Inspection on 05/05/09 for Elmsleigh Care Home

This inspection was carried out on 5th May 2009.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elmsleigh Care Home 23/07/10

Elmsleigh Care Home 11/06/10

Elmsleigh Care Home 06/11/09

Elmsleigh Care Home 30/08/07

Elmsleigh Care Home 26/09/06

Elmsleigh Care Home 06/06/06

Elmsleigh Care Home 18/01/06

Elmsleigh Care Home 22/06/05

Elmsleigh Care Home 02/12/04

Extracts from inspection reports are licensed from CQC, this page was updated on 06/08/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Elmsleigh Care Home Elmsleigh St Andrews Road Par St Austell Cornwall PL24 2LX     The quality rating for this care home is:   two star good 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: Mandy Norton     Date: 1 2 0 5 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 Older People 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 Older People Page 2 of 27 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 Older People Page 3 of 27 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): Type of registration: Number of places registered: Robert Gregory Thomas care home 48 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia Additional conditions: 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 48 48 Over 65 0 0 Care Homes for Older People Page 4 of 27 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 £330.00 to £675.00 per week. Toiletries, newspapers and certain activities are the financial responsibility of the resident. Care Homes for Older People Page 5 of 27 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: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place from 10.30 am to 12.50 pm on 5th May 2009 and from 10.30 am to 2pm on the 12th May 2009. The inspection was conducted with the nurse in charge on the first visit and the registered manager on the second visit. A tour of the home was carried out and people who live at the home and staff working in the home were spoken to and observed. This key inspection was bought forward due to 2 complaints/concerns received by the Commission. It was decided to carry out an inspection to look into a number of aspects of the complaints/concerns. There was no Annual Quality Assurance Assessment document (a self assessment document submitted to the Commission annually, this document is not yet due to be submitted) or completed Service User or staff surveys used to write this report. Care Homes for Older People Page 6 of 27 There were 43 people living at the home on the day of the inspection. What the care home does well: What has improved since the last inspection? What they could do better: There were no requirements or recommendations made as a result of this inspection. The manager was reminded to send the findings of any formal quality assurance process to the Commission. Care Homes for Older People Page 8 of 27 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 Older People Page 9 of 27 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 27 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 and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. 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 them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service currently have information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move to the home. Evidence: The Service Users Guide is in the process of being updated, the provider showed us the progress he was making on the computer. The current one is given to people when they move in to ensure they have access to information about what the service can offer. The manager (and the nurse in charge on the first inspection day) said that people are always assessed prior to moving into the home to ensure their needs can be met. If people are to be admitted they and their representatives are given as much up to date information about the service as possible, invited to look around and spend some time at the home and ask any questions they may have. A completed pre Care Homes for Older People Page 11 of 27 Evidence: admission assessment form was examined and contained a lot of useful information including information about any deprivation of liberty assessments, under the Mental Capacity Act 2005, that are in place. The current fee level ranges from £330 to £675 per week (correct May 2009). The previous inspection report is available to anybody at any time but is not on display in the front entrance or at the bungalow entrance. Care Homes for Older People Page 12 of 27 Health and personal care 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 health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they 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. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will always be met. Evidence: The manager said that all of the care plans are up to date and used by nursing and care staff to refer to when caring for and supporting people and to document ongoing progress. The care plans seen were up to date and contained a lot of relevant information about the person and their health, personal and social care needs. The nursing staff complete daily records about a persons welfare and detail what care has been provided. The nurse in charge said that the care staff have a communication book to document ongoing changes and use handover to report changes so that the nurses can complete the care plans. Information was included about visits made by or to health care professionals such as GPs, social workers, opticians and dentists. A tour of the home showed that equipment necessary for the promotion of tissue viability and prevention of pressure sores is available to meet peoples current needs. The nurse in charge and the manager said that they have enough equipment to meet Care Homes for Older People Page 13 of 27 Evidence: the needs of the current residents. The home uses a blister pack system for administration of medicines. They are kept in a locked trolleys in locked treatment rooms. The drugs fridges have their temperature measured and recorded daily. The medication administration records (MAR) sheets seen were completed as required. The procedure for receipt, storage and disposal of unwanted medicines was explained and is in accordance with laid down legislation. The manager said she carries out regular audits of medication administration practices to ensure ongoing good practice. Staff were heard and observed interacting with people appropriately and providing care and support in a discreet manner. Staff were knocking on doors before entering and doors remained closed whilst personal care was taking place. Care Homes for Older People Page 14 of 27 Daily life and social activities 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 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. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. 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. A range of activities within the home and the local community mean that people have opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and staff are available to help make them an enjoyable and social occasion for people. Evidence: People are encouraged to exercise choice in how they spend their time and activities are offered individually or in groups and are facilitated by an activity co-ordinator who works 3 12 hour a shifts a week. The manager said they have just employed a trained nurse to do cognitive therapeutic activities for people with dementia 3 times a week. Outside links are encouraged and some people attend local day centres. The care plans are designed so that information about peoples interests and hobbies (life story) is recorded and can be used when trying to develop person centred care. Visitors are welcomed at anytime and some people regularly go out with friends or relatives. A number were seen coming and going during the inspection. There are large mature gardens around the home which are used for barbeques, fetes to which the local community are invited and for people just to enjoy and sit out in. People with mobility aids are able to access the gardens. Some areas of the gardens are secure to allow Care Homes for Older People Page 15 of 27 Evidence: independent access to outside space for people with dementia. Most people have their meals in one of the dining areas. People are asked what they would like for their meal and there is always a choice. Drinks and snacks are available 24 hours a day. Records are kept of what people eat to ensure they are receiving a balanced diet. The mealtime observed in the bungalow showed that staff are available at to give people any help or support they may need. A porter is employed to serve the meals and clear the tables, freeing care staff time to help people, the meals are also served individually from a heated trolley so people can have the portion sizes they want. People spoken to said the meals were lovely. A recent concern bought to the attention of CQC said that people were using a piece of kitchen roll as a table mat as no table mats were available. Staff checked to find the table mats but could not find any. The provider said he was purchasing some more that week. Other dining areas of the home had table mats in place and they were being used. Care Homes for Older People Page 16 of 27 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. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. 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. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. Staff undertake safeguarding training. This means that people who live at the home are adequately safeguarded. Evidence: The complaints procedure was seen displayed at the homes main entrance and is included in the Service users Guide. It is comprehensive and gives some options about who to contact and timescales for responses to be made. It was advised to include the address of the local Department of Adult Care and Support address and contact details. There have been 2 complaints made to the Commission since the last random inspection in August 2008. This key inspection was bought forward as a result of those concerns but most elements of the complaints were not able to be substantiated. The manager said that people are seen by senior staff daily and hopes that any issues or concerns would be bought up then. Some of the residents visit day centres so are able to raise concerns to people outside the home if necessary. A number of staff have attended the local authority safeguarding training and staff studying for an national Vocational Qualification (NVQ) and new staff during their induction also have information about safeguarding. The manager showed that she Care Homes for Older People Page 17 of 27 Evidence: had a good level of knowledge about Deprivation of Liberty Safeguards (a new system in place under the Mental Capacity Act 2005 to ensure people are not been restricted of their liberty unless it is in their best interests for their personal safety and welfare and the correct assessments have been carried out) and had all the appropriate information available for staff to read. Care Homes for Older People Page 18 of 27 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, 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. 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. Ongoing refurbishment, redecoration and maintenance means people have a comfortable, homely and safe environment in which to live. Evidence: Elmsleigh is currently registered to take up to 48 people. On the day of the inspection 43 people were resident at the home. A tour of the home showed that peoples rooms are personalised with furniture and momentos they bought in with them. People spoken to said they were happy with their accommodation. Communal areas consist of a variety of lounges and dining areas throughout the whole home, all on the ground floor, they are bright areas with appropriate decoration. They contain a variety of seating suitable for the current residents. The dark corridor mentioned in the previous report remains quite dark, but the manager explained the building regulations dictate the type of bulbs that can be used. No accidents or incidences have been reported in this area and residents do not often use this area unaccompanied. The large gardens are accessible to the residents and the manager and a number of staff spoken to said that the front lawn is often used for ball games in the good Care Homes for Older People Page 19 of 27 Evidence: weather. Some of the outdoor areas are secure so that people who have dementia are able to go outside independently without the risk of getting lost. There is outside furniture available for use by the residents and a lot of wildlife to be seen in the trees and gardens that surround the house. Some rooms have en-suite facilities and there are sufficient assisted bathrooms and toilets throughout the home suitable for use by the current residents. On the day of the inspection the home was clean, tidy and hygienic. A selection of completed cleaning schedules were seen and we discussed the ongoing audit of the domestic service with the manager and the domestic supervisor. The manager said that updating of policies and procedures is ongoing and the ones relating to infection control are up to date and available to staff at all times. Care Homes for Older People Page 20 of 27 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 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 to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. 