close by, she mentioned Catholic and Anglican, and said she didnt know of any Mosques in the area. But as it happened, everyone who lived in Elmslea is a Methodist church goer Over the two days of the inspection we noted that the food was of a very high standard. Food was cooked from fresh ingredients. The larder was well stocked- with a good range of high quality ingredients. We were told that the people who live at Elmslea were involved in planning the menu for the next day. A record of the meal eaten is kept in the diary. We had no concerns about the quality and standard of food offered, however there was a lack of information and records relating to people who were on specific diets. This information is important because it should be used in managing conditions such as diabetes. Care Homes for Adults (18-65 years) Page 17 of 39 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who use this service cannot be assured that they will receive the support they need with their health care, and as a consequence their well being may be put at risk. The management of medication has improved, however there are still major areas, such as the supporting people who are self administering, auditing and control of medication and homely remedies, where there is a lack of a clear implemented policy. This means that it not possible to be certain that people have received the correct medication. Evidence: Everyone seen throughout the two days of this inspection visit was well dressed and appropriately dressed. People wore clothing suited to the activities they were taking part in. As part of the process of checking whether people received the care and support that has been agreed, we tried to look at reviews carried out by the people (Social Workers/Care Managers) responsible for monitoring care. These documents were missing for many of the people who live at the home. As has already been noted the homes care plans are not comprehensive and lack detail. Care Homes for Adults (18-65 years) Page 18 of 39 Evidence: We also found that where it had been agreed that a person should for example should be developing domestic skills there was no evidence that this was being approached in a structured manner. The inspectors examination of records and from information from the expert by experience showed that people at Elsmslea have been in reciept of crystal healing, hypnotherapy, acupuncture, and councelling, as well as podiatry and services from their General Practitioner. The people at Elmslea are entitled and free to use whatever service or therapies they feel they will benefit from. However the service provider, Mr and Mrs Stanbury have a duty to ensure that any therapies that they introduce or provide are discussed and agreed within the Care Plan. We noted that one of people who lives at Elmslea is to be provided with counselling, by a member of staff at the home. However when we checked the individuals qualification in this are they are not qualified to counsell. Mrs Stanbury explained that the individual used counselling skills, but was not a counsellor. We also noted that one person had recieved hypnotherapy in relation to alleged historical abuse. We were shown a letter that informed the Social Worker that this had happened, however there was no evidence of any discussion about the use of such an unusual therapy before it was used. The Expert by Experience was told by people who live at the home that a member of staff provides crystal healing. We looked at the management of health care for an individual with longstanding physical health care needs. We found that there was no proper record of how the condition was to be managed. Information was fragmented, however in some of the documents it clearly stated that the indivdiual needed supervision and monitoring in the management of the condition. The Care Plan did not include all aspects of the condition and how it is to be managed. When we asked Mr and Mrs Stanbury about what actually they actually did, we found that the individual was not supervised or monitored in relation to their medication. There was no proper medication self administration risk assessment. After the completion of the site visit we contacted the Commissioners of the service and were provided with information about the level of care that Mr and Mrs Stanbury had recently said they were providing. There was a discrepancy between what the Commissioners thought was being provided and the care being received. When we looked at the records of medication administration, we were very concerned that the individual was not recieving the health care or medication required. Records indicated that medication was being given out to be self administered, in larger quantities that was required. This meant that medication was not being properly stored and that there was no proper audit of this medication. When we did a check of whether individual had received the correct amount of medication, it Care Homes for Adults (18-65 years) Page 19 of 39 Evidence: appeared that the individual had not received the correct dose of medication on many occasions over the months we checked. We found that where medication was being administered by staff from the monitored dose system provided by the pharmacist, this was generally in order. However, there