Inspection on 02/03/09 for Elmslea

This inspection was carried out on 2nd March 2009.

CSCI 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 16 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 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 19/06/2009.

Inspecting for better lives 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, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Helen Tworkowski     Date: 0 2 0 3 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. 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. 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 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 34 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). 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 CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 34 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): Mrs Irene Stanbury,Mr Henry Stanbury Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 15 Number of places (if applicable): Under 65 Over 65 0 mental disorder, excluding learning disability or dementia Additional conditions: 15 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 provides accommodation and personal care for up to 15 adults with a mental health needs. 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. Details of the cost of care are available from Mr and Mrs Stanbury. Care Homes for Adults (18-65 years) Page 4 of 34 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 inspection included an unannounced site visit to Elmslea on 2nd March 09, between 8.45 am and 5.40pm. As part of this visit we looked around the home, we looked at the care provided to six people and some of their records. We looked at the way staff were recruited and trained, and talked with one of the staff. We looked at the way medication was managed and observed medication being prepared for the coming week. We talked briefly with two of the people who lived at the home, and sat and talked with people who live at Elmslea whilst they had breakfast and had lunch. We talked with Mr and Mrs Stanbury about the care provided and looked at records relating to the managment of the home. Care Homes for Adults (18-65 years) Page 5 of 34 As part of this inspection we sent surveys to visiting professionals, and received 4 surveys back. We also spoke with one professional by telephone. In addition we sent surveys to all of the people who live at Elmslea, and received nine back although a number of those people chose not to complete the forms. In addition to this we also received a completed Annual Quality Assurance Assessment form, this document is completed the Registered Provider, is to give the Commission information about the home and the Providers own assessment of their service. Throughout this report the term we is used, this is because this inspection was carried out on behalf of the Commission. What the care home does well: What has improved since the last inspection? What they could do better: The information (the Statement of Purpose and Service User Guide) about what Elmslea does needs to be updated so it is clear what the service aims to provide and how these will be achieved. Where it is stated that Cognitive Behavioural Therapy or other such therapies are to be used then there must be clear evidence that staff are trained and competent in these areas. This will help people who are thinking about moving to the home, or professionals to know what they can expect from the home and how it will be done. References to restrictive practices must be reviewed so that they reflect current good practice and legislation. People need to be thoroughly assessed prior to a move, even for a trial period. This will help ensure that any care plan that is drawn up reflects peoples needs. Such documents should clearly state how peoples needs are to be met. If people have goals that they are working on, then these need to be clearly identified, as are the ways that individuals will be rewarded and encouraged to meet these goals. People must be treated with respect and any records should reflect a positive approach to the individuals. Where people have specific needs such as in relation to diabetes, there must be a detailed care plan that reflects this aspect of care. The way medication is currently being managed is very poor and could potentially lead to errors. Whilst it is positive to see that people are able to manage their own medication at Elmslea, no risk assessments have been carried out to ensure that people are safe to do this. We were told by the people who live at Elmslea that they were happy to talk to Mr and Mrs Stanbury, however visiting professionals told us that they felt intimidated. We found that restrictions had been placed on peoples freedoms without proper recourse to the Mental Capacity Act. We received comments from health and social care professionals about the attitude of Mr and Mrs Stanbury that they have found it difficult to raise concerns because of their antagonistic stance, that the service could be improved if it was less authoritarian and paternalistic, also that some of their Care Homes for Adults (18-65 years) Page 7 of 34 documentation adopts a patronising tone. 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 set out 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 34 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 34 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 poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who are thinking about coming to live at Elmslea may not be given comprehensive and accurate information about the nature of the home. The Registered Providers and staff may not be aware of peoples needs before they stay or visit; this could mean that a persons needs may not be met. Evidence: We asked to see a copy of the Statement of Purpose and Service User Guide when we arrived at Elmslea. The Service User Guide provides information for people who are thinking of staying at the home, about what it is like. The Statement of Purpose is a more detailed document that tells the Commission about the details of the service. We were given a copy of the Statement of Purpose, but no Service