Inspection on 19/01/06 for Elmwood

This inspection was carried out on 19th January 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 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

Elmwood 02/08/07

Elmwood 26/03/07

Elmwood 13/06/06

Elmwood 20/03/06

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 Unannounced Inspection 19th January 2006 17:00 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.V278845.R01.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 DS0000066220.V278845.R01.S.doc Version 5.1 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 (67) of places Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection New Registration. 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 move back to their own home. The two other floors are for those residents in the category of older persons. These two floors provide long-term care. Staff are allocated to specific floors to promote team working and provide a consistency of care. Each floor has a senior qualified staff member leading the team. A qualified nurse manages the home. Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was conducted at 17:00 hours by three inspectors. The inspection was conducted at this time due to concerns raised about access to the home, levels of information that staff were able to relate to ambulance personnel, and to observe the evening routines. The inspectors visited a floor each with the lead inspector dealing with the intermediate care unit. The environment was not inspected, nor were policies and procedures or other documents, which had been available on registration just some eight weeks previous. During the course of the inspection the evening meal on the ground floor was being served, and the teatime medication round was taking place. Records were examined in relation to medication, accidents and a selection of care plans from each floor. A number of residents and staff in general spoke to the inspectors. On the ground floor two residents and one relative also met with the inspector in private. What the service does well: What has improved since the last inspection? What they could do better: Care plan documentation and associated records were to a poor standard, in some cases there were no care plans available. This is particularly concerning as these are the key documents from which staff provide the care for the residents. Medication procedures and supporting records also need to be improved upon. Medication records were in some cases poorly completed and introduced a margin of error, which may be to the detriment of the resident. Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 6 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.V278845.R01.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 DS0000066220.V278845.R01.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): EVIDENCE: No standards in this section were assessed. Elmwood DS0000066220.V278845.R01.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): 7,9 The documentation in respect of assessments, care plans, risk assessments and reviews was not sufficiently completed or comprehensive in content to reflect residents’ needs. Staff would be unable to provide consistent care without these essential information documents. EVIDENCE: The three inspectors all viewed care plans and medication records on each floor. Their findings are as follows. Intermediate Care Unit- Care Plans Two care plans were randomly selected. One of a resident who had MRSA and another of a resident with a leg wound. In both cases the documentation was difficult to extract from the file particularly assessment information, care plans relating to identified problems, and supporting risk assessments. One document headed “Elmwood Admission Assessment – GP” had medical information but nil on actual nursing issues. The resident with MRSA did not have any care plan on file; this could not be located by the qualified nurse either. The file contained Primary Care Trust Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 10 information relating to mobility, neurological assessment and a therapist treatment plan. There was no actual care plan generated by the staff working with the resident at Elmwood. The second care plan was of a resident admitted 17/1/06. This resident had a left leg ulcer, staff stated. Again there was no nursing assessment on file and the FACE assessments were mainly blank. It is of particular concern that staff were not informed of which dressing to place on the leg ulcer and had used the one available on the unit. This resident will return home in six weeks and staff had taken the decision to treat the wound with an identified dressing without reference to what had been used before, or what was now appropriately required. More concerning was that this resident’s Waterlow score had not been completed even though all the information to complete this assessment was available. This resident’s condition indicated that skin integrity problems would occur with reference to poor mobility, existing leg ulcer etc. It is therefore essential that this basic risk assessment be undertaken. Intermediate Care Unit- Medication The inspector viewed the medication charts. Many of these were hand transcribed some without signatures, and many without the two staff signatures recommended. The amount of medication received into the home was also omitted. Other areas, which were not fully completed, were the allergies section and occasionally photographs were not in place. It is essential with such a quick turnover of residents – their maximum stay is six weeks that all information relating to residents is comprehensive in content. The hand transcriptions of medications need to have two staff signatures in place to confirm the accuracy of the information transcribed. Ground Floor - Care plan and records One care plan was left on the nurse’s station along with a couple of others; these were freely accessible to anyone passing. Grammatical errors in the resident’s history made the document difficult to read. In general daily entries were vague and brief referring to assisting with personal care. There was an absence of any information regarding resident’s well being, demeanour or activities. Staff stated information regarding activities was held in alternative file. The nurse in charge did say that the care plans were done differently on each floor. The document headed classification of pressure sores and threatened skin close referred to one resident as being obese. The inspector pointed out to staff that there was