Inspection on 24/05/05 for Elmstead

This inspection was carried out on 24th May 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Elmstead 09/05/07

Elmstead 16/05/06

Elmstead 08/11/05

Elmstead 18/01/05

Elmstead 27/09/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Elmstead 104 Elmstead Lane Chislehurst Kent BR7 5EL Lead Inspector Sue Meaker Unannounced 24 May 2005 10:00am The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Elmstead Address 104 Elmstead Lane Chislehurst Kent BR7 5EL Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8467 0007 020 8295 3133 BUPA Helen Smith CRH 49 Category(ies) of OP 34 registration, with number DE 14 of places LD (E) 1 Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: The Service user category LD (E) relates to a named service user. The category to be reviewed if the Service user leaves the home. Date of last inspection 18th January 2005. Brief Description of the Service: Elmstead is a care home operated by BUPA, and caters for thirty four elderley frail people and fifteen elderley people with Dementia. The care home is located in Chislehurst, Kent within the London Borough of Bromley. The home is a large three storey detached building situated on a busy thoroughfare in a residential area and offers accommodation and care to older people of either sex. There is limited off road parking to the front of the building, and a pleasant seculded garden to the rear, with a patio and seating areas. The home offers accommodation in mainly single rooms although there are four shared rooms in the home; the bedrooms are well decorated and furnished to a good standard. Bathrooms and toilets are easily accessible to the residents and benefit from specialist moving and lifting aids as appropriate.athrooms. All bedrooms, bathrooms and toilets are fitted with locks to ensure privacy, but are accessible from the outside in the event of an emergency. The home is centally heated and all radiators are guarded to lessen the risk of accidents; and there are grab rails and handrails on stairs, corridors, toilets, showers and b The communal areas are well maintained and provide pleasant seating areas that are accessible to the the residents and their visitors; a passenger lift gives the residents access to the first floor. Residents have access to a telephone and are able to make calls when they wish; there is also provision for residents to have a telephone in their room at their own expense. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a statutory unannounced inspection of Elmstead a residential home for thirty four elderly frail people and fifteen elderly people with dementia. Elmstead is part of the BUPA care home group. The inspection took place over eight hours, a tour of the premises took place, records appertaining to the provision of care, medication, health and safety, staff and training were inspected. Lunch was also observed. Conversations with fifteen residents, five relatives and six members of staff took place during the inspection. Discussions with the deputy manager and the operational manager also took place and feedback was given at the conclusion of the inspection. Generally this was a very satisfactory inspection and the residents and relatives spoken to were very positive about the home and the quality of care provided. The staff spoken to also viewed the home in a positive light and commented favourably about the support and encouragement from management. What the service does well: The home provides good quality care for the residents; care plans and corresponding risk assessments are comprehensive and the recording on the documentation is of a good quality; residents and relatives said they were involved in the care planning process and that their wishes and preferences were taken into account. It was evident when walking around the home that the staff were committed to providing personal and social care in a way that promoted the independence of the residents whilst respecting their right to choose how they wished to live their life within the home. The staff are able to access comprehensive training and take advantage of courses offered particularly relating to dementia and challenging behaviour which they found helpful and informative when caring for this resident group. The training coordinator accesses appropriate courses from local colleges, and assesses those members of staff undertaking NVQ qualifications. The management of the home are approachable and residents and relatives said they could discuss any concerns confident that they would be resolved satisfactorily. Residents and relatives expressed their satisfaction with the standard of food provided and said that they enjoyed mealtimes and that there was always a choice of meals. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR 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) Scoring of Standards Statutory Requirements Identified During the Inspection Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1,2,3,4 and 5 Residents and their families are able to access comprehensive information about the home; enabling them to make an informed decision as to whether the home can meet their assessed care and social needs. EVIDENCE: The homes Statement of Purpose is readily available to residents and their families; all residents receive a copy of the homes Service User Guide prior to admission to the home. A number of residents and relatives spoken to, during the inspection, stated that the information provided by the home helped them decide if the home could meet their needs and that the introductory visit gave them the opportunity to meet the other residents and management and staff of the home. The home is able to arrange a four to six week trial period enabling residents to ascertain whether the home is the home is the right place for them and if the home can meet their care and social needs. Residents are given a contract specifying the terms and conditions of their admission to the home; a copy of the contract is kept on the residents personal file. The home has a rigorous assessment process; referrals are usually from social services, the home receives an assessment of need completed by the care Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 9 manager. The prospective resident is then invited to spend the day at the home, during this time a member of the management team completes an assessment of its own to determine whether the care and social needs can be met. Currently the social services assessment is kept on the residents’ personal file; but the homes assessment is recorded in the daily progress notes, it would be better if all the assessment documents were to be kept together and that an assessment form be completed for all residents. