Random inspection report
Care homes for older people
Name: Address: Elmsleigh Care Home Elmsleigh St Andrews Road Par St Austell Cornwall PL24 2LX two star good service 12/05/2009 The quality rating for this care home is: The rating was made on: 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 review of the service. We call this review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lynda Kirtland Date: 2 3 0 7 2 0 1 0 Information about the care home
Name of care home: Address: Elmsleigh Care Home Elmsleigh St Andrews Road Par St Austell Cornwall PL24 2LX 01726812277 01726815479 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Windsor Type of registration: Number of places registered: Conditions of registration: Category(ies) : Robert Gregory Thomas care home 48 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 48 48 The maximum number of service users who can be accommodated are 48. The registered person may provide the following category of service only: Care home providing nursing or personal care - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia, excluding learning disability or mental disorder (Code DE) maximum 48 places Mental disorder, excluding learning disability or dementia (Code MD) maximum 48 places Date of last inspection
Care Homes for Older People 0 6 1 1 2 0 0 9 Page 2 of 12 Brief description of the care home Elmsleigh provides nursing care for service users who have a dementia and or a mental disorder. Elmsleigh is a period property in a peaceful area, set in extensive secluded attractive grounds approached by a long drive. Car parking is available. The home is situated in Par, approximately three miles form the town of St Austell. Residents private accommodation is set out across two floors in the main house where there is a stair lift to provide access to the first floor accommodation. Some of the bedrooms are only accessible to residents with good levels of mobility due to relatively steep stairs. All of the bedrooms are for single occupancy and there are sufficient bathing facilities. The new extension known as the bungalow is on one level and all single bedrooms are provided with en suite bathroom facilities. The communal facilities include two dining rooms, a variety of lounge areas and in the bungalow residents and their relatives have access to a communal kitchen. The home is run and managed by the registered provider and registered manager with a team of staff to assist them. The fees range from £357.00 to £775.00 per week. Toiletries, newspapers and certain activities are the financial responsibility of the resident. Care Homes for Older People Page 3 of 12 What we found:
An inspector visited the service to undertake a random inspection on the 23 July 2010. The inspection lasted five hours. I met with the Acting Manager Chris Lydon and spoke with staff and people who use the service to gain their views and experiences of living or working at Elmsleigh Nursing Home. At the time of this inspection 35 people were using the service. The random inspection was conducted due to concerns we received regarding the care that people who use the service were provided with. The Focused Intervention Team are working with the home to address some of the concerns highlighted. The purpose of this random inspection was to focus on the following areas; care planning, health needs staffing and management arrangements in the home. Chris Lydon is acting manager whilst the registered manager is on long term sick leave. Chris Lydon showed me relevant documentation to confirm that he is eligible for this role. He said he is a Registered General Nurse (RGN), and has managed two nursing homes before being employed at Elmsleigh as a RGN 15 months ago. He has been acting manager since June 2010 and is clear that he will cease this role on 1 September 2010. It is unclear what the management arrangements of the home will be after the 1 September and I will liaise with the registered provider to gain clarity on the future management arrangements of the home to ensure that there is a competent and efficient manager in post to oversee service delivery. Care plans are currently being reviewed. I inspected their model care plan. In the main all areas of care were identified. Some improvements to the care planning process are needed, please refer to What they need to do better section of this report. Daily logs are completed and the quality of records kept varies. Some examples of good recording where staff have written what follow up action has been taken were highlighted to the acting manager as examples of good practice. Information from health professionals were evident on files and showed that there is good communication between the staff at the home and relevant agencies i.e. SALT, Hospital departments and GPs. The guidance provided around nutritional needs was incorporated in the care plan and monitoring of weight was also recorded From a tour of the home it was evident that the home provides clean, safe accommodation that is attractive in appearance and in its furnishings. During the inspection decorators were refurbishing a bathroom area. The smoking area has now been relocated to outside of the home, there was no evidence of consulting with residents re this decision. What the care home does well:
The acting manager told me of the following improvements made to the service. Staffing levels have increased. Three new carers plus a further three applications are in progress to be recruited, plus a domestic has been employed. Staff said that the levels of staffing were higher. An advert for qualified nurses is to be published in the papers the following
