Inspection on 13/06/06 for Elmwood

This inspection was carried out on 13th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Elmwood 02/08/07

Elmwood 26/03/07

Elmwood 20/03/06

Elmwood 19/01/06

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 Elmwood 42-46 Southborough Road Bickley Kent BR1 2EW Lead Inspector Miss Rosemary Blenkinsopp Key Unannounced Inspection 13th June 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 DS0000066220.V290372.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. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmwood Address 42-46 Southborough Road Bickley Kent BR1 2EW 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 8249 1904 020 8249 4117 Mission Care Mrs Susan Diana Powis Care Home 67 Category(ies) of Old age, not falling within any other category registration, with number (66), Physical disability (1) of places Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 1 place registered for service user category PD for named service user only. 20/03/06 Date of last inspection Brief Description of the Service: Elmwood is a purpose-built facility providing accommodation for up to sixtyseven residents in the category of older persons. It is located over three floors with a large reception area on the ground floor. The manager’s office is also located in this area. The middle floor is dedicated to intermediate care where the beds are funded through the Primary Care Trust. The maximum stay in this unit is six weeks. A multi disciplinary team of staff work intensively with residents to facilitate a move back to their own homes. The two other floors are for those service users in the category of older persons. These two floors provide long-term care and occasionally respite. Staff are allocated to specific floors to promote team working and provide a consistency of care. Each floor has a senior qualified nurse leading the team with support and ancillary staff. A qualified nurse manages the home. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted unannounced by four inspectors. The purpose of four inspectors conducting the site visit was to address the key standards in one day. All four inspectors addressed different areas of key standards, and three inspectors covered a floor each addressing the environment care plans and risk assessments. Prior to the inspection five comment cards were sent to relatives, care managers and the GP of those residents who were involved in the case tracking exercise. Three relatives responded with favourable comments. In preparation for the key inspection the home had provided a completed preinspection questionnaire and additional information. What the service does well: What has improved since the last inspection? What they could do better: All residents need to be appropriately assessed prior to admission. In addition care plans and supporting risk assessments must be comprehensive in content and reflective of individual needs. The food preparation storage and serving needs to be safe with supporting records maintained at appropriate intervals. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 6 The recruitment of staff both in terms of the actual checks made prior to employment and thereafter induction needs to be improved upon. Training of staff is limited and staff must be provided with sufficient knowledge to enable them to carry out the tasks they undertake. All staff must be sufficiently knowledgeable in adult protection procedures. Staffing levels must be adequate to meet resident’s needs with an appropriate skill mix A review of the choices and routines for residents should be undertaken to ensure that they have a quality service provided. All areas in the home must be maintained hazard free 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 DS0000066220.V290372.R01.S.doc Version 5.2 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 DS0000066220.V290372.R01.S.doc Version 5.2 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): 3,6 The quality rating in this section is adequate. This is based on all information including the site visit. Information relating to assessment was in parts limited particularly in reference to nursing needs. It is imperative that staff have information prior to admission on which to base care practices. EVIDENCE: On the intermediate care unit all contracts for placement are through the PCT. The information relating to three residents on this floor were inspected. There was evidence of the home’s own assessment – although this was limited in actual content, particularly the nursing section. This was true of all three files. There was more information regarding the resident’s background and medical history. Other items of information included hospital discharge letters and the FACE overview assessment. On the second floor, two files of residents were inspected who had been admitted since the home opened, neither of which contained the local authority assessment. Both contained an assessment carried out by the home and contained some core information. However, it is difficult to ascertain when the Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 9 assessment was completed, as there were few dates and signatures on the records. The unit had recently admitted a resident with learning disabilities. According to the RGN the reason for this was so that she could be near her brother. The home is not registered to provide care to those with learning disabilities and the staff do not have experience of caring for this category of client. This may be in breech of the home’s registration. Contracts, Terms and conditions are kept in a separate area. One relative spoken to said they had visited the home prior to their family member being admitted. Please see Requirement 1. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10 The quality rating in this section is poor. This is based on all information including the site visit. Care plans, risk assessments and supporting documentation are not fully reflective of needs or sufficiently comprehensive in the intervention section to fully address the identified issues. Medications are satisfactorily managed however more input is required in those areas detailed in the report EVIDENCE: There was no key worker system in operation on the ground floor. The inspector case tracked two files, on the ground floor, and spoke with both of the residents concerned. The information obtained was as follows: One of the residents with whom the inspector met stated that she would like more choice about the time she gets up. She said that she is woken up every morning at 6.00 am washed and dressed and put back to bed. Another resident spoken to said, “some staff show more love than others, some staff can be quite harsh”. She felt that this may well be because staff Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 11 work too hard, that there is not always enough staff on duty, and sometimes she has to wait quite a long time for staff when they are called. One resident said that she would like to spend more time in the lounge and have her lunch there, but she needs help to get there and by the time the carers get to her lunch is over. All the residents that the inspector spoke to were able to answer questions and hold a reasonable conversation. These issues of basic care practice and quality of care need to be addressed. Files had photographs of the residents in place. The following were areas of concern. Care plans had not been reviewed. The information on both residents’ files was out of date. Care plans mainly reflected the physical health needs with limited information on social aspects psychological needs and mental health issues. Risk assessments covered only limited issues and included only the basic information. Risk assessments were in place for skin integrity – the waterlow score, however there was no indication how often these are reviewed. Generally the inspector found the staff on this floor lacking in knowledge about the social and psychological needs of the residents, although staff were very aware of the physical needs of the residents. There appeared to be very little interaction between the staff and residents unless tasks were being addressed. On the top floor two residents were case tracked whose assessment information had been inspected. Both files viewed contained care plans which provided basic information in relation to the individual’s identified needs. However, the care plans need to be more specific about how carers are to meet the residents’ identified needs. There were also gaps identified in the care plan, such as the wound care required, continence, health issues such as chest infections and poor eyesight. The care plans did not reflect all the needs identified in the initial assessment. The records also indicated risk assessments to be completed in respect of nutrition, pressure care and falls. However, where a risk had been identified the home has not followed this up with the interventions required to minimise the risks. One example of this was a resident’s waterlow score was 14, which indicated a medium risk however no intervention/preventive action had been recorded. The home must ensure risk assessments are completed in relation to all residents, which are comprehensive, appropriately detailed and kept under review. Also on the top floor the inspector observed that a resident was in his room sitting on an armchair, top half clothed, bottom half unclothed, with only a towel over him. He had a catheter in situ – his lower half of his body was exposed with his catheter on full view. The door was open. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 12 On the Intermediate Care Unit, three residents were case tracked and their care plans inspected. As with care plans on the other floors the information was limited in respect of specific areas of need. One resident was seen to have lost weight and was noted as “eating little “ yet their was no care plan for this. This particular resident also had postural hypotension, a history of falls and a high waterlow score as well as MRSA and a pressure sore. Risk assessments and care plans around these specific and multi-faceted problems were limited. This resident needed cot sides to be applied when in bed. The care plans and risk assessments for the use of cot sides were also limited. The resident’s wound care plan was completed and reviewed every two days. This resident was seen in her bedroom, she was able to answer the questions. She had fluids at hand although the call bell was out of reach. Appropriate items were in place for her barrier nursing. She herself stated that the food was” ok”, but the staff were variable in their approach and attitude. A second resident was seen in her bedroom as part of case tracking exercise, she was unable to answer questions due to her level of confusion and she was hard of hearing. Her care plan included Dementia in her diagnosis. Risk assessment information included her hearing problem, although her care plans did not include reference to her confusion/dementia, difficulty with communication or her hearing impairment. In general care plans and risk assessment information was not cross-referenced and relevant issues omitted. Staff signatures and dates were also omitted on several records. The key worker for one of the residents was interviewed and demonstrated a good knowledge of the residents’ physical health needs. Another staff member demonstrated a limited knowledge of the residents needs, indicating that she only needed assistance to go to the toilet, even though this resident had multiple fractures and needed a lot of help in many areas. The care plan was also out of date indicating a catheter “in situ”, which had been removed. The home has a visiting GP service and the intermediate care unit operate with a multi-disciplinary team. Other services such as chiropody, optician and dental care are provided through domiciliary visits. There was good evidence of multi- disciplinary input within the files inspected on the Intermediate Care Unit. The home had had a full pharmacy inspection in April 2006,conducted by the CSCI pharmacy inspector. The findings of this visit were generally satisfactory although some omissions were noted on records including allergies. In addition there was no protocol for oxygen use, or appropriate available equipment in which to stand oxygen cylinders. The policies and procedures needed to be reviewed, as they did not contain sufficient detail. Regular reviews of medications need to be set up as a formal process through the GP. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 13 The medications were inspected on the Intermediate Care floor. Medications are stored in a separate facility adjacent to the nurse’s station. This room was found to be very hot. It is recommended that the room temperature be monitored and recorded as many medications have an optimum storage temperature. Records for the fridge temperature were in place. At the time of the inspection there was no oxygen in use there for the inspector was unable to check if the correct equipment was available. Each bedroom has a lockable facility for storage of the residents’ own medications. The medication administration charts had photographs of residents in place. Two staff signatures were in place for those medications, which were hand transcribed. As stated in the pharmacy report the policies and procedures were limited. There was no formal risk assessment in place for those residents who are self medicating, although it was referenced in the “medication benchmarks” information. Homely remedies again had limited information and there was no homely remedies list. Those medications which were received into the home and those disposed of were recorded. Those medications, which were used on a regular basis, had clear instructions recorded. Those medications which were administered “ as required, needed fuller information including duration, maximum dose and reason for administration. The controlled drugs register contained all appropriate information including two staff signatures. The controlled drug cabinet is located inside another wall mounted cabined although not fixed to the wall. This needs to be addressed using appropriate fixtures. Please see Requirements 2 and 3. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 14 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 rating in this section is adequate. This is based on all information including the site visit. Activities are provided within the home. Choices in all aspects of daily living are limited and in some cases not in line with residents’ wishes. EVIDENCE: Several visitors were in the home during the time of the inspection. Visiting hours are generally open and flexible. There are a number of varied activities provided within the home and there is a printed leaflet which details the activities timetable for that week. There are three activities workers covering the home during different days of the week. There is a cinema room on the top floor and some of the residents had chosen to watch the football in the cinema while others had chosen to stay in their own rooms. On the top floor there were no menus on the units and therefore for some residents it may be difficult to remember what was on the menu and their stated preference. The inspectors have previously received comments regarding the quality and amount of food provided. Three residents were spoken to during this inspection of the top floor. They said that the food was of Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 15 a variable standard. Today’s choice included a meat pie, which the three residents had chosen. All said that the quality of the pastry was poor. One resident said, “My mother would say that this pastry was made with a very heavy heart.” It was difficult to put a fork through it. However, all felt that the amount of food was adequate and that choices were satisfactory although one resident felt that there was “too much mashed potato” and that there were often frozen mixed vegetables provided. The inspector noted that whilst cabbage was a vegetable on offer this had run out before all residents had been served. The residents felt that it was the quality of the cooking that was the issue and not generally the food offered. The residents also spoke of the lack of condiments on the table. A relative told the inspector that their family member is well fed and that the food is pureed. The food is separated out into individual portions and not served as one item. This is good practice. Some residents took meals in dining rooms or in their own bedrooms. One resident spoken to felt she was comfortable having meals in her room and had all that she needed. Three residents spoken to on the second floor felt that there were enough activities on offer, which included bingo, games, quizzes and exercises. They all enjoyed watching TV. One resident stayed up until late at night and there was no pressure from staff for her to go to bed. One other resident spoken to said that she wished to spend her day in bed. She spent her time reading, sewing and watching TV. Staff assisted her with all her needs. An external catering firm provides the catering within the home. A brief tour of the kitchen and viewing of the records showed that there are some areas, which needed to be improved upon. This included the labelling of opened foods, including dates of opening and “use by” dates as well as the records relating to fridge and freezer temperatures. Discussions with the cook showed that whilst temperatures of cooked foods are taken as they are placed into the hot trolleys. There was no record of the temperature of the food as they are served in the units. There may be a great temperature variance, especially as the lids of containers are removed throughout serving. The temperatures may well fall below that which is required. There was evidence that most of the staff had undertaken food hygiene training. Of those foodstuffs seen many were branded names and suitable for diabetic diets. Please see Requirement 4. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 16 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 rating in this section is adequate. This is based on all information including the site visit. Avenues by which to raise a complaint are available including external bodies. Complaints investigations are undertaken and responded to. Staff have a limited knowledge of adult protection procedures and the measures, which must be addressed to effectively deal with such allegations. EVIDENCE: Mission Care has developed a complaints procedure, which meets with the Care Homes Regulations 2001. However, this needs to be updated in light of recent changes to senior staff, namely the Nurse Director‘s post is vacant. There was no evidence of the complaints procedure on display within the reception area or on any of the units. The displaying of the complaints procedure would demonstrate openness in approach to individuals raising concerns. The home records complaints in a logbook and a complaints file. However, the recordings of such were variable with some logged in one but not the other. The records in relation to any investigation were also of a mixed standard with the inspector unable to determine whether the complaint had been fully investigated and resolved. In many the complaints procedure had not been followed in relation to a written response to receipt of the complaint. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 17 In the last six months, since opening, the home have received nineteen complaints, of which one was fully substantiated and eleven were partially so. Two were still undergoing investigation. Five of these have led to adult abuse investigations. There have been a number of complaints/concerns referred to the CSCI, five of which were raised through the London Ambulance Service (LAS) within a short time frame, since the home opened in November 2005. Many of the complaints are along similar themes regarding the standard of care provided. The home are attempting to set up a meeting with the LAS to facilitate a greater understanding of their respective roles. Two staff with whom the inspectors met were aware of who to refer complaints to within the organisation. In respect of adult abuse both staff members stated this topic had been covered in a one-hour training session, although they were aware of what action to take and one had had previously training. One staff had a very poor comprehension of whistle blowing procedures, this must be addressed. Another care staff stated that she had received no training regarding abuse Please see Requirement 5. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 18 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): 19,20,25,26 The quality rating in this section is adequate. This is based on all information including the site visit. The home is a high specification build with single rooms spacious communal areas and additional facilities such as the cinema and coffee lounge. Issues relating to health and safety need to be addressed to ensure that resident’s accommodation is maintained in a safe and suitable manner. EVIDENCE: The home is a purpose built facility located in the Bickley area. It opened at the end of 2005 and built to a high specification and includes a cinema and coffee shop for residents/ relatives to use. There is a large reception area with a piano. The Manager’s office and administration office are located in the ground floor area. A lift serves all floors. Each floor has its own dining and sitting areas. A nurses’ station and clinical room are provided on each floor. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 19 On the ground floor there are twenty beds, ten on each side. This is staffed with two members of staff on each side and one registered nurse. Each room has en-suite facilities. Rooms are also equipped with computer and telephone points. The inspector toured the ground floor initially with the Patient Relationship Manager and then with the nurse who was in charge of the ground floor on the day of the inspection. The communal areas on the ground floor are bright, clean and free from odours. In both bathrooms there were laundry bins stored. Hoists were visible in the corridors as there is no storage space. One bathroom had sprays and cleaners fully visible and not stored appropriately in respect of COSHH Regulations. In one cupboard described as a Laundry Cupboard, there were plastic bags of pads stacked almost up to the ceiling and dangerously close to the light. The inspector pointed out that this is a fire hazard however; by the end of the day there was no attempt to remedy this. On the second floor the standard of furnishings and decoration is good. A number of rooms were viewed which were found to be clean and fresh. Infection control precautions were available in one room where there is an issue at present. Gloves and aprons were seen in the rooms viewed. Residents spoken to were happy with their rooms and felt they were clean and comfortable with the furniture and possessions they needed. There are some issues of health and safety including the wide openings of the windows in all areas. Whilst this was beneficial on a warm day there are risks attached to having windows open to a level where residents may be able to fall or even climb out them. The inspector also noted that the doors to stairways were blocked with hoists and laundry storage equipment. In the event of a fire, this would present a great hazard to the residents and staff and had been referred to in the independent fire assessors report Bathrooms had also been used for storage. The Intermediate Care Unit was clean although storage space was at a premium. Again bathrooms and some en suite facilities had been used as storage areas making these very congested whereby ease of access for staff and residents would be difficult. Bedrooms were provided with appropriate equipment although not individually personalised due to the shortness of stay i.e. eight weeks. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 20 Within the laundry there were three staff on duty. They are also responsible for the laundry from three other homes. The Manager for the laundry was on holiday at the time of the inspection. The person in charge on the day said that he has a Level 1 NVQ in housekeeping. Ventilation in the laundry was an issue and there are a number of fans on the wall. However these were insufficient to keep the room cool. A fire door in the laundry room was wedged open. Please see Requirement 6. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 21 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 rating in this section is poor. This is based on all information including the site visit. The staff in this home are not subject to robust recruitment procedures nor are they fully inducted or trained to undertake the work, which they perform EVIDENCE: On the ground floor there were four care staff and one qualified nurse on duty. However from the rotas seen and from comments from the residents, this is often not the case as there are often staff shortages with members deployed to other floors. The inspector saw two staff; both had started work at the home when it was first opened. Neither staff members had had previous experience of working in a care home, and had only received very basic training since commencing work at the unit. Training received prior to the home opening included how to speak to and treat the residents, use of the hoist also brief training in fire safety and other health and safety issues. This was for a period of two weeks in house training conducted by the nurses. Staff had not received first aid training, or any instruction in relation to adult abuse or POVA. Neither of the staff members spoken to fully understood the concept of formal supervision. They felt that supervision was provided directly by the senior nurse on duty however did not understand what formal supervision was. This was also true of the qualified staff on duty. One of the carers suggested that this is done in a group but it is likely that she was talking about a staff meeting that was held. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 22 On the top floor, which accommodates long stay elderly, the staff members felt that the quality of staff was quite variable. There are some good staff whilst others are not so good. There are often issues with the staffing levels with staffing ringing in sick at quite short notice. This was also picked up from the staff rosters and the diary. The rosters showed units to be short of a carer and that many of the carers worked long days. Five of the care staff were in fact doing long days, the day the inspection took place. On the 13/6/06, from the duty rota provided, six staff were sick and one other left the shift early. This left the shift with three staff on an early instead of the five staff it should have been, with three staff on the late rather than four. On the day of the inspection a member of staff had rung in sick for their shift that day, was actually doing a long day and neither morning nor afternoon shift had been covered. Feedback received from residents and relatives involved in the inspection said that there was little interaction between residents and staff as they were quite task orientated and it took time to respond to call bells. One of the factors could be the amount of sickness and the lack of cover. Two residents said that they felt that some staff did not pay much attention to what residents needed. For example they did not look for signs that a resident may wish help to go to the toilet and were often left a while before being attended to. On the Intermediate Care Unit there were two qualified during the morning and afternoon period with four care staff. There are twenty-two residents on this floor. Staff within this floor were able to confirm a two day induction covering some of the basic topics, although training thereafter seemed limited. Topics such as manual handling, food hygiene were not always included in the two day induction .It is essential that all statutory topics are included in induction and on going training is in place to support this. Training on specific topics such as Dementia, depression and other resident’s related conditions was not provided. Supervision was said to be informal and through daily contact. Staffing levels were said to be satisfactory except when sickness occurred. The staff off duty rota indicated several long days, most staff seemed to do four a week i.e. forty-eight hours or more. During the inspection the senior staff team leader on the Intermediate Care Unit was in great demand both from other staff, telephone queries and members of the multi disciplinary team. She was also the designated responsible person, in charge on the home on day of the inspection, in the absence of the Registered Manager .It is questionable how much opportunity she has to over see care plans, practices and the general workings of the unit. Staff training was addressed by one of the inspectors as part of the key inspection. Discussions with staff and viewing of the home’s records show that the level of training is poor. There was little evidence of a sound or structured induction programme being implemented even though Mission Care do have procedures for this. Two members of staff spoken to had received the majority Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 23 of their training in previous employments and had little in the six months since commencing at Elmwood. One staff member related that she had not received any health and safety, fire training, involvement in fire drills, adult protection or food hygiene training. One of the staff members’ training had not been updated since 2004 leaving her without moving and handling etc. She had limited knowledge and understanding of dealing with accidents and the protection of vulnerable individuals