User Guide could be found. We looked at the Statement of Purpose and found that it did not contain all the points that are required by regulation. The Service User Guide must also be available not only for inspection but to everyone in the home. It also must contain the elements identified in the regulations and standards. Care Homes for Adults (18-65 years) Page 10 of 34 Evidence: We discussed with Mrs and Mrs Stanbury the purpose of the home as some of the documents seen in the home referred to it as an Assessment and Rehabilitation Centre, and made references to the use of Cognitive Behavioural Therapy (CBT) and behaviourism . It must be clear what the home is trying to achieve and the techniques use to achieve these ends. If techniques or therapies such as CBT or group therapies are to be used, then staff must be trained and competent in these areas. Such therapies or ways of working must be described in the Statement of Purpose and Service User Guide. One of the comments that we received in a survey from a visiting professional was that the home could improve by providing Clearer more explicit structures regarding the aims of the service in individual cases and what will constitute successful rehabilitation before the individual care progress and move on from the service. We looked at what the home knew about people before they came to the home. We found that one person had moved in the Autumn of 2008. There was information about this individual that had been compiled some years before. However, there was no recent assessment of needs. We looked at the information that the home had about a person who was staying at the home for a trial visit. There was no assessment of needs or plan of care. We were told that is was because it had not been decided if the individual was to move to Elmslea. We discussed with Mrs Stanbury the need to have an assessment of a persons needs before they come to stay at the home, even as part of a trial period. An assessment of an individuals needs must be the basis for all service provision. The lack of any information about the individual or their needs and the implications of these needs, places people at risk. Care Homes for Adults (18-65 years) Page 11 of 34 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. The people who live at Elmslea may not be able to make the choices and decisions about their lives. Restriction are imposed on people without appropriate discussions or records of decision making. Evidence: We looked at the Care Plans and care records relating to a total of six people who live at Elmslea. Such documents should give information about how care is provided, any risks and how risks will be managed. We found that information in care plans was very general rather than specific for example for one person the care plan stated, Sleep pattern- needs structure and routine, however it was not clear what structure and routine were to be provided. Statements were made in care plans but it was difficult to see any clear evidence of how this was being followed up. For example for one person it stated that the aim was to improve his table manners. However there was no evidence of how the person would be supported to make this change. Clear evidence is particularly important in a service which is working with people to support them to Care Homes for Adults (18-65 years) Page 12 of 34 Evidence: change their behaviour and develop their skills. We looked at the way people who live at Elmslea made decisions. We found that there was evidence that some people did make a number of decisions for themselves and did take significant responsibilities, such as managing their medication. However we found that there was little information to show that such risks had been assessed and managed. We also found that for some people the decisions or choices they made about their lives were being restricted. It is recognised that it may be necessary to do this at times, however this must be done within the parameters set down in the Mental Capacity Act. We found no evidence of this Act informing decisions to restrict individual freedoms. We found that in the case of one individual they had been prevented from going out. There was no proper record of how this decision was made. We discussed with Mr and Mrs Stanbury an incident where we had witnessed where Mr Stanbury comment on a person who attends the home for day care, to some of the people who live at Elmslea. We advised Mr Stanbury that such a discussion was both inappropriate and unprofessional. We noted that at the last inspection in March 2008 that it was noted that in relation to a discussion that ... the Inspector told the provider that this should not have discussed openly in front of other people because it did not respect the persons dignity or right to confidentiality. We received feedback from one of the visiting professionals, comments included that the care service never respected privacy and dignity and Service Users needs are discussed in the communal area, at meal times, in front of others. We were told that there is a weekly meeting where there is a group discussion about each persons progress. Whilst it is recognised that it may be healthy for people to be given feedback about how others perceive them, the Registered Provider has a duty to ensure that standards are set in terms of dignity, respect and privacy. Care Homes for Adults (18-65 years) Page 13 of 34 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 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 have the opportunity to take part in a wide range of activities, including college courses, farm work and gardening. Contact with friends and family may be restricted, without evidence of proper checks and balances being place on such restrictions. Evidence: We were told that the people who live at Elmslea are generally occupied in the day time. A group of people were attending a course run by Duchy College at Elmslea. This course was to help people develop their skills in independence. Other individuals were on work placements, and some people worked with Mr Stanbury on a farm. We were shown a large vegetable garden, just across the road from