Care Homes for Older People Page 4 of 12 week. In addition the acting manager now uses two nursing agencies to gain cover for shifts. However there are still some occasions when it is difficult to gain nursing agency cover and the acting manager is aware that the consequence of this means the permanent staff are having to cover more shifts which is not ideal. On the day of inspection the acting manager, ten carers, one agency carer, two nurses, cook, kitchen porter, two domestics and a administrator were on duty. There is now a dedicated staff team to oversee and arrange staff training, It was evident on the day of inspection that all staff training records have been reviewed and mandatory refresher courses have been applied for. Staff said that they were pleased that training has been reinstated. Over 50 percent of care staff have achieved a minimum qualification of NVQ level 2. The acting manager has reinstated staff team meetings, the first one arranged for the 28 July 2010. He has also reinstated recorded formal supervision of staff. Job descriptions are now in place so that staff are aware of their role, expectations and accountability. Staff stated that with Chris Lydons acting manager position there is now some leadership again in the home. All staff said that they felt they were not providing satisfactory care prior to this as there was no management lead in the home. Now this is reinstated they feel that the quality of care has risen as more staff are on duty and training is being provided to update their skills. The acting manager and staff said that the level of activities has increased. The acting manager has arranged for a trainer from the memory clinic to give staff training on 23 August around activities that can be provided at the home. She will then visit monthly to review progress. They will also be introducing all about me booklet for staff to complete with residents and family. Music for Health visit monthly as does a singer. One resident was at the library during inspection, and staff said some residents go out with staff for a walk to the duck pond. During this inspection I observed people socialising in lounges, watching TV in their own rooms or listening to music. One resident told me that she is happy with her own company and chooses to spend time in her room watching TV and listening to music. I also observed smokers using the designated smoking area, socialising in the front garden area. The medication policy is now in place and with PCT for approval. The Controlled Drugs book was completed accurately. In the case I inspected records demonstrated that regular checks on people are undertaken as specified in their care plan, for example diet sheets and turning charts are in place and kept up to date. Risk assessments were evident on the file and in the main identified a risk, and what assistance, equipment is needed to assist a person in their transfers. The acting manager acknowledged that risk assessments would also benefit form review and expansion. What they could do better:
The acting manager said that all care plans are being reviewed as he acknowledged that the care plans were not accurately identifying peoples care needs and did not inform, direct and guide staff sufficiently in what staffing interventions were needed to meet the individuals needs in a consistent manner. Therefore I inspected one care plan that had
Care Homes for Older People Page 5 of 12 recently been reviewed. The acting manager stated that the care plan is assessed by two staff members. The Registered Mental Nurse assess the persons cognitive, behaviour and psychological emotional needs. After which the nurses or deputies assess the areas of communication, moving and handling, nutrition, continence, pressure care, breathing, medication and night care. In this care plan in the main it informed and guided the carers as to what the care need was and what intervention was needed. However in some instances it would have benefited from expansion, for example in how to approach a person who experiences anxiety and distress this would benefit from a description of how the staff member should approach the person and give reassurance, i.e. should this be verbally, by touch, just being present etc. In some instances this did occur for example telling staff to speak slowly and allow the person to make a response. In discussion with the acting manager he acknowledged that the care plans could be expanded further so that they inform, direct and guide staff members to enable staff to be clear about what is expected of them so that consistent interventions are then provided to a person in the delivery of their care. The care needs identified were all entitled problem areas and this can give a negative light to people when reading their care plan. We discussed that care plans should look at what a person is also able to achieve and what their wishes, goals and aspirations are as this was missing. We also discussed that there are currently no care plans in relation to a person social and leisure needs. The home needs to show that they are taking into account the persons individual social needs and how they will meet them. The acting manager said that they have organised a training day for staff in this respect. The trainer will then be visiting them on a monthly bases to review the progress of activities provided. A pharmacy inspection occurred on 1 July 2010 and highlighted some areas for improvement. An inspection of the medication evidenced that a more robust system needs to be put in place. Some of the MDS medication tallied with the records kept. However it was noted that there were a lot of missed signatures on the MAR sheets so that staff were not evidencing if they had given medication to an individual. For example baclofen tabs to be given 5 times a day missed signatures on 5,6,7,12,20,21 July, Nacrogol compound one daily not signed for on 8,10,11,15,18 yet the medication was not in the blister packs so