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Inspection on 19/07/05 for Elmwood

Also see our care home review for Elmwood for more information

This inspection was carried out on 19th July 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

Residents at Elmwood say that standards of care are high. This was confirmed during this inspection. Elmwood is bright and airy, clean and hygienic throughout. There are many aids and adaptations in place to help less able residents to remain independent. These include hoists, ramps, a lift and a loop system for those who have hearing problems. Residents were all very complimentary about the home, the staff and the manager. Comments included `the staff are kind and helpful`, `I couldn`t be in a better place` and `they are always quick to help`. One resident said she had come to live in a home because she could no longer cope at home. However, her aim is to remain as independent as possible and she says the staff are helping her to achieve this. Another resident said she moved into a home because she was lonely. She says she now has lots of company when she wants it, can be private when she wishes and is no longer lonely. Staff are well trained and are employed in sufficient numbers to ensure they can meet the needs of residents. Throughout the inspection, they were observed using excellent communication skills, being discreet, respectful and helpful. Staff said they `put themselves in the place of the resident` and know that `little things or little extras mean a lot`. Good assessments prior to admission ensure that care staff can meet residents` needs and good care planning and communication ensures that consistently high quality care is given. Residents are particularly complimentary about the meals served at Elmwood. They say there is always plenty of variety, that food is well presented and served in nice surroundings. Residents said they feel safe and secure and that if they did have any concerns or complaints that could speak with the staff, manager or owner. Any concerns received had been documented and dealt with appropriately. Regular feedback from residents is sought and acted upon. Staff have a good understanding of what abuse is and what to do if they suspect or see abusive practices.

What has improved since the last inspection?

Since the last inspection systems for the administration of medication have been improved. The manager has obtained an up to date British National Formulary to ensure that up to date information regarding medications is available to staff. In addition she has obtained a Controlled Drugs register. At the last inspection, door wedges were being used to prop open many fire doors. This practice has stopped. The majority of fire doors now have magnetic door holders fitted (which release when the fire alarm sounds) or fire doors are kept shut. Redecoration work is ongoing. A balcony has been replaced and a step into a resident`s bedroom has been levelled. Work in the garden continues. Most recently a line of trees has been cut down which has, according to residents, made the home feel lighter and airier.

What the care home could do better:

The owner should ensure that all staff that work at the home receive appropriate Criminal Records Bureau Checks and Protection of Vulnerable Adults checks prior to commencement of employment. Risk assessments regarding the premises and risks to residents should be regularly updated. In particular risk assessments in relation to unguarded radiators and unrestricted windows should be updated as dictated by changing residents and changing residents needs. Maintenance checks and controls should include weekly cleaning of showerheads and regular checks on hoisting equipment.