Elmslea. This area has polytunnels and people are involved in growing vegetables.We saw that there are rotas, with everyone allocated household tasks. When we arrived we saw that some of Care Homes for Adults (18-65 years) Page 14 of 34 Evidence: the individuals were involved in cleaning or doing other domestic tasks. One of the visiting professionals commented that one of the things that they believe that the home does well is to provide structure and boundaries to support very vulnerable people. We sent survey forms to everyone who lives at Elmslea, and received nine back, although four of the people said on the form that they did not wish to complete the form. Of the people who did respond to a question about whether people could do what they wanted to do during the day, evening and weekend, five people said that they could not do what they wanted during the day, three said that they could not do what they wanted during the evening or weekend. We were given a copy of the Residents Placement Agreement this states that various rewards or privileges are awarded or withdrawn. This placement agreement also states that You may go home or to approved friends on pre-arranged weekends, again if you have not lost that privilege. Saturday Mornings are usually spent helping on the farm or elsewhere, whilst we go off in the afternoons to places chosen by the group. Sunday mornings we all go to some place of worship, as we are part of that local social network. When we looked through residents files there was no specific information about how this system of privileges worked. Mr Stanbury told us how each week there is a meeting where each individual decides what they are going to work on that week, the group then decides as to whether this has been achieved and therefore if the person is able to go out on the Friday trip. It is of concern that people coming to live at Elmslea are being asked to sign up to these very open agreements, particularly as some people may not have the capacity to understand the agreement. These agreements could involve curtailing peoples ability to visit their family or friends. Such restrictions or agreement to such restrictions need to be made with in the limits of the Mental Capacity Act. No one we spoke with complained about this situation. When we asked Mr Stanbury about being required to attend church, he said that people were not required to do this and that the home respected different peoples beliefs. We were told that many of the people who live at Elmslea are involved in the church. We asked Mr Stanbury if people had to go to church. He said that this was not the case, and that he respected that other people had different beliefs. We were at the home during part of breakfast, during lunch and whilst tea was prepared. People ate breakfast in the large sunny dining room. People came and went as their differing time schedules required. A number of people ate a lunch that they had prepared as part of the course they were on. We asked about choice of menus and Care Homes for Adults (18-65 years) Page 15 of 34 Evidence: Mrs Stanbury said that they had a number of set meals that they knew people enjoyed, and a choice was made from these. We looked into the food stores, and there was ample and good quality produce. We were told that people were encouraged to have drinks at set times, we observed that this was not a rigid rule. One professional who had contact with the home commented that one of the things that the service does well is to promote a full week of activities which are varied. Care Homes for Adults (18-65 years) Page 16 of 34 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. People at Elmslea cannot be confident that they will receive the right support with all their health care needs, particularly in relation to diabetes. Medication is not properly managed, and this could potentially lead to errors and people receiving incorrect medication. Evidence: The four people who live at Elmslea who responded to the survey all said that staff always or usually treat them well. Comments included Henry and Irene (Stanbury) are understanding, and We have lovely staff here at Elmslea. We received four surveys back from Health Care Professionals. In relation to the question Does the care service seek advice and act upon it to manage and improve individuals health care needs, one person answered usually, two people said sometimes and one person answered never. Comments included In our experience the managers of Elmslea do not have the confidence in professional staff to seek advice from our services which in my opinion is detrimental to the residents care. We looked at the information about the help people need in their care plans. As has Care Homes for Adults (18-65 years) Page 17 of 34 Evidence: already been noted some of this information was not as detailed as it should be. As part of this inspection we looked information recorded on a daily basis about the help people were given with their personal and health care. Such notes were minimal. Mr Stanbury said that they only recorded what was out of the ordinary or things that they thought were important. When we looked at records for one individual we found that the individual had been asked to sign a disclaimer absolving Mr and Mrs Stanbury of responsibility if he/she left the home and was subsequently injured. We later found that the individual had had their shoes removed to stop them leaving the home. As has already been discussed any restrictions of liberty must be managed under the Mental Capacity Act. The issue had apparently been raised with the Care Manager, shortly before this visit. This had however been an issue for over two months. Comments in daily notes included No shoes - no problem. We looked though information recorded each day for one of the individuals we found that there were comments that indicated that someone had been told off for wetting themselves or for making a mess, comments included Roundly lectured by Irene for causing unnecessary work and hassle. We received comments from a visiting professional that some of the documents referring to challenging behaviour adopt a rather patronising tone. Any feedback to