it is assumed it was administered but not signed for. In inspecting loose medications a tablet count did not tally with the records kept and the acting manager was unable to account for the discrepancy. It was also noted that when there was a surplus of medication this had not been carried over onto the next months MAR sheets. The acting manager stated he has started to audit the medication monthly but this is not obviously working due to errors found, he said he would raise with staff team immediately. Transcribing of medication, for example amoxcillian, was not recorded correctly as double signature or amounts of medication received were not recorded On entry to the home a unpleasant odour was smelt and this also occurred in some individual bedrooms and corridors. In talking with the domestic staff they stated that they are aware of particular areas where they are offensive odours and do attempt to alleviate them. It was observed that some toilet call bells were tied up so that they were out of reach for people to use them if they needed assistance. Some baths and a wash basin were observed to be cracked and in need of repair. One bath had a hard board over it so was
Care Homes for Older People Page 6 of 12 not in use, and when lifted lumps of dirt were in the bath. It is noted that some bathrooms were clean and satisfactory and one bathroom was being refurbished. The acting manager said that there are sufficient bathrooms in use for the numbers of people using the service and that they want to refurbish the older bathrooms. It was also noted that signage on toilet doors stated that they should be checked hourly for cleanliness, yet there is only a record kept of one check each day whihc means that the domestics are not checking bathrooms as memo states they should be. Entrance to the hot water tank area needs to be made safer to prevent residents and staff from burning themselves on hot pipes. All these issues were discussed with the acting manager who agreed to address these issues immediately. The accident book was inspected and guidance was given in that in order to adhere to the Data Protection Act the records should be separated once completed and placed on the individuals file. The acting manger agreed to address this. 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 2. Care Homes for Older People Page 7 of 12 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, Regulations 2001 and the National Minimum Standards.
No. Standard Regulation Requirement Timescale for action 1 24 16 The registered manager of 16/12/2009 the home must ensure that all areas of the home have suitable fixtures and fittings which are in good repair and that all areas have a satisfactory standard of hygiene. This is needed to ensure that all areas of the home are clean, well maintained and there is a reduced risk of cross infection. Care Homes for Older People Page 8 of 12 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, 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 7 15 Care plans must be 30/09/2010 expanded further so that they inform, direct and guide staff in their caring interventions. This will enable the individual to receive consistent care from staff. 2 9 13 You must ensure that for 06/08/2010 each person living in this home you must always keep accurate, clear and complete records for all medicines received, administered and disposed of. this is to help make sure that all medicines are accounted for, that people receive their prescribed medication correctly and are not at risk of mistakes with medication because of poor recording arrangements. 3 12 12 Individuals social and leisure 30/09/2010 needs must be included in their care plan with a action plan as to how these will be
Page 9 of 12 Care Homes for Older People Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, 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 addressed. A individuals wishes, aspirations and goals to pursue their leisure needs must be assessed with action as to how this will be met for their emotional wellbeing. 4 21 23 All toilet call system must be 30/08/2010 in reach so that people who use the service can access them when needing assistance. This will prevent people from being placed at risk. 5 31 9 The registered provider must 01/09/2010 keep the Care Quality Commission informed of the management arrangements of the home and what action will be taken to ensure a permanent manger is in situ. This will ensure that a competent manager oversees the day to day management of the home and is registerd with the Care Qualtiy Commission. 6 38 13 All parts of the home should be free from preventable harm to people who use the service, staff and visitors. The hot water tank area must be assessed and preventive action taken to ensure peoples safety. 30/08/2010 Care Homes for Older People Page 10 of 12 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 8 Risk assessments should be reviewed to ensure that they identify the potential risk to the individual and specify what action should be taken to minimize the risk. Transcribing of medication should be witnessed by two people to prevent errors Consultation with people who use the service in the facilities of the home must be undertaken so that their views can be sought and considered when changes to the home are being planned. IE relocation of smoking area. This then needs to be evidenced. All areas of the home should be free from offensive odors. All records should adhere to the Data Protection Act to maintain confidentiality ie accident book. 2 3 9 12 4 5 26 37 Care Homes for Older People Page 11 of 12 Reader Information
Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for noncommercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 12 of 12 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