from abuse. The inspector was provided with the induction pack which should be given to all new staff members. This includes a copy if the job description; dress code and a skills workbook. The workbook provided to the Inspector had the name of another home typed on it. Its content is very basic but does have a requirement that staff competency be signed off. The book also allows to staff to read and sign to say they have read and understood Mission care policies and procedures. The inspector me with the three laundry staff to discuss their training. The person in charge on the day of the inspection said that he has a Level 1 NVQ. He stated that he had no other training. The other staff spoken to stated they had received no training including relevant topics such as infection control, COSHH, health and safety. Staff were aware of fire procedures in case of a fire. The Regulation Manager selected ten recruitment files. These were randomly selected and covered the various discipline within the home- qualifies and unqualified staff. The standard of recruitment checks and the evidence in relation to these was poor. There was limited information in respect of appropriate references, CRB clearance health checks etc, and did not comply with Schedule 2, of the Care Homes Regulations. Please see Requirements 7, 8 and 9. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 24 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): 31,33,38 The quality rating in this section is adequate. This is based on all information including the site visit. The home is managed by an experienced nurse and supported by other senior management personnel. EVIDENCE: The home’s manager meets with the CSCI registered managers criteria and has been approved. She has had previous experience in care home settings in a management capacity. The home is a new build therefore established systems for quality assurance are not fully operational yet. Systems to monitor quality assurance must be developed and Regulation 26 visits commenced promptly. This is a new home which is still within the oversight of the main contractor and his agents, therefore the normal health and safety checks required by the Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 25 Commission for validation are not available full. There was fire alarm installation certificate on site. There was a fixed wiring and emergency lighting certificate for the electrical installation for a period of five years. The lift was serviced the 15 May 2006. Initial fire risk assessments were done in April 2006, however an emergency response plan is required. The fire doors still require adjustments including two, which are not functioning on the ground and first floors. Weekly fire alarm checks were in place. Monthly hot water temperatures need to be recorded. The gas certificate was not available. Evidence of statutory training for all staff was not available. Please see Requirement 10. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 26 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 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 2 2 3 X X X X 3 3 STAFFING Standard No Score 27 2 28 2 29 1 30 1 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X X X X 2 Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 27 Yes 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 OP3 Regulation 14 Requirement The Registered Manager must ensure that all residents are appropriately assessed including nursing input, prior to admission. The home must confirm in writing its ability to meet service user needs. This is now outstanding, previous time frame for action 28/02/06 The Registered Manager must ensure that care plans, risk assessments and all supporting documentation is completed on all residents with comprehensive interventions on how to address the problems identified. This is now outstanding, previous time frame for action 28/02/06. Timescale for action 29/09/06 2. OP7 15 29/09/06 3. OP9 13 The Registered Manager must 29/09/06 ensure that all policies and procedures for medication are in place, including homely remedies and as required medications. Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 28 4. OP15 16 The Registered Manager must 29/09/06 ensure that food storage; preparation and cooking promote safe and healthy eating with consistent records in place to evidence this. The Registered Manager must ensure that staff are provided with training in respect of adult protection and whistle blowing. The Registered Manager must ensure that all areas of the home are maintained in a safe and hazard free manner. The Registered Manager must ensure that there are sufficient staff and skill mix within the team to meet residents needs. The Registered Manager must ensure that robust recruitment procedures are in place for ala staff including references and CRB checks. The Registered Manager must ensure that all staff receive sufficient induction to equip them with the skills they need to undertake the work they do and thereafter ongoing training. Previous time frame for action 28/04/06, this is now outstanding. The Registered Manager must ensure that all health and safety including service certificates and staff training are addressed 5. OP18 13 29/09/06 31/08/06 6 OP26 7 OP27 8 OP29 23 18 31/08/06 19 31/08/06 9. OP30 18 31/08/06 10 OP38 23 31/08/06 Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 29 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. Refer to Standard OP15 Good Practice Recommendations The Registered Manager should ensure that residents are offered a choice of meals The Registered Manager should ensure that staff receive supervision six times a year 2 OP36 Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Sidcup Local Office River House 1 Maidstone Road Sidcup 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 Elmwood DS0000066220.V290372.R01.S.doc Version 5.2 Page 31 - 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. 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