anyone living in the home, or records, should be done in a way that enhances not diminishes the dignity and well being of the individual. Where individuals have difficulties such as continence their must be a clear guidance in the care plan to describe and direct how this is to be managed. Whilst it is recognised that people may need feedback about their behaviour, this must be done in a manner that reflect current good practice, and is dignified and respectful. We discussed with Mr and Mrs Stanbury the fact that negative recording could be unhelpful, particularly for people who have low self esteem. On the day of the inspection a delivery of medication had just arrived in the home. We observed Mrs Stanbury putting the medication into boxes for dispensing throughout the following week. This system of secondary dispensing is regarded as poor practice, and potentially dangerous. Medication should be administered from the original package provided by the pharmacist. We were told that when Mrs Stanbury is away then medication is then put into a further pot, so that particular dose can be administered by another member of staff. This is tertiary dispensing and is also poor practice. We noted that one person was not being dispensed the medication that was recorded on the container from the pharmacist. We asked why this was the case, Mrs Stanbury said that this was because the doctor had told them to do this. We asked Mrs Stanbury to show us where such a change had been recorded, but Mrs Stanbury was unable to do this. Care Homes for Adults (18-65 years) Page 18 of 34 Evidence: We noted that a number of people who live in the home self medicate, and we observed that they filled their medication boxes for the week, in a similar manner to Mrs Stanbury. We discussed with Mrs Stanbury that there are medication systems that can be provided by a pharmacist, who prepares a weeks supply for someone to administer themselves. We asked to see a copy of the risk assessment to show that the person is competent and safe to manage their own medication. A requirement was made at the last inspection in relation to this matter and has not been completed. A risk assessment must be completed in relation to self medication. We asked about one of the people in the home who has diabetes. We were told that this person looks after their own medication with assistance from another person who lives in the home. We looked at the information that was on file about this persons needs. We found that there was a minimal reference to the condition. The home must have a diabetic care plan, which clearly specifies the needs of the individual in relation to their condition, how it is managed, and any directions if the condition should deteriorate. If an individual is to self medicate their must be a risk assessment. If that individual wish to have assistance from another person to support them with their diabetes, then this support must be risk assessed. Care Homes for Adults (18-65 years) Page 19 of 34 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. The rights of the people who live at Elmslea are not being fully protected, as inappropriate restrictions may be being placed on their liberty. Evidence: We have been told by Mr and Mrs Stanbury that they have received no complaints in relation to Elmslea. The people from Elmslea who completed surveys for us told us that carers always listened and acted upon what was said. One person commented Irene and Henry (Stanbury) are very good at listening to you. All four of the people who responded to the survey said that they knew who to talk to if they were not happy. We looked at the way money was managed in the home, and was shown that there were records of monies kept on behalf of individuals in the home. We were told that each individual had their own bank account, into which their benefits and any other monies are paid. When we arrived at the home we sat with a number of the people who live in the home. We were told that they had no concerns or complaints about the home. As has already been noted we have concerns about the way in which the Registered Provider manages restrictions on people, particularly in relation to leaving Elmslea. We Care Homes for Adults (18-65 years) Page 20 of 34 Evidence: were also aware of other evidence we received that Elmslea is not adhering to the principles of the Mental Capacity Act. Mr Stanbury told us that he had attended a course on the Mental Capacity Act. He would therefore be aware of his responsibilities in relation to this legislation. Mr Stanbury told us he was hoping to attend a course in relation to the Deprivation of Liberty. The Commission received information from other professionals who had visited the home to help establish what were the wishes of some of the people who lived in the home. This information indicated the views of professionals who are trying to advocate on behalf of people living at Elmslea are not respected and have difficulties trying to carry out their role. One of the comments that we received from a visiting professional was that he/she felt that the home could be improved by being less dismissive of professionals. We discussed with Mr Stanbury comments he made during this inspection, that were derogatory about other service providers. It is important that the Registered Providers act in a professional manner and do not undermine other people who have a role in offering support. We looked at the arrangments that were in place to safeguard people, and we were concerned about the ability of this service to protect people from harm or abuse. Evidence of this is given throughout the report. We looked at the policy on Safeguarding People and raised with Mr and Mrs Stanbury that it did not contain any reference to Cornwall Social Services, and their central role in ensuring that any investigations are properly managed. Care Homes for Adults (18-65 years) Page 21 of 34 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 benefit from a very good standard of clean and comfortable accommodation. Evidence: As part of this inspection we were shown around the house by Mr Stansbury. One of the people who lives at Elsmlea was very happy