was no proper system for homely remedies. We found that there was no proper medication policy, that included homely remedies. We were concerned that one of the homely remedies was lavender oil. Mrs Stabury told us this was applied immediately to any burns. We were concerned that this is not generally accepted first aid practice for burns, and that lavender oil, which is sometimes used in aromatherapy, is contraindicated for some people. Mrs Stanbury has previously advised the Commission that no aromatherapy or homeopathy is provided by the home. In looking around the home we found saw that one person had medication in her room. We were told that the individual concerned self medicated, however when we checked the medication that the individual had, against what the indivual was recorded as receiving, there was a discrepancy. We noted that the medication was not being safely stored in the indivudals room. It is recognised that an indivdual has the right to go to their GP themselves, and may not always inform the home of such a visit. The Provider, however, has a responsiblity to ensure that such matters are risk assessed and support is provided to the indivudal to monitor and check medication that they might hold. This must be supported by proper risk assessments. Care Homes for Adults (18-65 years) Page 20 of 39 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are systems for dealing with concerns. However, where issues have raised there is evidence that these have not always been dealt with in an open or professional manner. Also there is no proper audit of concerns. Evidence: We looked at the policies and procedures that govern how any concerns will be managed. We found that whilst there were policies in relation to the management of complaints and safeguarding issues, these were very basic. We noted that in one policy it stated that staff would have training in relation to abuse and neglect in their induction every 2 years there after. We found that this training had not been carried out. We looked at how concerns had actually been dealt with. We were aware of a concern raised regarding a member of staff who worked at the home. The correspondence that we saw showed the home to be evasive in their management of the issue, and failed to respond to the concern in a direct, open or professional manner. We also noted that one individual had been introduced to a hypnotherapist in relation to concerns about alleged historical abuse. There was no evidence that this approach had been discussed with the relevant professionals prior to this very unusual approach being used. Care Homes for Adults (18-65 years) Page 21 of 39 Evidence: We also noted that relatives of people living at Elmslea had been sent copies of care plans. Mr and Mrs Stanbury told us that they had sought individual consent regarding this issue, however there was no record on file of this consent. We did however see correspondence from relatives expressing some concerns about the inaccurate nature of some of the information. Care Plans appeared to have been reviewed following the correspondence, however there was no evidence of any audit of complaints. Care Homes for Adults (18-65 years) Page 22 of 39 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Elmslea are provided with a high standard of accommodation. The house is clean and well furnished and people are able to decorate their rooms in a way that suits their preferences. Evidence: We looked around the communal areas of the home and also the bedrooms. The home is decorated and furnished to a very high standards. All of the bedrooms have en-suite shower rooms, with the exception of one, which had a bathroom close by. The tidiness and furnishing of the bedrooms very much reflected individual choices. Mr Stanbury told us that individuals could have keys for their rooms, though on occasions these keys got lost. We noted that some of the casement windows in the home did not have window restrictors on them. We advised Mr Stanbury of the need risk assess such windows, taking into account advice from the Health and Safety Executive on this matter, which is to fit opening restrictors in all windows above ground floor level. All areas of the house was very clean. We were told that no specific cleaner is employed in the home. There was a rota on the wall with regard to the management of tasks around the kitchen and dining room. We were told that some of the people who live at the home like to help with the cleaning, and one person confirmed that she did cleaning. Care Homes for Adults (18-65 years) Page 23 of 39 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live at Elmslea are supported by a stable team of staff, however their training is patchy and inadequate. The people who provide therapies have not all had all the relevant checks made on their status. There was also evidence of people being provided with counseling by a person who is not suitably qualified to be a counselor. This means that the people who live at Elmslea can not be confident that they will always get the help and support they need. Evidence: No new care staff have been recruited to work at the home since the last key inspection. The recruitment records were thoroughly inspected at a Random Inspection on 13/11/09 and