CARE HOMES FOR OLDER PEOPLE Elmwood Swan Hill Colyford Colyton EX24 6QJ Lead Inspector Teresa Anderson Announced 19 July 2005 10:00hrs The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service Elmwood Address Swan Hill Colyford Colyton Devon EX24 6QJ 01297 552750 01297 551133 info@elmwoodonline.co.uk Elmwood Residential Home Limited Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mrs Josephine Victoria Newbery Care Home 33 Category(ies) of OP Old age (33) registration, with number PD(E) Physical dis - over 65 (33) of places Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 11 January 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 D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This announced inspection took place between 10.00am and 4.00pm as part of the normal programme of inspection. The inspector saw the majority of the home and spoke with approximately thirteen residents in depth. She also spoke with two members of care staff, one member of housekeeping staff, the manager, the director and the owner. Records relating to care plans, risk assessments, staff recruitment, complaints and maintenance arrangements were seen. The inspector spoke with a visiting GP and received nine comments cards from residents and relatives together with a preinspection questionnaire completed by the manager and owner. What the service does well: Residents at Elmwood say that standards of care are high. This was confirmed during this inspection. Elmwood is bright and airy, clean and hygienic throughout. There are many aids and adaptations in place to help less able residents to remain independent. These include hoists, ramps, a lift and a loop system for those who have hearing problems. Residents were all very complimentary about the home, the staff and the manager. Comments included ‘the staff are kind and helpful’, ‘I couldn’t be in a better place’ and ‘they are always quick to help’. One resident said she had come to live in a home because she could no longer cope at home. However, her aim is to remain as independent as possible and she says the staff are helping her to achieve this. Another resident said she moved into a home because she was lonely. She says she now has lots of company when she wants it, can be private when she wishes and is no longer lonely. Staff are well trained and are employed in sufficient numbers to ensure they can meet the needs of residents. Throughout the inspection, they were observed using excellent communication skills, being discreet, respectful and helpful. Staff said they ‘put themselves in the place of the resident’ and know that ‘little things or little extras mean a lot’. Good assessments prior to admission ensure that care staff can meet residents’ needs and good care planning and communication ensures that consistently high quality care is given. Residents are particularly complimentary about the meals served at Elmwood. They say there is always plenty of variety, that food is well presented and served in nice surroundings. Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 6 Residents said they feel safe and secure and that if they did have any concerns or complaints that could speak with the staff, manager or owner. Any concerns received had been documented and dealt with appropriately. Regular feedback from residents is sought and acted upon. Staff have a good understanding of what abuse is and what to do if they suspect or see abusive practices. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 1 and 3 Residents receive clear information enabling them to make an informed choice about living at Elmwood. Service users benefit from comprehensive assessments which ensure that their needs are assessed and can be met. EVIDENCE: Elmwood provides prospective and current residents with comprehensive information regarding the services available. Many residents said they, or a member of their family, had read the brochure prior to visiting. When they then visited and were shown around the home, they had been invited to stay for lunch and to chat with residents and staff for as long as they liked. Prior to admission residents undergo comprehensive assessments in relation to their needs. These are kept with care planning documentation to enable the manager to monitor progress. Residents were very complimentary about the time staff took to get to know them and ‘our little ways’. Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 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 standard(s) 7, 8, 9 and 10. Residents are respected as individuals by staff and good systems are in place to ensure that their health and personal care needs are identified and met. Residents would benefit from improved risk assessment documentation demonstrating how decisions balancing risk against service user preferences and wishes are made. Procedures and practices ensure the safety of residents in relation to medication. EVIDENCE: Residents said that staff look after them very well and that staff give good advice about how they can help to look after themselves. They call the doctor and district nurses when needed and always help them if they are not feeling well. Care plans show that all aspects of the health of residents are monitored and attended to. This includes out patient appointments, referrals to specialist services such as speech and language therapy, chiropodist, psychiatrists and dentists. A visiting GP said that staff always called for a doctor appropriately Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 10 and always when the resident asks. One care plan in particular demonstrated how the health of one resident has improved since moving into Elmwood. Residents say they are involved in making decisions about their care and how care is provided. Of the three comments cards received, one relative/visitor commented that s/he was not always kept informed of important matters affected their relative. The inspector has been unable to follow this up. Not all risk assessments are comprehensive or detail the actions which need to be taken to minimise particular risks to residents. Some residents are offered advice on how to minimise risk but decline to take this. This too needs to be clearly documented. The staff spoken with understand residents needs and preferences and say they get this information from care plans, through oral communication and through the communication book. They talked of how each resident is different and how important ‘little extras’ and ‘little things’ are. They were observed treating residents with respect, for example using resident’s preferred title, and were seen being careful to ensure residents privacy and dignity. Systems for handling and storing medications have improved and staff who administer medication receive appropriate training. The home has recently undergone inspection by the community pharmacist who was satisfied with the systems and practices in place. A new British National Formulary has been obtained and although none of the residents currently require Controlled Drugs, the manager has obtained an appropriate register to prevent delay if such medications are prescribed. Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 15 Residents benefit from a varied and appealing diet eaten in a social and pleasing environment. EVIDENCE: All residents said they enjoy the food and that if they do not like what is on the menu they can have something else. Menus are given to residents weekly for them to choose what they would like to eat. Residents are then given a copy of the choices they have made if they so wish, and each menu offers the opportunity for residents to offer suggestions. The chef has received training in the preparation of special diets and some training in dietetics. The manager has recently attended a course on the management of malnutrition and the use of supplement drinks. Elmwood has two dining rooms, both presented to a high standard with, what residents call ‘beautifully laid’ tables. Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 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 standard(s) 16 and 18 Residents are well protected by the homes policies and procedures in relation to the protection of vulnerable adults and the making of complaints. EVIDENCE: Staff at Elmwood have clear guidance regarding what to do if they observe abuse or if an allegation of abuse is made. Staff demonstrated a good understanding of what abuse is and what to do if they saw or were suspicious of abusive practices. Residents said they feel safe and secure and that staff are helpful and kind. They said that they can say anything to the staff, manager or owner and that their comments are always taken seriously. The complaints book was inspected and all issues raised by residents have been appropriately dealt with. Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 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 standard(s) 19, 25 and 26. Residents live in a comfortable environment that is clean throughout. Residents would benefit from risk assessments in relation to unguarded radiators that take account of changing needs, and improved practices in relation to the control of Legionella. EVIDENCE: All bedrooms at Elmwood are single with ensuite facilities. Married couples have two rooms which they can choose to use how they prefer. Rooms are well decorated and furnished to the individuals taste. There are two dining rooms, a lounge and a small library area. The smaller of the two dining rooms also has a small eating area. Some residents said they enjoyed meeting in the lounge whilst others felt they did not wish to sit here, where more dependent residents tend to sit. The gardens have been extensively refurbished and work continues. A hedge of tall trees has recently been removed and residents comment this has created more light and an airier feeling. Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 14 Many residents have direct access to the gardens from their bedrooms or to a balcony overlooking the garden and both dining rooms and the lounge overlook this area. There are many seating and shaded areas which residents say they enjoy. Since the last inspection one balcony has been replaced and a step in a residents bedroom has been levelled. Decorating is on going. The home is clean and hygienic throughout and residents say that their clothes are well cared for. The owner was advised to include the cleaning of shower heads to help control for Legionella and has added this task to the regular maintenance/cleaning routine. Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30. Residents are not fully protected from the homes recruitment practices. Residents benefit from a well-trained, skilled and experienced staff group. EVIDENCE: The preinspection questionnaire indicated that three members of staff who require Criminal Record Bureau Checks (CRB) have not had them completed prior to commencing employment. CRB guidance states that homes are required to undertake standard disclosures where the employee has regular contact with vulnerable adults but the job does not involve directly working with or caring for vulnerable adults (e.g. domestic, catering or maintenance worker). The home is required to carry out enhanced CRB checks on all staff employed at the home who provide care. The staff group at Elmwood are experienced and well trained. There has been no change in the care staff working at the care home in the last year providing a stable work force for residents. Carers are offered NVQ training and many have undertaken this. They talked of how this training had helped them in their daily care of residents. Residents said that the staff are busy but always helpful and able to take care of them. The duty roster shows that sufficient staff are on duty to meet residents needs. Extra staff are on duty during busier periods of the day and staffing numbers are changed according to residents dependency levels. In addition to care staff there are housekeeping staff on duty four days a week and catering staff seven days a week. Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33 and 38. Residents benefit from an audit and feedback system which ensures Elmwood is the home of the residents who live there. Residents safety and welfare could be better protected by improved risk assessments in relation to window restrictors and radiators guards, and by improved maintenance checks in relation to hoists used in the home. EVIDENCE: Residents at Elmwood have many formal and informal opportunities to offer their comments on the home and to suggest improvements. The home carries out regular satisfaction surveys and residents meetings. The owner is known to all residents and plays bridge with many of them. Menus request residents to pass on their comments and suggestions for improvement. Residents say ‘the home could not be better’ and ‘they listen to what we have to say’. None of the residents asked or who completed comment cards wish to be more involved in the running of home. Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 17 The safety of residents is promoted through regular mandatory training which includes fire training, manual handling training, food hygiene, infection control and first aid training. Good maintenance and servicing systems are in place (see Standard 26). Risk assessments regarding unguarded radiators and window restrictors are in place. However, these do require updating when residents’ conditions change or when new residents are admitted. The owner is planning to guard all radiators and to replace those windows that cannot be restricted. The owner has agreed to set up a maintenance programme for hoists used in moving and handling procedures to further promote the safety of residents. Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 4 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 x 15 4 COMPLAINTS AND PROTECTION 3 x x x x x 2 3 STAFFING Standard No Score 27 3 28 x 29 1 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x 3 x x x x 2 Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 19 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 13 (4) 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). The registered person must not employ a person to work at the care home unless he has obtained all the information and documents referred to in Schedule 2). 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 risks associated with unrestricted windows on upper floors are identified and acted upon). Timescale for action 31/12/200 7 2. 19 29 30/09/05 3. 13 (4) 38 31/08/05 Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 20 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 7 25 38 Good Practice Recommendations The registered person should ensure that care plans include comprehensive risk assessments. The registered person should ensure that practices in place to control for Legionella include the weekly washing of shower heads. The registerd person should ensure the maintenance of a safe environment including regular checks of hoist equipment. Elmwood D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 21 Commission for Social Care Inspection Suites ! & 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 © 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 D54 D06_s21933_elmwood_v230493 190705 stage 4.doc Version 1.40 Page 22 - 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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