Inspection on 18/07/06 for Elmstead House

This inspection was carried out on 18th July 2006.

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 House 05/06/07

Elmstead House 24/02/06

Elmstead House 27/09/05

Elmstead House 24/01/05

Elmstead House 10/08/04

Similar services:

Townley Road, 2-3

Foxley Lane (121a)

Tudor Lodge

Stacey Street Nursing Home

Delrose House Ltd

Clovelly House Residential Home Ltd

Abbey Road [53]

Cherry Tree House

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

CARE HOMES FOR OLDER PEOPLE Elmstead House 171 Park Road Hendon London NW4 3TH Lead Inspector Daniel Lim Key Unannounced Inspection 18th July 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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 House DS0000010436.V301129.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmstead House Address 171 Park Road Hendon London NW4 3TH Telephone number Fax number Email address Provider Web 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 8202 6177 020 8202 4157 manager.burroughs@careuk.com Care UK Community Partnerships Limited Ms Diane Maddaford Care Home 50 Category(ies) of Dementia - over 65 years of age (30), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (20) Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Three specified service users who are under 65 years of age may be accommodated in the home. The home must advise the regulating authority at such times as any of the specified service users attains 65 years of age or vacates the home. 24th February 2006 Date of last inspection Brief Description of the Service: Elmstead House is a care home registered to provide both nursing and personal care for people with dementia and other mental health problems. The home is part of a scheme originally developed by Barnet Health Authority for the reprovision of patients who were receiving long term care at Napsbury Hospital. The original Elmstead House has now combined with April Lodge (adjoining home) and is now registered as a single home. The home may accommodate a maximum of fifty older adults who are over the age of 65 years. It is owned by a Colchester based company Care UK Community Partnerships Limited. The company has a number of care homes in London. The aims and objectives of the home are; To provide a safe and homely environment To offer a stimulating environment To recruit adequate, qualified and experienced staff. Invest in employees To provide care support in a way which encourages self-determination and enable each service user to achieve their best quality of life. To deliver care in a manner which maintains dignity and respect and which recognises service users rights. The home consists of two separate adjoining buildings. The building accommodating service users requiring nursing care is a large single storey building with thirty bedrooms. The manager’s office is at the front of this building. The building accommodating service users requiring personal care is in the adjoining double storey building. It has twenty bedrooms located across both floors. There is a parking area at the front of the home and gardens at the back and sides of the home. The home is situated at the end of a residential street and is close to transport Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 5 and community facilities around Hendon Central Station. The fees charged by the home range from £420 - £630 each week. The provider must make information about the service available (including reports) to service users and other stakeholders. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was carried out on 19 July 2006 and took a total of 4 hours to complete. The inspector found that many of the National Minimum Standards assessed had been met and the feedback from residents was positive. During this inspection, the inspector was accompanied by the registered manager of the home (Mrs Diane Maddaford) and deputy managers (Ms Anne Belcher and Mr Biju Abraham). The inspector was able to interview four residents and a relative. The feedback received from them indicated that they were satisfied with the care provided for residents. Statutory records including four residents’ case records, the maintenance records, accident records, complaints’ record and fire records of the home were examined. The premises including bedrooms, bathrooms, laundry, main kitchen, gardens and communal areas were inspected. Three staff on duty were interviewed on a range of topics associated with their work. Staff records and training records were examined. What the service does well: What has improved since the last inspection? Improvements had been made in the physical environment. A shower drain had been repaired and a shower chair replaced on the nursing unit. The defective toilet seat in the nursing unit had been replaced. Senior staff had been provided with supervision training and staff had been provided with regular supervision. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 7 The Registered Person had requested that an inspection be carried out by the LFEPA. The LFEPA had visited the home and carried out a fire drill. 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 House DS0000010436.V301129.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 9 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 the following standard(s): 3, 4, 6 The quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Arrangements were in place to ensure that residents’ needs are assessed. This ensures that their needs can be identified and met at the home. Further action is needed to ensure that three residents who are not appropriately placed at the home are transferred to appropriate accommodation. EVIDENCE: The four residents who were interviewed indicated that their care needs had been met at the home and they were happy with the care provided. Comments made included, “well treated” and “satisfied with care here”. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 10 A sample of four residents’ case records which were examined, contained comprehensive assessments, plans of care and details of how residents needs had been met. The inspector observed that residents in the home were clean, appropriately dressed and appeared well cared for. The inspector noted that staff had experienced difficulties meeting the needs of three residents because of their inappropriate behaviour. Reviews carried out with mental healthcare professionals involved had concluded that they should be transferred. A requirement is therefore made in this report for these resident to be transferred to appropriate accommodation. The manager informed the inspector that this was in the process of being actioned by the funding authorities. The manager informed the inspector that the home does not provide intermediate care. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 11 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 the following standard(s): 7, 8, 9, 10 The quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. The arrangements for healthcare and personal care were generally satisfactory. This ensures that residents needs are being met at the home. Improvements are needed in the storage of medication and the arrangements for handover of information between shifts. EVIDENCE: The four residents interviewed, indicated that their healthcare needs had been met. Comments made included, “Have seen the doctor” and “my injections have been given by the community psychiatric nurse”. A relative who was present was able to confirm that the healthcare needs of her husband had been met. The sample of four case records examined were up to date and plans of care had been reviewed regularly. Records of medical and healthcare treatment Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 12 including appointments with the psychologist, optician and chiropodist were recorded. Residents interviewed were able to confirm that they had been given their medication. The home had a record of temperatures of the medication fridge and the room where medication was stored. These were not always within the required temperature range. The inspector noted that on several occasions, the temperature of the medication fridge was higher than 8C (temperature range must be between 4 - 8C) and the room temperature was at times over 25 C (must be no higher than 25 C). This was brought to the attention of the deputy manager and manager and requirements have been made accordingly. Staff were interviewed on how to prevent dehydration in residents during the hot weather. They were able to inform the inspectors of steps taken. This included ensuring that extra drinks are provided between meals and providing fans for the use of residents. The inspector noted that the staff handover of information about residents (from one shift to another) was carried out in a designated area at the bottom of the stairs and along the ground floor corridor opposite the large lounge. To ensure that confidentiality is maintained, such exchange of information must be carried out in the office or in a restricted area. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 13 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 the following standard(s): 12, 13, 14, 15 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The daily life and routines of residents were well organised. This ensured that the dietary, cultural and social preferences of residents are met. EVIDENCE: The home had an activities organiser. On the day of inspection, an outing had been organised for residents. The inspector was provided with a programme of daily activities organised. These included arts and crafts sessions, music, outings, reminiscence sessions, gentle exercises and games. The inspector was informed by the manager that a room had been designated as a sensory room and complimentary therapy facilities such as light, music and aromatherapy therapies would be provided. The bedrooms inspected had been personalised by residents with their personal items such as photos and souvenirs. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 14 The kitchen was clean and well equipped. The menu examined was varied and balanced and reflected the cultural preferences of residents. There was a choice of main dish provided at meal times. A record of daily fridge and freezer temperatures had been kept. These were satisfactory. There was documented evidence that staff had been provided with food hygiene training. The kitchen had been inspected by the local environment health officer and recommendations made for improving the facilities had been complied with. Resident interviewed were generally satisfied with the meals provided. They confirmed that there was a choice of alternative main dish. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 15 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 the following standard(s): 16, 18 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. Arrangements for responding to complaints and adult protection were satisfactory. This ensures that residents are well treated and protected from abuse. EVIDENCE: The complaints record was examined. There was documented evidence that complaints recorded had been promptly responded to. Staff who were interviewed were found to be knowledgeable regarding adult protection procedures. There was evidence that arrangements had been made for staff who had not yet received training in adult protection to be provided with it. The three residents who were interviewed stated that they had been well treated and no complaints were received by the inspector. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 16 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 the following standard(s): 19, 20, 21, 22, 23, 24, 25, 26 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The home was clean, well equipped and furnished to a high standard, therefore providing a nice environment to live in. EVIDENCE: The premises were inspected and found to be clean and well furnished. Residents who were interviewed stated that they were happy with the accommodation provided. Bedrooms inspected had been personalised with souvenirs and photos. New flooring had been provided in some areas of April Lodge. The inspector was informed that other areas of the building would also be provided with new flooring. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 17 No offensive odours were detected. The manager provided confirmation that safety inspections had been carried out on the portable appliances, hoists and assisted baths. The gas installations safety inspection had been carried out recently. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 18 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 The quality in this outcome area is good. This judgement has been made from evidence gathered both during and before the visit to this service. The staffing arrangements were satisfactory. This ensures that residents are cared for by a competent and effective staff team. EVIDENCE: Residents who were interviewed indicated that staff were responsive and had treated them with respect and dignity. The duty rota was examined. It indicated that in addition to the manager, there was normally at least 11 staff during the day shift and 5 staff on waking duty during the night shifts. Staff who were on duty were interviewed on a range of topics associated with their work (such as health and safety, adult protection, fire procedures and the mental healthcare care of residents). They were noted to be knowledgeable regarding their roles and responsibilities. There was documented evidence that staff had been provided with essential training. This included food hygiene, mental healthcare, first aid and health and safety. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 19 The staff records examined indicated that the required recruitment standards and procedures (including obtaining satisfactory CRB disclosures and two references) had been followed. Staff further stated that they worked as a team and had been supported by their managers. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 20 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 34, 35, 37, 38 The quality in this outcome area is adequate. This judgement has been made from evidence gathered both during and before the visit to this service. Arrangements were in place to ensure that the home is well managed, safe and secure. This ensures that the home is run in the best interest of residents. However, one improvement is required to ensure that statutory records are easily accessible. EVIDENCE: Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 21 The manager was noted to be knowledgeable regarding the management of the home. She had the required qualifications (RMA). Staff, a relative and residents interviewed were of the opinion that the home was well managed. Those interviewed were able to confirm that that residents and relatives had been consulted regarding the management of the home. Window restrictors were in place in bedrooms inspected. Weekly fire alarm checks, fire drills and fire training had been documented. The home had a fire risk assessment. This had been updated. The manager had written to the fire authorities (LFEPA) and requested that the home be inspected. The home was visited by the LFEPA on 21 March 2006 (a fire drill was conducted). A current certificate of insurance displayed. A sample of financial records of residents was examined. These were well maintained and receipts had been obtained for financial transactions. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 22 There was evidence that quality monitoring systems were in place and arranged by the company to ensure a high quality of care. An audit report was available for inspection. Some of the care plans, complaints and accident records of residents were stored in the computer. The inspector noted that staff experienced some difficulty accessing these records on computer and these were not readily made available for inspection as hard copies were not always available. To ensure that these statutory records are available for inspection and easily accessible to staff, hard copies must be provided. The required safety inspections on the portable appliances, gas and electrical installations had been carried out. Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 2 X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 2 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 3 3 X 2 3 Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP4 Regulation 10(10) 12(1) Requirement The registered person must ensure that the three residents identified in the section on Choice of Home (who are inappropriately placed) are transferred to appropriate accommodation. The registered person must ensure that medication in the home is stored in an area or areas where the temperature can be maintained at 25° C or below. The registered person must ensure that medication fridge is stored in at a temperature of between 4° – 8° C. The registered person must ensure that confidentiality is maintained and staff handovers (between shifts) about residents is carried out in the office or in a restricted area. The registered person must ensure that hard copies of the statutory records are kept in the home. Timescale for action 18/09/06 2 OP9 13(2) 01/09/06 3 OP9 13(2) 01/09/06 4 OP10 12(3)(4) (5) 01/09/06 5 OP37 17(1)(2)( 3) 01/09/06 Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 25 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Elmstead House DS0000010436.V301129.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Southgate Area Office Solar House, 1st Floor 282 Chase Road Southgate London N14 6HA 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. 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