Inspection on 17/03/08 for Elmslea

This inspection was carried out on 17th March 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 6 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 10/02/10

Elmslea 13/11/09

Elmslea 17/09/09

Elmslea 27/08/09

Elmslea 02/03/09

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 27/09/2008.

CARE HOME ADULTS 18-65 Elmslea 34 Dunheved Road Launceston Cornwall PL15 9JQ Lead Inspector Susan Taylor Unannounced Inspection 17th March 2008 15:00 Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 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 Elmslea DS0000009018.V356787.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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmslea Address 34 Dunheved Road Launceston Cornwall PL15 9JQ 01566 777661 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered provider (if applicable) Type of registration No. of places registered (if applicable) Mr Henry Stanbury Mrs Irene Stanbury Care Home 15 Category(ies) of Mental disorder, excluding learning disability or registration, with number dementia (15) of places Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 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 13th June 2007 Brief Description of the Service: Elmslea provides accommodation and personal care for up to 15 adults with a mental disorder. 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 with en suite facilities. There are various communal spaces and garden areas for residents to use. The cost of care is currently £450 per week. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. We were at the home with people for 10 hours over two days. The purpose for the inspection was to look at key standards covering: choice of home; individual needs and choices; lifestyle; personal and healthcare support; concerns, complaints and protection; environment; staffing and conduct and management of the home. We took an Expert by Experience to meet people at the home on 17th March 2008. CSCI are trying to improve the way we engage with people who use services so we gain a real understanding of their views and experiences of social care services. They are an important part of the inspection team and help inspectors get a picture of what it is like to live in or use a social care service. The term ‘experts by experience’ used in this report describes people whose knowledge about social care services comes directly from using them. The expert spoke to people for 3½ hours about their experiences of living at the home for as well as making some general observations and their comments are included in the report. We looked at records, policies and procedures in the office. A tour of the home took place. We tracked the care of three people. We also spoke to people alone in private and in groups about their experiences living at the home. We sent surveys to all of the people living in the home and received 7 back. Only 2 people chose to complete the surveys and the remainder were returned to us. We spoke to people about this at the inspection and they told us they did not like filling in forms but preferred instead to talk directly to us. We suggested that the group of people living at the home might like to consider having a ‘link’ person that can hand out and help people to give us feedback about the quality of their lives at the home for future inspections. The link person would be someone who lives in the home. The comments of people that did fill in the surveys are in the report. We sent surveys to three GPs and other professionals responsible for commissioning care for people at the home. We received 1 back. We have included some of their comments in the report. Additionally, professionals told us that they would like to send us information about their experiences and those of the people they support that live at the home. However, we did not receive this so have been unable to include this in planning and doing the inspection or adding any comments to the report. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 6 As at March 2008, the fees were £450 per week for personal care. Extra charges are made for chiropody, hairdressing, newspapers and magazines and toiletries and these vary. People funded through the Local Authority have a financial assessment carried out in accordance with Fair Access to Care Services procedures. Local Authority or Primary Care Trust charges are determined by individual need and circumstances. General information about fees and fair terms of contracts can be accessed from the Office of Fair Trading web site at www.oft.gov.uk People living there described Elmslea as being “a safe place to develop as a person” and feeling “secure”. Staff we spoke to told us that they enjoy working at the home and that the provider is very “supportive” and offers them “plenty of opportunities to do training”. We also did a random inspection in February 2008. This was because we were told about an incident involving a person who lived at the home. We wrote a report about our visit, which is available on request from the Commission. What the service does well: People have told us that as soon as they visited the home and decided to move in they were “made very welcome” and were given a lot of information about what to expect. The team are very good at finding out about people and ensure that every person has a care plan. People living at Elmslea say that they have the freedom to do what they want to, when they want to so long as they stick to a few house rules. They feel able to voice their concerns, if they have any. Similarly, people understand their responsibilities and are given regular feedback about how they are doing to help them get better. This can be daunting, but people say that their lives have improved for the better as a result of it. People say that their friends and families are encouraged to visit whenever they wish to. Additionally, a lot of events have taken place that families have been invited to, for example the Christmas Party in which everyone played a part in the show put on for friends and relatives. The people living at the home get support to keep in touch with their families and friends if they need to. Elmslea is a converted house that is a comfortable place to live. People living there say that they are encouraged to see it as their own home and that it is always clean and well maintained. Staff feel well supported and are encouraged to do training so that they have the right skills and experience to care for people. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: The following are legal requirements: Information about people is not always handled appropriately in a way that maintains their right to confidentiality and to have accurate records kept about them. This would include ensuring that care is regularly reviewed with every person living in the home so that staff have up to date information and are able to meet individual needs. Risk assessments must show that safety, independence and choice has been considered and is regularly reviewed with people so that they are able to lead as fulfilling lives as possible. Individuals with more diverse needs may find it harder to have their opinions listened to and ways to help them do this need to be found. They also need to feel confident that their privacy and dignity is maintained in terms of information that is written about them and the way they are treated in the home. The provider needs to demonstrate that there is always sufficient staff in such numbers to meet the needs of people living in the home by keeping accurate records of this (duty rosters). Quality assurance processes need to be put in place across all functions of the home to ensure that people receive a consistently good service and are consulted about every aspect of it. More supporting evidence to illustrate what the service has done in the last year, and/or explicitly how it is planning to improve is required. All records that relate to people living in the home must be kept up to date so that staff have the right information with which to care or support them. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 8 The following are recommendations: The daily routines and house rules should promote independence, individual choice and freedom of movement for people living in the home, subject only to restrictions agreed in the individual’s care plan and contract. Protect people that live in the home and staff that work there further from the risk of infection by using the Department of Health guide ‘Essential Steps’ to audit current infection control management. 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. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Quality in this outcome area is good. People are supported to be fully involved in the assessment process. Information is gathered from a range of sources including other relevant professionals, and with the individuals agreement, carer’s interests are taken into account thus ensuring that people’s needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We read the document that is the statement of purpose, which briefly outlines the philosophy behind the rehabilitation service as being ‘holistic….with an emphasis of self help and behaviourism’. Additionally, there is a strong emphasis upon participation in activities such as work, socialising at the local church and other community events in the area. We also read a document entitled ‘Elmslea House rules’ covering behaviour that is expected of people living in the home regarding their rooms, alcohol, smoking, mealtimes, visitors, medication, laundry, cooking, use of the telephone and fire procedures. All of the people we spoke to had been given a copy of the document and we saw signed copies in three care files. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 11 100 of the people responding to our survey verified that they were given sufficient information enabling them to make a decision about whether to live at the home or not. Eight people we spoke to at length told us that the group meet with a potential resident and are then consulted about whether the person should be offered a place or not. Therefore, people living in the home have a say over who comes to live with them. The provider told us that people are assessed by themselves and that they go to visit the person in their current setting to make an assessment. We looked at three care files. A thorough assessment of needs had been completed with people before and after they had moved into the home. Assessments established what risks there might be for an individual about their mental health and highlighted triggers that cause them to deteriorate or self harm with a clear strategy in place to minimise them for people. Additionally, information had also been obtained from social services about individuals, where appropriate. Assessment and care plans had been reviewed for two out of the three people whose needs we tracked. We spoke to ten people at length in the home, all of whom felt that Elmslea meets their needs. One person gave us a note during the inspection and had written [they] ‘gave me a home’. Another person said “I spent years lying in my bed, the main thing that makes it work here is the structure and routine and because of that I have got my life back”. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 12 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6,7,8, 9 & 10 Quality in this outcome area is adequate The care and support of people at Elmslea is underpinned by exacting principles that suits individuals who respond well to peer pressure and behaviour modification; we observed good outcomes for people whose mental health had improved. Individuals with more diverse needs may find it harder to have their opinions listened to. Information about people is not always handled appropriately in a way that maintains individual rights to confidentiality and to have accurate records kept about them, and is an area that needs improvement. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We tracked the outcomes of care for three people that have lived at the home for varying lengths of time. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 13 We spoke in private to someone who had a bipolar disorder. They showed us their own copy of the ‘service users guide’ in their room. This, they told us, “gives a good picture of the home” although they had found the first few months “much harder” than they had anticipated. They went on to tell us that it was “difficult to get up in the morning” and one of their goals was to do this, “I have to shower, put clean clothes on and make my bed.” We looked at the individual’s care file and read assessment information, including risk assessments, about the person that had been obtained from other professionals involved in supporting them. A care plan had been written using this and other observations made by the care team at the home that had been recorded on an ‘individualised programme description sheet’. This corresponded with what the person had told us about their goals and their experiences living at Elmslea. Daily records were incomplete and did not provide a clear picture of the person’s progress since 22/2/08. During the inspection, the expert by experience and inspector observed this person asking the provider why they wouldn’t be able to go out at the end of the week. The provider, in front of people in the lounge gave the person feedback about their behaviour and told them that they would be able to go out if they met their goals for the week and there was “still a chance to turn it around”. The inspector read the behavioural plan for this person, which was a reward based system, and spoke at length to the provider about what we had observed. The reward for achieving mutually agreed goals for the week was a trip out to the pub on Friday evening. Whilst this was something positive that the individual had chosen to work towards, the inspector told the provider that this should not have been discussed openly in front of other people because it did not respect the person’s dignity or right to confidentiality. The provider accepted the constructive criticism and agreed that they should have taken the person to one side or to the office to discuss the matter in private. We spoke in private to another person that had lived at the home for a long time who said “I feel emotionally safe at Elmslea”. They went on to tell us that they had lived in other places where their mental health had deteriorated and “had no direction, but now I have direction and have got my life back”. We looked at this person’s care file and saw comprehensive assessment information on file. The individual told us that the provider held reviews regularly with them to give them an opportunity to reflect on their progress and received feedback about positive and negative aspects of their behaviour. From the lengthy conversation we had, the individual had experienced good care and a quality of life that had enriched them as a person. We observed that the person was confident and spoke openly in private to us about what worked for them and what did not work. They also told us that as they developed new skills and interests they had “taken on more responsibility” for their own life. As a result, they were also actively encouraged to give peer support to other people in the home that needed it, particularly those who were still settling in. We did not, however see any documentary evidence on Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 14 the individual’s care file to support that reviews of their care plans had regularly taken place. We looked at another person’s care file and read their care plan. The person had told us that they needed a lot of support with budgetting. They told us they were well supported by the providers with this. The person’s care plan had been reviewed in August 2007 and measures put in place to protect them from potential financial abuse. We saw correspondence on the file about this. The registered persons had been tasked with monitoring and managing the person’s finances with them. The risk assessment on their file was dated 12/7/06, and had not been reviewed to reflect the events leading to changes in care. We spoke to the provider about this and she verified that the risk assessment had not been reviewed. We spoke to small groups of people about the home’s emphasis of ‘self help and behaviourism’ and an expectation to participate in activities such as work, socialising at the local church and other community events in the area. We were told that there are ‘rules’ at Elmslea, which people felt were “reasonable” and what you would expect living communally as a group to help them stay safe. People told the expert by experience that they could only go out on their own after speaking to the provider. They also told us they had a lot of freedom so long as they followed the ‘rules’. We read a document entitled ‘ Elmslea House Rules’ which covered responsibilities that people had when living in the home. People told us that ‘sanctions’ were used to help them reflect about their behaviour and consider what impact inappropriate behaviour might have on other people. At the same time, people told us that they were given positive feedback and had insight that they would be better accepted in the community if they demonstrate the behaviours agreed with them individually. ‘Sanctions’ had been agreed individually and were documented in the behavioural plans we read for three people whose care we tracked. Two out of three plans had been reviewed with the individual concerned. There was no supporting evidence in the third file to demonstrate that this had occurred for the individual concerned. One person explained this further “I would place sanctions on myself if I was becoming unwell” and they are “not used to tell you off, I would never have got as well as I am without it. They [the providers] respect me and I respect them”. The expert by experience commented that everyone they spoke to felt that their mental health was “improving” as a result of living at the home. On the second day of the inspection, we observed an interaction between an individual and the provider about advocates that had turned up to visit them without notice. Initially, the person told the provider and that they did not want to go out and asked the provider to tell the visitors this. The provider reflected this back to the individual and told them that it was their decision and if they did not want to go out they did not have to. However, the provider Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 15 suggested that it “might be nice to go out” with the visitors so that they could speak to them in private and suggested several places including a local garden centre to go to. The person chose in the end to go out for the afternoon. Over the course of two days, we observed similar interactions and discussions during meals. We were told that people living in the home are consulted about potential new residents (as discussed under the choice of home section) and prospective employees before being accepted to live or work there. All of the people living in the home had their own savings/bank accounts. The provider told us that they managed money on behalf of one person only that needed considerable support with budgeting. We had also looked at another person’s care file for someone that was at risk and needed support with budgeting his or her money. We were told that a close relative of the person identified by the provider had ‘Enduring Power of Attorney’ and that purchases were made as and when necessary and that the home was “reimbursed” for this. We looked at the records; the balances were accurate. Receipts for purchases had been obtained and entries described what had been purchased so that they could be audited. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 16 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 & 17 Quality in this outcome area is adequate People at Elmslea have a range of opportunities that helps to improve their social inclusion within the local community, which are limited for an initial period. Participation is an expectation and initial limitation of these opportunities is not always made clear enough to people when they move into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We read the ‘statement of purpose’ and ‘service users guide’ which stipulates that work on the farm is ‘optional’ if there is no other activity available for the individual at the time. We talked to ten people at the inspection. They told us that they fill some of their time by cooking and cleaning in the home. People showed us their Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 17 bedrooms, which were nearly all clean and tidy and reflected the individuality of the occupant. Additionally, we were told that if they need support to do this there is a small team of staff that work in the home to support them. The home has good links with Duchy College and classes are held throughout the week in a craft room to the rear of the building. People showed us examples of their craftwork on day one, and offered us cakes that they had made on the second day of the inspection that were delicious. Three people told us that they work on a farm that is owned by the registered providers. Two people said that they really “enjoyed” farming and would like to work towards getting a job in the industry. One person did not particularly like working on the farm, but said, “it is just a stepping stone to get to where I want to go to”. We asked the person why they were working on the farm and they told us because they had previously enjoyed working with animals in the past so it was the “natural choice initially to do this to get me doing something with my life”. Two people told us that they work, at charity shops and a local supermarket and “enjoy this very much as we get to meet other people”. We spoke to small groups of people about the home’s emphasis of ‘self help and behaviourism’ and an expectation to participate in activities such as work, socialising at the local church and other community events in the area. We were told that there are ‘rules’ at Elmslea, which people felt were “reasonable” and what you would expect living communally as a group to help them stay safe. People told the expert by experience that they could only go out on their own after speaking to the provider. They also told us they had a lot of freedom so long as they followed the ‘rules’. We read a document entitled ‘ Elmslea House Rules’ which covered responsibilities that people had when living in the home. People told us that ‘sanctions’ were used to help them reflect about their behaviour and consider what impact inappropriate behaviour might have on other people. At the same time, people told us that they were given positive feedback and had insight that they would be better accepted in the community if they demonstrate the behaviours agreed with them individually. ‘Sanctions’ had been agreed individually and were documented in the behavioural plans we read for three people whose care we tracked. Two out of three plans had been reviewed with the individual concerned. There was no supporting evidence in the third file to demonstrate that this had occurred for the individual concerned. One person explained this further “I would place sanctions on myself if I was becoming unwell” and they are “not used to tell you off, I would never have got as well as I am without it. They [the providers] respect me and I respect them”. The expert by experience commented that everyone they spoke to felt that their mental health was “improving” as a result of living at the home. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 18 Socially, the home has strong links with local churches. People told us that they go to church every week. One person said that whilst “this might not suit everybody initially we have all be made welcome by the congregation and that has raised our self esteem”. Two people told us that they make toys for charity one day a week and enjoy this. We were told that on Friday evenings a group of people go out to the local pub to play skittles and pool and this is seen as a ‘reward’ for meeting their individual goals for the week. Families are made welcome at the home. People showed us photographs from the Christmas party in which everyone had played a part in the show they put on for friends and family. Everyone we spoke to told us that they had “fun” doing this. Additionally, some people said that they visited their relatives regularly. We were shown the cooking rota that had everyone’s names on it. People told us that one person tended to go with the provider to do the weekly shop for food, which was always a busy time trying to cater for everyone’s tastes and preferences. We joined the group for two meals over the course of the inspection. Both meals were appetising and nutritious and provided people with a good level of choice. People told us that they usually discussed what to have for the evening meal at breakfast. We saw that a number of different alternatives had been cooked for people who were consulted about their choices throughout the meals we had. One person told us that they were trying to eat more healthily to reduce their weight. Another person, was an insulin dependent diabetic who told us that they tried to eat a well balanced diet to stay healthy and avoided sugar and foods that were highly processed or were high in saturated fats. People told the expert by experience that the food was good, and the menu was varied. Their comments included, “we have lovely roast dinners, which Henry cooks” and “really good food here”. People told us that they have a pet parrot, a cat and tropical fish, which everyone takes responsibility for looking after. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 19 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 & 20 Quality in this outcome area is good People living at Elmslea have their healthcare needs closely monitored. Procedures ensure that medication is stored and recorded in a manner that protects service users by ensuring that they are given the right medication, at the right time. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In a survey of people living at the home, 100 of people that responded were satisfied with the healthcare they received. Similarly, people that we met told us that they had good access to healthcare professionals who visited them or at the local health centre. We tracked the healthcare needs of three individuals. All had been registered with a local GP. Correspondence on all of the files verified that other health and social care professionals e.g. Psychiatrist, social worker, and community psychiatric nurses were involved in the care of these individuals. The provider told us that they were constantly “battling” to ensure that people have access to “diminishing resources”. We Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 20 received a survey from a healthcare professional that verified that the team communicated well with them and had a clear understanding of the needs of the people living in the home. Additionally, they wrote that people’s medication was appropriately managed in the home. There is a procedure for reporting accidents. Examination of entries in records demonstrated that appropriate action had been taken and where needed had included emergency services being called out. We observed people being given their medicines at mealtimes in line with the homes policy and procedures. A local surgery dispenses medicines for people living at the home. The provider is responsible for stock taking. Records of medicines ordered were seen. The system was easy to audit Medication charts had been completed appropriately. All medication was kept in a secure place. Three people told us that they self medicate and were sat at the table putting their own medicines into weekly dispensers which they keep in their rooms for this purpose. They told us that they are asked to count how many tablets are left each week and write this on the box so that the provider can check the right amount is being used. People told us that this meant that they could move closer to independent living as they learnt how to take responsibility for their own medication. We observed this to be an empowering experience for people. One of the people whose care we tracked showed us their bedroom, which had furniture that was lockable and where they kept their medicines. A risk assessment and care plan seen in the same individual’s care file made no reference to the fact that the person was self medicating and or provided detailed information about how risks might be eliminated or minimised. This matter was discussed with the provider in the context of standard 10, which highlights that people should expect to have accurate records kept about them. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 21 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23 Quality in this outcome area is good Safeguarding procedures have been followed and protect people living in the home. People know who to voice their concerns to. This judgement has been made using available evidence including a visit to this service. EVIDENCE: In a survey 100 of people responding verified that they know who to complain to and that they were ‘always’ treated well. Similarly, we spoke to ten people at the inspection who all knew who to go to if they had any concerns. We observed interactions between the people living in the home and the provider, provider and staff on duty, which were good humoured. The complaint procedure was clearly displayed on the notice board outside the office and is clearly written and easy to understand. Information that the provider sent to us verified that no complaints had been received since the last inspection. Records examined verified this also. Elmslea has a clearly written adult protection procedure that make reference to the ‘Alerter’s guide’ and the provider and provider demonstrated an awareness about the local safeguarding procedure. In information sent to us, the provider told us that no referrals had been made to POVA (Protection of Vulnerable Adults). Additionally, that no safeguarding referrals had been made. However, we looked at a care file for a person whose care we tracked during this inspection. We saw correspondence on the file (August 2007) that Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 22 demonstrated the provider had acted promptly and followed the correct procedures to safeguard the individual by alerting the local social services department about the risks for that person. The person’s care plan was reviewed in August 2007 and measures put in place to protect them from potential financial abuse. The registered persons had been tasked with monitoring and managing the person’s finances with them. The risk assessment on their file was dated 12/7/06, and had not been reviewed to reflect the events leading to changes in care. We spoke to the provider about this and she verified that the risk assessment had not been reviewed. We looked at our records and we were not notified about these events, the action taken and outcome for the person concerned. This may have been an oversight, since our records show that we have received information of this nature from the home in the past. However, we reminded the provider of their legal duty to notify the Commission of all events outlined under regulation 37. We spoke to one member of staff who demonstrated that they understood adult protection procedures. They told us that they had also had recent N.A.P.P.I training that covered techniques about defusing incidents in a non abusive way. We saw certificates in staff files that also verified that this had been provided for them. We also did a random inspection in February 2008. This was because we were told about an incident involving a person who lived at the home. We wrote a report about our visit, which is available on request from the Commission. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 23 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good People at Elmslea live in a well maintained, comfortable and clean environment. Further development of the home’s quality assurance measures should be considered to reduce the risk of infection for people living, visitors and staff working there and ensure that best practice is followed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: 100 of people responding in a survey felt that the home was clean. Information sent to the Commission by the provider as verified that there are two staff and a maintenance person on the staff. Additionally, that there is a refurbishment plan in place. A new staff room has been developed and the company is using an external health and safety consultant. Maintenance certificates for gas, electrical and fire installations verified that external contractors had inspected all of these. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 24 A tour of the premises took place with three people that live in the home. We met a number of people throughout the course of the inspection and observed a handful of people doing domestic chores such as tidying their bedrooms and the kitchen after mealtimes. Bedrooms varied in size and layout. All were personalised and spotlessly clean and provided comfortable private space for the individual concerned. We tested lights in corridors and some bedrooms, all of which were in full working order. People showed us the furniture they have, which includes bedside tables and lights for subtle lighting during the evening and at night. People told us that people are easily disturbed when the hall lights are used, so night lights are used instead to light up hallways. We (the inspector and expert by experience) found some parts of the home were colder than others, particularly bedrooms facing the road. People told us that the heating usually comes on between 5pm and 6pm in the evening. We asked people about this and they said “[the provider] comes round and asks us if we are cold and then overrides it” and “I have an extra heater in my room and extra blankets. I tend to feel the cold anyway to like to have a hot water bottle at night and am very cosy”. We asked the provider about the heating times in the home and she said “it [the heating] usually comes on early evening and first thing in the morning. If it’s cold we override the system. There are colder parts of the home, particularly on the side of the road as it doesn’t get enough sun there”. Communal areas felt comfortable. Maintenance staff told us that they were always available to do repairs and had made the french doors that opened into the dining room. We observed people asking this person to fix furniture and put up shelving for them, which was done whilst we were there. Information sent to us by the provider verified that the department of health guidance has not been used to find out the effectiveness of infection control practices in the home . Additionally, none of the staff have attended training about the prevention and management of infection control. We observed that there was a plentiful supply of aprons and gloves, which in people living in the home and staff used appropriately. People told us that they had been asked whether they wanted to have a flu vaccination in the autumn, which most had chosen to have. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 25 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate There is a training and development culture at the home that ensures staff have the right skills, experience and knowledge to care for people that live there. The absence of duty rotas means that the registered persons do not have the evidence to demonstrate that the home is staffed effectively, with particular attention given to busy times of the day and changing needs of the people who use the service. People are safeguarded by the recruitment procedures of the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People responding in a survey and those we met during the inspection verified that staff were “always” available when they needed them. We were also told that the staff ‘treat them well’. Staff we spoke to said there is a “low turnover of staff”. We asked the provider for old duty rosters and she said we “don’t have any really”. People we met as we toured the building felt “well supported”. We examined the files of three staff. Two satisfactory written references had Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 26 been obtained for all of the staff prior to employment. Criminal records bureau certificates had been obtained also before employment commenced. All of the staff whose files we looked at had been employed before it was a legal requirement to check whether they were on the POVA list. However, the provider verified that if anyone new was recruited this check would be done automatically when the criminal record bureau check is appplied for. The home had a written procedure about recruitment and retention of staff and it was clear that this had been followed to protect the people living in the home. We saw induction records, which staff told us prepares them with everything they need to know when they started the job. Similarly, staff verified that they receive training, which is relevant to their role, helps them to understand individual needs and keeps them up-to-date with new ways of working. In personnel files we saw certificates that demonstrated this. Staff had attended training about dealing with challenging behaviours, awareness of medicines, managing anger and conflict. In a survey a professional verified that the home is providers and staff have the right skills and experience to support the social and health care needs of people living at Elmslea. At the same time, they felt that the service ‘always’ responded to the different needs of individual people. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 41 & 42 Quality in this outcome area is adequate Experienced people run the home. Quality assurance processes need to be implemented across all functions of the home to ensure that people receive a consistently good service. People living in the home are aware of safety arrangements and have confidence in the safe working practices of staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: One of the Registered Provider’s is a qualified occupational therapist. She has managed the home for a number of years with her husband who is also registered and is an approved social worker. She told us that she keeps up to date by doing regular training. Throughout the inspection Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 28 we found the provider to have a good understanding of her role. The provider gave the Commission a brief picture of the current situation in the service, in a document entitled AQAA (Annual Quality Assurance