to show us his room. He said that it was warm enough, and was clearly very proud of his accommodation. We were told that all of the bedrooms have ensuite facilities. There are four lounges and various other rooms for crafts or other hobbies or intersts. The house was clean, well ordered and furniture was of a good quality, and domestic in character. The four people who responded to the survey all said that the home is always or usually fresh and clean. One person commented It is kept spotless at all times. The Registered Provider commented in the information sent to the Commission that visitors to the home infer that it is not like a care home- which is the aim. There is a garden to the rear of the property- which is also well maintained. It contains a summer house where people can sit in fine weather. There is also a conservatory area which is used by one of the people who live at Elmslea for over wintering plants and to grow on seedlings. Care Homes for Adults (18-65 years) Page 22 of 34 Evidence: One area of concern noted was we observed a person who lives at Elmslea disposing of used needles for blood sugar testing belonging to another person who lives at the home. They did this in an unsafe manner and placed themselves at risk of a needlestick injury. Care Homes for Adults (18-65 years) Page 23 of 34 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 home appears to be well staffed with competent staff. The recruitment systems are not robust and this could mean that the people who are not suited to the work are employed. Evidence: We were told in a survey of people who live at Elmslea that staff always or usually treat them well. We asked to see a rota, and were given a document that laid out the staffs usual working patterns. This did not include Mr and Mrs Stanbury. A requirement was made at the last inspection that a rota is provided this requirement has not been met. A duty rota is important, it is not only one of the ways that we establish if there are sufficient staff, but it is also important in that it helps establish accountability. If something untoward were to happen it could be an important part of an investigation to establish who was providing care at that time. Mr Stanbury told us that he and Mrs Stanbury live at the top of the house and are on duty much of the time. We saw no evidence of a lack of staff. We looked at the recruitment records of two staff who had started work in the last Care Homes for Adults (18-65 years) Page 24 of 34 Evidence: year. We found that one person had references that were many years out of date and had not been sent for as part of the homes recruitment procedure. We found that there had been no Protection of Vulnerable Adults check (a check of a list of people who are not suited to work in care), nor had there been a criminal records bureau check. For the second person we found that only one reference had been taken, the other was a testimonial (letter to whom it may concern). We noted that the individual had previously worked at another care home, however this reference had not been taken. We were told that the Criminal Records Bureau check had been sent off, though had not been returned. The individual had started work a year before this inspection. An employee may only start work in a care home in a supervised capacity when two relevant written references have been obtained, and a check made of the POVA list. They may only work in an unsupervised capacity once their criminal records bureau check has been completed. We asked about inductions, and were shown an unsigned single page check list. Inductions should be comprehensive and should include training on the principles of care, safe working practices, the organisation, the workers role, the experiences and particular needs of the service user group. We spoke with one of the staff who said that she had received an induction and had read the care files. We were shown a file that contained information about the training that had been provided to staff in the home. We discussed with Mrs Stanbury using a training matrix, so that it would be easier to see what training people have received, and when additional training is needed. We saw that there were records of supervision with staff and were told by a member of staff it there was a relaxed atmosphere and there there were good systems in place. Care Homes for Adults (18-65 years) Page 25 of 34 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. Mr and Mrs Stanbury have considerable experienced in mental health service provision and in running a care home. The style of management in the home is not open and visiting health and social care professionals say they experience intimidation. The people who live at Elmslea cannot be confident that they will receive the services they are entitled to because of the way the home is managed. Evidence: The home is run by Mr and Mrs Stanbury, we understand that they both have many years of experience in social care. Mrs Stanbury was a qualified occupational therapist and Mr Stanbury was an Approved Social Worker. The feedback we received from the people who live at the home was that the home suits them. We have received feedback from visiting professionals that the manner in which this home is conducted is paternalistic. There was evidence of this in the Residents Placement Agreement, and in the unauthorised restrictions place on individual liberty. Care Homes for Adults (18-65 years) Page 26 of 34 Evidence: One health/social care professional commented that what this home does well is that it provides structures and boundaries for vulnerable people, and that this had had some extremely good results with some very challenging people. However the person also commented that the home would be improved by more explicit structures about the aims of the home. One visiting health/social care professional who has had contact with the home said that he/she had been subjected to verbal abuse from Mr and Mrs Stanbury. The individual went on to comment that she thought The role they provide could be invaluable, but they need to move from the view point that they are always right and we are always wrong. Another professional