therefore were not specifically looked at during this visit. The requirements made at previous inspections in relation to checks on new staff and induction have therefore been carried over. We asked Mr Stanbury what were the arrangements for recruiting new staff, and was told that there were no arrangements, staff were recruited by word of mouth. We were shown a folder that contained various checks in relation to therapists who are used by the service. There was evidence that efforts had been made to obtain a Criminal Records Bureau check for each person, and that a copy of their qualification had been seen. However these checks were not complete, as not all of the individuals Care Homes for Adults (18-65 years) Page 24 of 39 Evidence: had a current Criminal Records Bureau Checks. We noted in a review carried out by Social Services that one person who lives at the home is to be provided with counseling. However when we checked the qualification of the member of staff who is apparently to provide this service, we found that they are not a qualified counselor. Mrs Stanbury said that staff used their skills in talking with the individual. We also noted that the Expert by Experience was told that staff provide crystal healing. We have not seen any qualification in this area among staff, nor have we seen any mention of the needs for such a service in any care plan. We noted from the rota that Mr and Mrs Stanbury work seven days a week, from early morning till late at night. There is very little evidence of any time off duty. We discussed with Mr and Mrs Stanbury having time away from the home. We looked at the training that staff have received which would indicate that they have the knowledge and skills in relation to provide support to the people who live at Elmslea. We found that there was evidence that staff were in recent months being required to complete training work books in relation to areas such autism or mental health, this training is at a very basic level. Training remains patchy, for example there was no evidence that anyone had received any training in relation to the Mental Capacity Act or in relation to conditions such as diabetes, or first aid. We discussed with Mrs Stanbury a training matrix that would help her to have an overview of training needs. Care Homes for Adults (18-65 years) Page 25 of 39 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people who live Elmslea cannot be confident they will receive the care and the support they require because the management has failed to provide the safe and proper systems of care, particularly in the areas of medication and health care. Evidence: We looked how the home is managed. This included looking at policies and procedures, guidance that specifies how specific situations will be dealt with. The home uses a set of policies that have been developed by another organisation. The documents had not been altered or amended to reflect practice at Elmslea. For example the policy on first aid states that We determine the nature of our first aid cover making sure we always have a suitable first aider on duty at all times, in reality this does not happen as there are insufficient trained staff. There were also gaps in policies and procedures- for example there is no policy in relation to homely remedies, self medication. We looked at when equipment and systems in the building had been last serviced or maintained. We found that there was a fire risk assessment and checks had been Care Homes for Adults (18-65 years) Page 26 of 39 Evidence: made of fire equipment. There were records to indicate that fire drills had been completed however there was no proper information as to the nature of the drill. As part of the process of checking that the people at Elmslea have a voice in the quality of the care provided, the Commission expects that regular surveys will be carried out of people who use or who have contact with the service. We saw that such surveys had been carried out, but that there was no analysis of these or evidence that the views had been taken into account in the development of the service. We noted that these surveys were used to obtain feedback on the inspection process carried out by the Commission. Mr and Mrs Stanbury have worked with the Commission since the last inspection visit, and have expressed a willingness to make the necessary changes to the service. However many of the necessary changes that have been required have not been evidenced at this inspection visit. This lack of openness in the management of complaints was of concern. However, most serious is the poor management of the medication system and the support provided in relation to health care. Failings in these areas indicate that the management of this service does not have safe systems in place to ensure that people received the support they need and are kept safe, in spite of repeated requirements over the last year. Care Homes for Adults (18-65 years) Page 27 of 39 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 2 14 The Registered Provider must 01/05/2010 have a copy of a comprehensive written needs assessment of a person, before any stay Elmslea, including a trial visit. People must be confident that their needs will be known and can be met if they move to Elmslea. This requirement was made on 17/3/09 and due to be met by 1/6/09. No new people have been admitted since the last inspection the due date has therefore been extended. 