no documentation to indicate how they had formed this Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 11 conclusion and was provided with a copy of medical check. Such entries must be clinically evidenced with supporting documentation. During the course of the conversation with one resident, the inspector noted skin abrasions to her right arm. She informed the inspector that this had happened when a member of staff had used the hoist to move her without the assistance of a colleague. Information in this resident’s care plan, regarding moving and handling, stated that she required two members of staff and the hoist for this purpose. The inspector asked staff on duty to see copies of the accident book, there was no record available regarding this incident, although Brian James, Personnel Director, stated a Regulation 37 notice had been submitted to the CSCI, a copy of this could not be located at this time. The accident book also indicated a further accident involving another resident, who slipped from a sling when a carer was enabling her to stand. This is currently under investigation by Mission Care. Ground Floor- Medication The medication round was observed. The RGN administering medication ensured the cupboard was locked each time she removed an individual resident’s medication and then signed the Medication Administration Record (MAR) sheet when returning to take out the next persons medication. When the medication trolley was returned to the ground floor storage room the inspector asked to see a resident’s MAR sheet as a note on the front sheet of her care plan indicated that it was necessary for her to be given a steroid early morning. There was no reference to the resident’s general time of waking in the care plan. The MAR sheet indicated that the medication was administered at 9 a.m. The inspector asked the nurse if this was the approximate time that the resident woke. She stated that it was earlier and the medication was administered earlier. The inspector pointed out that the medication record should be accurate. The nurse stated she would discuss the matter with the GP next week to amend the printed time on the MAR sheet. One resident had an inhaler on the table in front of her which she stated she requires for her asthma. There was no record of this being monitored on her MAR sheet or risk assessment. The use of a hole punch on MAR sheets means that it is not possible to see the names of all medications in full. This could introduce a margin for medication errors. The medication room is small with limited storage, however appropriate airconditioning prevents the room from becoming too hot. Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 12 Top Floor-Care Plans and Assessments There was some confusion as to whether the assessments for prospective residents were completed by the home prior to their admission. The inspector found the layout of the paperwork difficult to work through. One file viewed contained the Health Authority assessment. In general there was a lack of signatures and dates on many aspects of the paperwork. The completion of documents was variable and incomplete in some cases. The care plan paperwork was also of a mixed standard and did not contain the information or guidance, which accurately reflected the resident’s current needs. Top Floor –Medication Medication practices require significant improvement. On arrival at the unit the medication trolley was located in the hallway, unlocked with the keys left in the trolley and the RGN not in the vicinity. The inspector also observed the practice of placing medication into a pot, but then placed into the resident’s hand from the RGN’s hand. This is not an appropriate practice. For some residents there were two medication records, which could lead to confusion and then errors in administration. Handwritten medication records had one signature only and therefore accuracy could not be confirmed. There were gaps in the receipt of medication, with some medication not having a record of their receipt. Not all medication records had photographs of the residents and there were few with allergies noted. Medication records also lacked clarity on the start date for many. One of the medications, stored in blister packs, showed the medication for Monday of week two given, but the day was Thursday. The medication trolley is stored securely in the drugs cupboard where a fridge is also located for storage of some medication. The room did not have a thermometer to monitor the temperature. However, the room is automatically ventilated when the light switch is activated. The record of fridge temperatures could not be located. In addition, the inspector found medication in the fridge belonging to residents who had departed the home weeks earlier. One such medication did not have a label attached to it but had a handwritten first name only. Please see requirements 1,2 and 3. Please see recommendation 1. Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 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): 13,15. Choice was available during the evening meal and residents confirmed the availability of activities. EVIDENCE: On the ground floor tables were appropriately laid and a small vase of fresh flowers stood on each table. The evening meal was being served at the time of the inspection, care staff assisted residents who require assistance with eating appropriately. In general residents spoken with stated the food was “all right. There was sufficient food to enable residents to have a second helping. One resident declined the chocolate mousse and requested ice cream, which was provided. During the course of the evening meal a relative arrived and a cup of tea was provided for both the resident and visitor. Although the main kitchen was now closed, the fridge on the unit had been stocked with bread, crackers and cheese. Stocks of teabags, drinking chocolate etc were in the cupboard to enable staff access to provisions if residents required beverages etc during the night. Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 14 Staff stated that generally residents would be offered the choice of a hot drink and biscuits at approximately 8 oclock in the evening. Comments by relative A relative spoken with stated that he comes to visit his father at various times during the day and evenings. He stated that teething problems had now been sorted out. Initially the nurse in charge of the floor would phone him at home with what he perceived as every little problem. His father had also been upset when he asked a carer for cup of tea, and she then in turn asked the nurse if it would be all right for him to have this. However, this matter had been addressed appropriately internally. He felt his father had benefited from the move from another nursing home . He had a ground floor room and a suitable bed for his needs. His father had told him he enjoyed the activities, which had taken place earlier in the day. He stated when he returned his father to the home following a night out at approximately 11 p.m. staff had answered the door promptly and assisted his father to bed. Resident’s comments and observations Both the residents spoken with stated they were happy with the accommodation provided, although thought the home was too hot. Staff stated that radiators in bedrooms were fitted with individual thermostatic controls and said they would discuss this with residents. Residents stated that they had different views on the activities provided. One had enjoyed listening to the person playing the guitar earlier in the afternoon; the other said she had chosen to stay in her room. Residents could not recall if they had been asked about their likes and dislikes in respect of food when they moved in. One resident stated that she was surprised that there was not a choice of food provided at mealtimes, although she was aware that she could request a salad, jacket potato or omelette etc. This point was discussed with staff and Brian James, Personnel Director. Residents should be given the opportunity of having an equally nutritional meal to their peers. It was stated that menus were currently under review and the matter would be discussed with the catering contractors. On the top floor, five residents were in the dining room eating their tea. This was a relaxed time and one member of staff was seen to be encouraging residents to eat. However, there was little other interaction. Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 15 One resident was observed taking their tea in a comfy chair. When they needed assistance with some personal care screens were brought in to ensure privacy and dignity whilst using the hoist. One member of staff was also observed assisting a resident who was quite anxious whilst mobilising. She was tolerant and showed a patient and encouraging approach, which not only encouraged independence but also monitored their safety. The record of food provided to residents was not available for inspection; staff stated they did not keep this record and were not aware if the kitchen staff maintained this record. Please see recommendation 2 and 3. Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 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): EVIDENCE: No standards were assessed in this section. Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 17 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): EVIDENCE: No standards in this section were assessed. Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 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 Staff are provided in sufficient numbers, however with the increase in numbers and dependency, the staffing number and skill mix must be kept under review. EVIDENCE: Two residents on the ground floor, perceived staff to always be busy and in a hurry. One resident stated she could walk but was always pushed in a wheelchair, as it was quicker for staff, and she was worried that if she did not use her muscles her mobility would decrease further. Both residents main concern was the amount of time that it takes staff to respond to the emergency call system, another resident stated that on some occasions she has to press the buzzer two or three times before she received a response. The inspector discussed this issue with the RGN. She suggested that whenever possible staff responded promptly, however, she agreed to discuss this with the staff group. Emergency call system Regulation 37 During this conversation the inspector was informed that there was a problem with the emergency call system . The problem was that the panel was visually indicating the system had been activated by showing the room number, but Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 19 not issuing an audible warning sound. A Regulation 37 notice was submitted to the CSCI, regarding this issue, 20 January 2006. This should have been forwarded immediately the problem was identified. On the top floor five carers, one of whom was on induction, and one RGN were on duty caring for seven residents. Discussions with the newest member of staff were difficult as the inspector was unable to understand the member of staff as she had limited understanding and spoken English. However, the member of staff was on a period of induction, which included shadowing of staff. Please see requirement 4. Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 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): EVIDENCE: No standards in this section were assessed. Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 21 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 2 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 X 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X X X X X X X X x STAFFING Standard No Score 27 3 28 X 29 X 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X X x X X X Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? Not applicable 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 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. The Registered Manager must ensure that all records relating to medication procedures and administration are fully completed. All medication procedures must be safely applied. The Registered Manager must ensure that all events affecting the welfare of the residents is reported to the CSCI immediately . Timescale for action 28/02/06 2 OP7 15 28/02/06 3 OP9 13 28/02/06 4 OP22 37 28/02/06 Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 23 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 3 Refer to Standard OP9 OP25 OP15 Good Practice Recommendations The Registered Manager should ensure that the records relating to the fridge temperatures are addressed. The Registered Manager should ensure that the temperature in the home is maintained at an optimum level. The Registered Manager should ensure that residents are offered a choice of meals Elmwood DS0000066220.V278845.R01.S.doc Version 5.1 Page 24 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.V278845.R01.S.doc Version 5.1 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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