Assessment). We had to request this twice and there were areas when more supporting evidence would have been useful to illustrate what the service has done in the last year, and/or explicitly how it is planning to improve. The certificate of registration was displayed in the hallway, which was out of date. This matter was discussed with the provider, who told us that the current certificate was filed away. We told the provider that the current certificate must be displayed in a conspicuous place at all times. People responding in a survey told us ‘..they always try to make the home happy and friendly with plenty of laughter’. Staff we spoke to told us that their main role was to “make people happy” and that communication about their needs was good. We spent lengthy periods observing interactions between people living in the home, the staff and the registered providers. The atmosphere was open and positive. The expert by experience commented that people said that they “get on very well” with the registered people and staff, and that they felt “very secure” living at Elmslea. The provider verified that they had “not done a formal survey lately” to seek the views of other stakeholders, relatives or the people living in the home. The provider went on to tell us that most of the quality assurance was done “informally” in meetings. People we spoke to verified that they “had not been asked to do a questionnaire” to rate the service that they receive. However, in the care files we looked at people had been asked to formally comment on the rehabilitation programme soon after they had settled in. In a survey done by the Commission, a healthcare professional verified that overall they were satisfied with the care provided to people that live in the home. We looked at financial records for two people that live in the home. All were accurate when cross checked with the balance kept for safekeeping. Entries had been signed for. Receipts corresponded with entries for items such as outings, magazines and toiletries. Secure facilities were in place to safeguard personal documents and money. As discussed previously under the section, ‘individual needs and choices’ information about people is not always handled appropriately in a way that maintains their right to confidentiality and to have accurate records kept about them, and is an area that needs improvement. One person did not have a risk assessment that provided up to date information about their needs. Daily records were incomplete. Similarly, information in care plans did not always provide sufficient information about limitations on individual choice. Other records were missing, namely duty rosters were not in place. Therefore, policies and procedures have not been followed and the rights of people living in the home have not been safeguarded. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 29 We spoke to staff during the inspection, who told us that they had regular 1:1 supervision sessions with the provider. We looked at three personnel files; all recorded that a recent supervision session had taken place. This was also borne out when we spoke to staff that told us they felt well supported by the provider and provider. Comprehensive Health & Safety policies and procedures were seen, including a poster displayed near to the office stating who was responsible for implementing and reviewing these. Staff we spoke to told us that they had been regular training training. We were shown the induction pack and saw that completion of this had been recorded in the files we looked at. We toured the building and observed that cleaning materials were stored securely. Records of accidents were kept and showed that appropriate action had been taken. The fire log was examined and demonstrated that fire drills, had taken place regularly. Similarly, the fire alarm had also been regularly checked. People living in the home told us that the alarm was regularly “checked once a week”. Certificates verified that an engineer had checked the fire alarm. First aid equipment was clearly labelled. Maintenance certificates were seen for fire alarm and electrical systems. The provider had verified in information sent to the Commission that a local electrician had inspected both the electrical system and appliances. Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 30 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 x 26 x 27 x 28 x 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 2 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 3 1 1 LIFESTYLES Standard No Score 11 x 12 3 13 3 14 x 15 3 16 2 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 x 2 1 x 3 x Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 31 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. 1. Standard YA6 Regulation 15(2)b Requirement People living in the home are fully involved in the planning of their care and this is regularly reviewed with them. Risk assessments must show that the safety, independence and choice has been considered and is regularly reviewed with people living in the home. People living in the home must be confident that their privacy and dignity is maintained. Duty rosters must be kept to demonstrate that there is always sufficient staff in such numbers as to meet the needs of people living in the home. Quality assurance processes need to be implemented across all functions of the home to ensure that people receive a consistently good service and have the opportunity to comment about it. All records that relate to people living in the home must be kept up to date. Timescale for action 30/07/08 2. YA9 13(4)c 30/07/08 3. 5. YA10 YA33 12(4)a 17(2) Sch 4.7 31/05/08 31/05/08 6. YA39 24(1-5) 31/10/08 7. YA40 17(3)a 30/07/08 Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 32 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 YA16 Good Practice Recommendations The daily routines and house rules should promote independence, individual choice and freedom of movement for people living in the home, subject to restrictions agreed in the individual Plan and Contract. Use the Department of Health guide ‘Essential Steps’ to assess current infection control management to protect people that live in the home and staff that work there. 2. YA30 Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA 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 Elmslea DS0000009018.V356787.R01.S.doc Version 5.2 Page 34 - 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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