2 6 15 The Registered Provider must 01/04/2010 have Care Plans that are comprehensive and include details of any goals, skills being developed or therapies used. The people at Elmslea and staff need to know what help is needed and how it should be given. This requirement was set 17/3/09 to be met by 1/6/09. It has not been met. The requirment has therefore been set again. Care Homes for Adults (18-65 years) Page 28 of 39 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 3 9 13(4)c Risk assessments must show 01/04/2010 that the safety, independence and choice has been considered and is regularly reviewed with people living in the home. This requirement was made on 17/3/08 to be met by 30/7/08 and was not met. A further due date has been set. 4 20 13 Review medicine records and 01/05/2010 care plans for people living in the home to make sure that for all medicines prescribed with a direction when required or with a variable dose there is clear, up to date and detailed written guidance on how to reach decisions to administer the medicine and at a particular dose, taking into account the provisions of the Mental Capacity Act 2005. This will help to make sure people living in the home receive the correct amounts of medication in a consistent way in line with planned actions. This requirement was made 28/8/09 to be met by 7/11/09. It has not been met. A further date for this requirement has been set. 5 20 13 Arrangements must be made 01/04/2010 to record any verbal dose changes safely. Page 29 of 39 Care Homes for Adults (18-65 years) Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action This is to make sure that people receive their medicines safely and as the prescriber intended. This requirment was made 15/10/09 to be met by 30/11/09. It has not been met. A futher date for meeting the requirment has been set. 6 20 13 Make arrangements so that 01/04/2010 any medicine that needs refrigerated storage is always kept securely within the correct temperature range indicated by the manufacturer. Use a maximum and minimum thermometer to keep daily records of the temperature in the medicine fridge. This will help to make sure medicines are kept at the right temperature to retain their potency. This requirement was made on 28/8/09 to be met by 7/11/09. It has not been met. A further date has been set. 7 20 13 Make sure that when people 01/04/2010 living in the home look after and administer any of their medicines themselves there is a full written risk assessment process in place with actions taken to reflect best practice guidance and to Care Homes for Adults (18-65 years) Page 30 of 39 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action make sure this is safe for everyone in the home. Make accurate and compete records when medicines are given to people to look after, as well as regular checks that they are using their medication correctly. This to help make sure that people are taking the correct amounts of medication and that the arrangements are safe for everyone in the home. A similar requirement was made on 18/3/09 to be met by 1/6/09. It was not met. This requirement was made 28/8/09 to be met by 7/11/09. It has not been met a further date has been set. 8 20 13 For each person living in this 01/04/2010 home you must always keep accurate, clear and complete records for all medicines received, administered and disposed of. This is to help make sure all medicines are accounted for, that people receive their prescribed medication correctly and are not at risk of mistakes with medication because of poor recording arrangements. This requirement was made 27/8/09 to be met by 31/8/09, it has not been meet and a new due date Care Homes for Adults (18-65 years) Page 31 of 39 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action has been set. 9 20 18 Make sure that any staff who 01/05/2010 administer or deal with medication for people who live at this home have completed and passed a proper formal course about the safe handling of medicines are assessed as competent to handle medication. This will help to make sure that staff are competent to manage medication safely and people living in the home are not at unnecessary risk from mistakes with their medicines. This requirement was made on 28/8/09 to be met by 30/11/09. It has not been met. A further due date has been set. 10 20 13 Make sure and demonstrate 01/05/2010 that all the arrangements for recording, handling, safekeeping, safe administration and disposal of medicines received into the care home are safe for everyone in the home by having clear, safe procedures in place that follow accepted best practice guidance and with robust checking and auditing at a frequency to demonstrate that people are consistently having their medication correctly and all Care Homes for Adults (18-65 years) Page 32 of 39 Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action medicines are accounted for. This is to help make sure that people living in the home receive the correct levels of medication and are not put at unnecessary risk because of poor practices or recording. This requirement was made 28/8/09 to be met by 