CARE HOMES FOR OLDER PEOPLE
Elmwood Swan Hill Road Colyford Colyton Devon EX24 6QJ Lead Inspector
Teresa Anderson Unannounced Inspection 10th February 2006 10:00 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 Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 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. Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Elmwood Address Swan Hill Road Colyford Colyton Devon EX24 6QJ 01297 552750 01297 551133 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) Elmwood Residential Home Limited Mrs Josephine Victoria Newbery Care Home 33 Category(ies) of Old age, not falling within any other category registration, with number (33), Physical disability over 65 years of age of places (33) Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 19th July 2005 Brief Description of the Service: Elmwood is a home offering 24-hour residential care and accommodation to up to 33 service users. It is set within the conservation area of Colyford in East Devon. The house was built at the turn of the century and was established as a care home in 1983. It has remained with the same owner ever since. Over the years it has been extended and improved to provide private en-suite facilities throughout. Bedrooms are on the ground and first floors and the floors are linked by a passenger lift. All bedrooms are single and all have ensuite facilities. The grounds have recently been landscaped to include a prominent water feature and the owner continues to develop the gardens for the enjoyment of service users. Car parking is ample. Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place as part of the normal programme of inspection between 10.00am and 1.30pm. The inspector saw the majority of the home and looked at records in relation to risk assessment and care planning. She joined in the quiz and chatted with some of those residents who were enjoying this activity. She also spoke with 6 residents in depth, with 3 members of staff and the manager. What the service does well: What has improved since the last inspection?
Since the last inspection many areas of the home have been redecorated and this is ongoing. An area in the hall housing electrical wiring has been housed giving it a more homely look. A system for ensuring that showerheads are cleaned has been introduced together with a programme of maintenance for the hoisting equipment. The recruitment procedures have been improved to ensure they are robust. The majority of windows have been restricted and those that have not have been risk assessed as the occupant does not wish them to be restricted. Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 6 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. Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 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 Outcomes Statutory Requirements Identified During the Inspection Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 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 the following standard(s): These standards were inspected and met at the last inspection. EVIDENCE: Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 9 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) Care plans do not demonstrate that multidisciplinary decision-making is fully supporting residents. EVIDENCE: Since the last inspection risk assessments for individuals have been further developed and clearly demonstrate risks and how these are minimised. The care plan of one resident who has very complex needs does not however demonstrate that multi-disciplinary decision-making has taken place. The manager agreed to invite this residents GP and CPN to take part in his care planning, to discuss available options and to contribute to some of the decision making around his care. This would support staff who are working extremely hard to support this gentleman to stay at this home and would ensure that all options for care and good practice have been considered. Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 10 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) The lives of residents who live at Elmwood are enriched by the activities on offer, through good community contact and by having their rights to make choices promoted. EVIDENCE: All the residents spoken with were very complimentary about the activities on offer at Elmwood. These activities include quizzes, bingo, scrabble, painting, word games and bridge. Two days a week residents are offered the opportunity to go out for a drive. On the day of inspection, a Christian group were due to come to the home but had had to postpone. As a replacement the gardener initiated a quiz which eleven residents joined. Activities tend to take place in the morning when residents have more energy and are advertised in the lounge. Staff offer reminders to residents of what is on. Residents told the inspector that daily routines are flexible. For example, they get up when they like, go to bed when they like and eat where, when and what they like. One resident talked of how she appreciated being supported to make her own decisions. Another told the inspector that she preferred to eat in her room but that if she changed her mind, staff were always helpful and obliging. Another said she what was important to her was being allowed to sit quietly in her own room and that staff always supported her to do this, but were very quick to come if needed. Staff demonstrated an excellent understanding of the importance of supporting residents to make choices in their everyday lives and equated this to the choices in their own lives that could be taken for granted
Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 11 when a person moves into a care home. Staff described how they support one resident to continue in his role as husband and carer and are mindful of the importance of this to this man and his wife. Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 12 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): These standards were inspected and met at the last inspection. EVIDENCE: Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 13 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): (25) Residents benefit from living in a clean and hygienic home within an environment which is homely and comfortable. The overall safety of the home continues to improve through a programme of radiator covering in order to prevent scalding. EVIDENCE: Elmwood is clean and hygienic throughout. The residents say it is always clean, warm and cosy. The programme of covering radiators to prevent accidental scalding continues and the majority of radiators are now covered. One or two radiators are posing problems as covering them will reduce the space around them. One radiator is in a residents bedroom and if covered will stop the bathroom door opening. Another is in a corridor and might present a trip hazard to a resident who walks with a frame. The owner was not in the home on the day of inspection but these areas were discussed with the manager and handy man who wish to discuss options with the owner. Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 14 Decoration of many areas has and is taking place. In particular the hall looks fresher and more homely having been painted and had the electrical wires boxed in. Since the last inspection a system for ensuring that shower heads are cleaned to help control for Legionella has been introduced. Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 15 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): (28 and 29) Residents are well supported by a staff group who are trained and who have been recruited using robust procedures. EVIDENCE: Seven of the fourteen care staff employed at Elmwood have are trained to NVQ Level 2 or above. Six of these carers have attained Level 3. This is in line with the recommendation that at least 50 of care staff are trained to NVQ Level 2 or above. At the last inspection it was required that all care staff underwent checks through the Criminal Record Bureau. Although records were not available, the manager reports that this has been completed. Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 16 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, 32, 35, 37 and 38) The manager has a clear vision for this home which is effectively communicated to staff and translated into practice. Residents’ monies, their possessions and safety are protected by good systems of management and working practices. Record keeping does not always uphold residents rights to confidentiality. EVIDENCE: Jo Newbery has been the Registered Manager at Elmwood since 2000. She has successfully completed the Registered Managers Award and continues to update her skills through appropriate training. She consistently demonstrates a good understanding of issues associated with physical disability, the ageing process and has a real flair for dealing with people. She is well liked and respected by the owner, staff and residents. Jo has the support of her staff and has built a strong and able team. Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 17 Residents and staff talk of their confidence in Jo and her ability and willingness to make their lives easier and better. Comments included ‘excellent’ and ‘the best’. The system for managing residents’ monies is simple and clearly auditable. Receipts for all purchases are kept and records demonstrate how and where monies are spent and received. At the last inspection it was recommended that a hoist maintenance programme be implemented. This has been set up. Risk assessments regarding window restrictors and unguarded radiators are kept up to date. The windows in one room remain unrestricted at the request of the occupant. She reports that she cannot open one window because of it’s weight and wants to be able to open the other window. The manager is advised to keep risk assessments up to date. The programme of covering radiators continues. It has become practice in the home to share information about residents in a communication book. The majority of this information belongs in care plans. In addition the way this information is recorded (having information about several residents on one page) does not comply with the Data Protection Act. Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 18 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 x x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 x x x x x x x 2 x STAFFING Standard No Score 27 x 28 3 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x 3 x 2 3 Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 19 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 OP13 Regulation 25 Requirement The registered person must ensure that unnecessary risks to the safety of service users are identified and so far as possible eliminated. (This refers to the need to ensure that any risks associated with unguarded radiators are identified. The timescale for action refers to the date by which all radiators will be guarded). Timescale for action 31/12/07 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 OP7 OP37 Good Practice Recommendations Care plans should demonstrate that multidisciplinary decision-making is taking place or has been attempted. Individual records should not be maintained collectively and should be kept in accordance with the Data Protection Act 1998. Elmwood DS0000021933.V273941.R02.S.doc Version 5.1 Page 20 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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