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 staffing levels and skill mix are satisfactory meaning peoples needs are being met at all times. The robust recruitment procedure means that people who live at the home are being looked after by appropriate staff and their welfare is not at risk. Evidence: The manager, nursing and care staff are supported by administrative staff, a training officer, activity co-ordinators, catering (including a porter who serves meals allowing staff to assist and support people as required), domestic, laundry and maintenance staff. The duty rota showed that there are 2 trained nurses during the day supported by 8 carers (one is on 1 to 1 duty), overnight there are 2 trained nurses and 4 -5 carers. The manager told us that the staffing levels are based on the dependency of the residents. She said she has just employed a nurse to do cognitive therapeutic activities, for people with dementia, three times a week and another person does three 12 hour shifts of general activities during the week. The training officer who works one day a week said that she supports people in their NVQs and is able to carry out some supervision sessions, she said that other supervision sessions and appraisals are carried out by the manager. Training opportunities were seen displayed in the office during the inspection. Staff spoken to Care Homes for Older People Page 21 of 27 Evidence: said that there are plenty of training opportunities. Staff spoken to were relaxed and were seen spending time with the residents. Two nurses on duty spoken to said the home runs well and that the manager is respected. Two social workers spoken to said Elmsleigh always manage the more challenging clients well and the staff are friendly and professional, one added that the staff are good with residents families in what is often a stressful situation for them and good with assessments. One family visited many homes and chose Elmsleigh and have been pleased with their choice. Elmsleigh has a robust recruitment procedure that includes receiving 2 written references and a CRB check. The manager interviews prospective staff and if they are successful they then start a period of induction monitored by the training, officer the manager and other senior staff. Staff files examined included all of the required documentation, they are stored securely and only accessible by the manager and provider. Care Homes for Older People Page 22 of 27 Management and administration 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 led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate 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. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. 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 systems and procedures in place are designed to meet the needs of the service as they continually strive to improve the service the home offers to the people that live there. The attitude to health and safety shown by the providers, nursing, care and ancillary staff means that people live in a safe and well maintained environment. Evidence: The registered manager is a trained nurse and is suitably skilled and competent to run the home. She is well supported by the provider who visits the home regularly and has an office there. The manager has enrolled on the new Leadership and Management for Care Services Award (this will meet the requirement for the relevant management qualification/management component of the NVQ level 4 Registered Managers Award). Staff and residents commented positively about the registered manager and all stated Care Homes for Older People Page 23 of 27 Evidence: they felt able to approach the management team with ideas of improvements to the service, or if they had any concerns. A formal quality assurance assessment is in place based on seeking the views of residents and their representatives. In the meantime the provider and the manager have an open door policy and are happy to hear any concerns or issues as they arise and are then able to act on them immediately. The manager showed us ongoing audits of cleaning, medications and a variety of others. The completed documentation shows where improvements can be made and details how that is to be achieved. Individual risk assessments were seen in care plans examined and general risk assessments are completed and are available to staff. For the people that the home manage money for records were seen of income and outgoings and receipts are kept as evidence of the transactions. Residents have access to their money at all times. The manager said and staff files examined confirmed that all staff have statutory training that includes health and safety, first aid, lifting and handling and food hygiene as required. A number of routine servicing and maintenance documents and the fire log book were examined and found to be up to date. The maintenance man checks the faults book daily and carries out repairs as requested. He also carries out ongoing in house and outdoor routine maintenance tasks. Care Homes for Older People Page 24 of 27 Are there any outstanding requirements from the last inspection? Yes £ No R 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 Care Homes for Older People Page 25 of 27 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 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 26 of 27 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. 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. Care Homes for Older People Page 27 of 27 - 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!