7/11/09. It has not been met. A further date has been set. 11 20 13 Make arrangements to have in place effective stock control arrangements for medication so that all medicines are always within their expiry date, only those medicines in current use for people in the home are kept and that all medicines can always be accounted for. This will help to make sure that all medication can be accounted for and that people in the home at not at risk of receiving the wrong medicines or medication that is out of date. This requirement was made on 28/8/09 to be met by 7/11/09. It has not been met. A further date has been set. 12 34 18 The Registered Provider must 01/06/2010 have a suitable system for the recruitment of staff, Page 33 of 39 01/04/2010 Care Homes for Adults (18-65 years) Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action including receiving two appropriate written references, and a POVA check, prior to working in a supervised capacity. A CRB check must be completed before any person may work unsupervised. Only people who are suited to the work may be employed in care homes. (This requirement was made on 18/3/09 to be met by 1/6/09. No new staff have been recruited to the home, and as such the requirement has not been met, the due date has therefore been extended) 13 34 19 The Registered must ensure 01/06/2010 that arrangements are in place to ensure that they have obtained the necessary information, as specified in the regulations, for all new volunteers, before they start work at the home. This is to ensure only people suited to the work, volunteer. This requirement was made 30/9/09, due by 7/11/09. No new volunteers have started work, the due date has therefore been extended. 14 34 19 The Registered Providers 01/05/2010 must put in place arrangements to ensure that Page 34 of 39 Care Homes for Adults (18-65 years) Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action when staff are employed at the home with a POVA First check that they are appropriately supervised in accordance with the regulations, until a CRB clearance is received by the home. This is to ensure that people are supervised until all the relevant checks have been completed. A similar requirement to this was also made on 18/3/09 due 1/6/09, and not met. This requirement was again made on 28/8/09, due by 7/11/09. No new staff have been recruited, the due date has therefore been extended. 15 35 18 New staff must be provided with a comprehensive, structured induction to the work. New staff need to be made aware of their role, and good practice. This requirement was made on 28/8/09 to be met by 7/11/09. No new staff have been appointed, therefore a new date has been set. 16 38 12 The Registered Providers 01/04/2010 must ensure that the home is managed in a manner that respects the rights of individuals and provides them with the support they Page 35 of 39 01/06/2010 Care Homes for Adults (18-65 years) Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action need. People who live in care homes must be treated with respect. This requirement was made on 15/9/09 to be met by 7/11/09. It has not been met, the due date has therefore been extended. 17 38 12 The Registered Provider must 01/04/2010 act in a professional manner and facilitate contact with health and social care professionals. Recording must be done in a professional manner. This is so that the people who live at Elmslea can receive the services to which they are entitled. This requirement was made 18/3/09 to be met by 1/6/09, and again on 30/009/09 due by 31/10/09. It was not met, and a new due date has been set of 1/4/10. Care Homes for Adults (18-65 years) Page 36 of 39 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action 1 18 13 You must ensure that there 12/02/2010 is a clear and comprehensive policy and guidance to direct how diabetes will be managed, including the administration and monitoring of insulin. Peoples need to know that their health care needs will be met. Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 16 13 A proper record must be kept of how specific dietary requirements are met. So that individuals can be confident that their needs are met and monitored. 31/03/2010 2 22 12 Complaints must be managed in an open and professional manner. The people who use or have contact with the service must be confident that any issue raised will be dealt with appropriately. 04/04/2010 Care Homes for Adults (18-65 years) Page 37 of 39 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 3 24 13 Risk Assessments must be 31/03/2010 completed on all opening windows above ground floor. To avoid falls and injury. 4 35 18 A training plan must be 17/04/2010 drawn up and implemented to ensure that the people who provide care and support are appropriately trained and qualified to carry out their role. The people who live at Elmsea need to be supported by competent people. 5 40 12 There must be a comprehensive and implemented set of policies to under pin and guide the operation of the home. People need to be confident that their care will be guided by good practice. 30/04/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Adults (18-65 years) Page 38 of 39 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 39 of 39 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!