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 and 10. Comprehensive care planning systems ensure that the health, personal ans social care needs of the residents are clearly defined ensuring that he staff have the necessary information and skills to meet the needs of the residents; promoting and protecting their privacy, dignity and independence. EVIDENCE: Two care plans on the residential unit, and two care plans on the dementia unit were looked at in detail. Care plans are generic and then personalised to the individual resident, using Maslow’s theory of care planning relating to older people. The care plan is formulated from the information contained in the initial assessment and specific outcomes are identified and a plan put in place to achieve these desired outcomes, enabling the residents to maintain an independent lifestyle within the home environment. Care plans also included risk assessments relating to moving and handling, health and safety and environmental; therefore identifying potential risks to the resident and steps to be taken to minimise the risk enabling the residents to fell safe within the home and its environs. From speaking to residents and relatives in the home it was clear that they are involved in the care planning process and that their wishes and preferences are taken into account; however the care plans are signed by the key worker, there is no signed agreement either by the resident Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 11 or their family. From speaking to the staff in the home they felt that they were involved in the care planning process and said that they involved the residents family and friends as much as possible, particularly around the residents lifestyle prior to coming into the home, and that they endeavoured to find out about the residents preferences and found this helpful when caring for residents with dementia. It was evident from inspecting the care plans and risk assessments that they are reviewed and updated on a regular basis and that a formal annual review meeting is held with the resident, family, health professional, key worker and team leader, this review is documented fully in the care plan. The assessment and care planning processes are currently under review by BUPA and new documentation is to be put in place focussing on a person centred approach. The home has comprehensive policies and procedures relating to the administration of medication. Medication was inspected on one unit; all the medication is stored securely in a locked trolley in a locked room. Medication is administered via a pharmacy filled “Nomad” system; the medication administration records for all the residents on the unit were inspected and found to be up to date and correctly completed; individual MAR sheets were identified with a photograph of the resident. Staff members responsible for administering medication receive specific training; training records confirmed that training had taken place and the annual training plan shows that further training had been requested. The home maintains a record of all staff signatures used on the MAR sheets on the individual units; controlled drugs administered require two signatures, this procedure was checked and found to be correct. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14 and 15 The facilities offered by the home enable the residents to maintain their preferred lifestyle; by maintaining links with their family and friends and local community. EVIDENCE: From speaking to the residents, relatives and staff in the home it was evident that every effort is made to maintain the residents independence and choice. There is a range of activities on offer and the residents have input into what they would like to do and how much they would like to participate. During the inspection the hairdresser was in the home and many of the residents took advantage of this service and said they enjoyed interacting with the hairdresser and their fellow residents in the hairdressing salon. Other activities on offer include gentle exercise classes, quizzes and musical entertainment. The residents care plans gave details of their particular interests and the staff endeavoured to arrange activities to residents’ requests. Unfortunately there is no activities co-ordinator at present but every effort is being made to recruit to this essential post. During the inspection there were a number of relatives and friends visiting the home, they said that they were always made to fell welcome and that the management and staff were always available to discuss any queries or concerns that they have had; and that issues were dealt with quickly and sensitively. Residents are actively encouraged to maintain links with the local Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 13 community and there are shops, a library, post office, bank and chemist within easy reach of the home, the home is also on a bus route enabling residents to visit the local town should they wish. Whilst touring the home, lunch was being served; there is a central kitchen, lunch is taken to the units in hot trollies, therefore maintaining the temperature of the food served; the food looked appetising and residents said that there were choices on offer; the chef explained that the menu was on a four weekly cycle taking into account seasonal variations. The kitchen was in a reasonable condition, clean and tidy some work needed to be completed relating to the ceiling above the streamer, apparently this work was in hand and due to be carried out within a few days. The dining rooms on the units were adequate and afforded congenial surroundings for the residents to have their meal, it was noted that assistance was given in an unobtrusive manner, the meals were attractively presented and it was evident that the residents enjoyed mealtimes; viewing this time as a chance to talk with their fellow residents and staff. Hot and cold drinks as well as snacks are available throughout the day if requested. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17 and 18. The home has comprehensive policies, procedures and training relating to complaints and the Protection of Vulnerable Adults; ensuring that residents feel safe and protected in their chosen environment. EVIDENCE: The home has a comprehensive policy and procedure relating to complaints, these documents are included in the Statement of Purpose and the resident welcome pack (Service User Guide) and a prominently displayed in the home. Currently there are no complaints being investigated. The residents and relatives spoken to confirmed that they are aware of how to make a complaint, but they also said that any concerns they had were dealt with efficiently and effectively by the home manager. The home maintains a complaints log that was inspected and it was noted that there had not been any complaints since August 2004. From the training files and from speaking to the training co-ordinator that staff had received training relating to the Protection of Vulnerable Adults. The home also has a copy of the Local Authority guidelines detailing procedures to be followed in the event of an allegation of abuse; the home manager was aware of the legislation relating to the POVA register and how to access a POVA check for employees. The staff confirmed that the home has a comprehensive policy and procedure relating to “Whistle-blowing” and that they were aware of how to instigate the procedure should it become necessary. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,24 25 and 26. The home provides a safe, comfortable, clean and well maintained environment; enabling the residents to enjoy their preferred lifestyle. EVIDENCE: The home has an extensive annual on going redecoration and refurbishment plan that is implemented by the organisation; the home also employs a maintenance person for day to day routine maintenance in the home. The annual maintenance plan was seen and it was evident that all areas of the home in need of redecoration and refurbishment had been identified and an a schedule put in place to address these issues. Generally the home is in a reasonable state of repair, during the tour of the home it was evident that every effort is being made to improve the fabric of the building. Residents were happy to show their bedrooms that were decorated and furnished to their tastes and personalised with small pieces of furniture, ornaments and photographs. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 16 The communal areas of the home were clean and tidy; the domestic team making sure that the home is kept free from unpleasant odours. The decoration and furniture was of a domestic nature giving a comfortable and homely feel for the residents. The garden area is accessible to residents, their family and friends, ramps are in place for residents with mobility problems and the garden is well maintained providing a safe environment for the residents. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 and 30 The management of the home ensures that the staff team are able to meet the care and social needs of the residents by implementing robust recruitment and selection and training policies and procedures. EVIDENCE: From inspecting the weekly rota, the staffing levels maintained by the management of the home ensure that there are sufficient staff with the appropriate skills, on duty, to meet the assessed needs of the residents. A number personnel files were inspected and were found to contain the information specified in schedule two of the National Minimum Standards. It was evident from the files and in speaking to staff that enhanced CRB and POVA checks are completed prior to commencing employment. The home also has a separate training file detailing training completed such as induction training to TOPSS standard, moving and handling, first aid and health and safety. The annual training plan was seen and the training for staff was varied and complied with the needs of the services provided to residents including specialised training relating to the care of residents with dementia and those presenting challenging behaviour. From speaking to the training coordinator the NVQ programme of training is on track, currently five staff have completed NVQ 2, four staff have completed NVQ 3, and the deputy manager of the home has completed the Registered Managers Award. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,35,36and 38 The home has effective and efficient management and administrative systems in place, ensuring the stability of the home for both residents and staff. EVIDENCE: Currently the Registered Manager of the home is on long term leave, the home is the responsibility of the Operations Manager now based at the home, assisted by the deputy manager, the management structure is currently under review. The present management team were present during this inspection and demonstrated that they had the skills and experience to operate the service. Residents and relatives spoken to said that the managers were readily available to discuss any concerns and that issues raised were resolved quickly and effectively. The home holds senior staff meetings and unit meetings on a regular basis and staff receive regular supervision and undertake an annual appraisal that is documented in staff personnel files. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 19 The use of a resident and relatives questionnaire helps monitor the quality of service provided by the home and opinions and views expressed are responded to and appropriate action is taken. Health and Safety records were viewed and complied with relevant legislation detailed in the Care Homes Regulations – National Minimum Standards. Currently there has been no change in BUPA’s policy and procedures for the safekeeping of the residents’ personal allowance; in most instances their relatives have taken responsibility for managing their personal allowance. All personal allowances administered by the home are kept in one account, however individuals are able to access a personal statement of monies held, where all transactions are recorded on the computer system and receipted. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 x x x x 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x 3 x 3 3 x 3 Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 21 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. Refer to Standard 3 and 4 3 and 4 Good Practice Recommendations It would be helpful if a summary of the pre assessment document to be kept on the residents care plan It would be better to use a form for the assessment of prospective residents rather than documenting in daily progress notes during the day visit prior to admission; this would help when accessing assessment documentation. Although the care plan is signed by the key worker completing it, there is no space on the plan for the signature of the resident or relative. A copy of the activities programme for the home to be sent to the Commission, incorporating outings and day trips organised for the benefit of the residents. Please inform the Commission when the new activities coordinator commences employment detailing days and hours to be worked. Please inform the Commission when the work is completed on the ceiling in the kitchen. Please keep the Commission informed of the progress relating to the maintenace programme eg. when works ar completed. Version 1.30 G51G01s6930Elmsteadv215131.24.5.05stage4.doc Page 22 3. 4. 5. 6. 7. 7 12 12 19 19 Elmstead 8. 9. 31 35 Please notify the Commission about any changes made to the management structure of the home. Please advise the Commission of how the home/organisation will comply with Standard 35 .2 of the National Minimum Standards -Care Home Regulations. Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 23 Commission for Social Care Inspection Riverhouse 1 Maidstone Road Sidcup Kent DA14 5RH National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elmstead G51G01s6930Elmsteadv215131.24.5.05stage4.doc Version 1.30 Page 24 - 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. 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