commented that she had experience an intimidatory approach but also said that With an air of co-operation and a desire from the managment at Elmslea to engage with other professionals and residents, especially in the areas of concerns highlighted, this home has a potential to improve its service provision. The care home regulations place a duty on a registered provider to make arrangements for the people who live in a care home to receive treatment and advice and other services from any health care professionals. This may not be possible if professionals feel intimidated. We talked to Mr Stanbury about the Quality Assurance system they have in place and whether they had sent out any surveys. Mr Stanbury said that he thought that the Commission had sent out surveys. A requirement was made at the last inspection in relation to the home having its own quality assurance, this has not been met. We looked at the Fire Risk Assessment, and noted that it was dated 8/10/04, however it did not appear to have been amended since that time. We asked about fire training for staff, and was told that fire training was given in the initial induction and any fire training was as part of a fire drill. Care Homes for Adults (18-65 years) Page 27 of 34 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 6 15(2)b People living in the home are 30/07/2008 fully involved in the planning of their care and this is regularly reviewed with them. Risk assessments must show 30/07/2008 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. 31/05/2008 2 9 13(4)c 3 10 12(4)a 4 33 17(2)Sch 4.7 Duty rosters must be kept to 31/05/2008 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. 31/10/2008 5 39 24(1-5) Care Homes for Adults (18-65 years) Page 28 of 34 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 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 1 5 The Registered Provider 01/06/2009 must provide a Service User Guide to everyone who lives in the home. This document must contain all the elements specified in the regulations and standards. A copy must be provided to the Commission. People who live at Elmslea or who are thinking about such a move need to know what sort of service is provided. 2 1 4 The Registered Provider 01/06/2009 must have a Statement of Purpose that contains all the information that is required in the regulations and standards. A copy of this document must be sent to the Commission. The Commission and other interested parties need to know what services are provided in the home. Care Homes for Adults (18-65 years) Page 29 of 34 3 2 14 The Registered Provider must 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. 01/06/2009 4 6 15 The Registered Provider must 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. 01/06/2009 5 7 12 The Registered Provider 01/06/2009 must ensure that any restrictions or limitations placed on people at Elmslea, are undertaken with their consent or informed by the Mental Capacity Act. People must be protected from unnecessary risk however they must not have their liberty restricted arbitrarily. 6 18 12 The Registered Provider must ensure that care and support is provided in a manner that maximises peoples dignity and independence. 01/06/2009 Care Homes for Adults (18-65 years) Page 30 of 34 The people at Elmslea should be treated with respect. 7 19 13 The Registered Provider must ensure that risk assessments are drawn up in relation to people who look after their own medication. People need to be able exercise their independence, however must also have the support they need. 8 19 12 The Registered Provider 01/06/2009 must ensure that where people have specific medical needs such as diabetes, care plans identify how these needs will be met. People need to know that their health care needs will be met. 9 20 13 The Registered Provider 01/06/2009 must ensure that any changes in the administration of medication are fully recorded, and confirmed by prescription, as soon as possible. Incorrect medication administration could cause harm. 10 20 13 Medication must be administered from the containers provided by the pharmacist. The Registered Provider must ensure that the practice of secondary 01/06/2009 01/06/2009 Care Homes for Adults (18-65 years) Page 31 of 34 and tertiary dispensing of medication ceases. Secondary dispensing places people at risk of receiving incorrect medication over a prolonged period. 11 23 12 The Registered Person must 01/06/2009 implement the Mental Capacity Act. Restrictions and limitations may only be placed on people in line with this legislation and the relevant guidance. People who live in care homes have the same rights as any other person. 12 30 13 The Registered Person must have a safe systems to dispose of used sharps. This is so that people are not exposed to unnecessary risk of infection. 13 33 17 The Registered Provider must have a record of staff who are rostered to work in the home. The provider and staff must be accountable for the work they carry out. 14 34 18 The Registered Provider 01/06/2009 must have a suitable system for the recruitment of staff, including receiving two appropriate written references, and a POVA check, prior to working in a supervised capacity. A CRB check must be completed 01/06/2009 01/06/2009 Care Homes for Adults (18-65 years) Page 32 of 34 before any person may work unsupervised. Only people who are suited to the work may be employed in care homes. 15 38 12 The Registered Provider must act in a professional manner and facilitate contact with health and social care professionals. This is so that the people who live at Elmslea can receive the services to which they are entitled. 16 39 24 The Registered Provider must have and implement a Quality Assurance system . This is so the providers can have feedback, and so look to improving their service. 01/07/2009 01/06/2009 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 1 42 The Fire Risk Assessment should be reviewed, and if appropriate updated. Care Homes for Adults (18-65 years) Page 33 of 34 Helpline: Telephone: 03000 616161 or Textphone: or 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. 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