Inspection on 07/11/08 for Elmwood

This inspection was carried out on 7th November 2008.

CSCI found this care home to be providing an Good service.

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 18/01/10

Elmwood 09/11/06

Elmwood 10/02/06

Elmwood 19/07/05

Elmwood 11/01/05

Elmwood 09/08/04

Elmwood 24/03/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 20/07/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: Elmwood Swan Hill Road Colyford Colyton Devon EX24 6QJ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Rachel Fleet     Date: 0 7 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 32 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 32 Information about the care home Name of care home: Address: Elmwood Swan Hill Road Colyford Colyton Devon EX24 6QJ 01297552750 01297551133 info@elmwoodonline.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Elmwood Residential Home Limited Name of registered manager (if applicable) Mrs Josephine Victoria Fitch Type of registration: Number of places registered: Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability Additional conditions: The maximum number of service users who can be accommodated is 38. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (Code OP) Physical disability (Code PD) Date of last inspection Brief description of the care home Elmwood is a home offering 24-hour residential care and accommodation to up to 33 older people. Nursing care cannot be provided other than that which the local community nurses can provide or supervise. It is set within the conservation area of Colyford in East Devon, on the main road through Colyford. The house was built at the Care Homes for Older People Page 4 of 32 care home 38 Over 65 38 0 0 38 Brief description of the care home turn of the century, being established as a care home in 1983. It has remained with the same owner since then, who has extended the home and who continues to improve the facilities year on year. Bedrooms are on the ground and first floors, with floors linked by a passenger lift. All bedrooms are single, and all have ensuite facilities. The grounds have been landscaped to include a prominent water feature, and the owner continues to develop the gardens for the enjoyment of service users. There is ample car parking space on site. The fees charged range from 323.00 - 430.00 pounds per week. This does not include items such as toiletries, newspapers, chiropody etc. Further information about this home, including our previous reports, is available direct from the home. We last inspected the home on 9 November 2006, carrying out an Annual Service Review in February 2008. Care Homes for Older People Page 5 of 32 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This inspection took place as part of our normal programme of inspection. We made an unannounced visit to the home, lasting about 10 hours, on a week day. We met with at least 11 of the 36 people who were living at the home, several of whom were able to give us their views in depth. We also spoke with 2 relatives, 2 visiting health professionals, 3 members of care staff and 2 ancillary staff. We looked more closely at the care and services offered to 4 people who lived at the home, as a way of helping us to understand the experiences of people who use this service. This included someone new to the home as well as someone who had lived there some years, someone with cognitive impairment, people who were privately Care Homes for Older People Page 6 of 32 funded and those funded by Social Services. We visited communal and service areas of the home, as well as several bedrooms. We saw records in relation to assessment of peoples needs, their care, staff recruitment, peoples monies, and fire safety, amongst other information. Before the visit, the home had sent back to us a questionnaire about themselves and their plans for the year ahead (the Annual Quality Assurance Assessment or AQAA). We also sent surveys to 10 people who lived at the home and 7 were returned; to 10 members of staff, and 4 were returned; to 6 health and social care professionals, all of which were returned. No-one requested on their surveys to speak to us. We discussed our findings at the end of the visit with Mrs Fitch, the registered manager, and Mr Sadeghi, the Responsible Individual representing the provider. Information gained from all these sources and from communication with the service since the last main or key inspection is included in this report. What the care home does well: What has improved since the last inspection? What they could do better: Additional written detail in care plans and daily care notes would promote consistency Care Homes for Older People Page 8 of 32 in the care and support offered to individuals. Any alterations to care plans should be signed and dated, as good practise, partly to ensure clarity about the care a person was to receive at a particular time. To ensure each individuals leisure-time needs are met, further work should be done on identifying individuals interests and providing suitable, enjoyed activities for them. Establishing effective systems for monitoring cleanliness in all areas of the home over time would ensure high standards are maintained throughout the home. Regular staff training or updating in safe working practices and topics related to the needs of people living at the home would help to ensure peoples needs will be properly met in the future. Other aspects of health and safety need attention to ensure the welfare of people at the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 9 of 32 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 32 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Exchange of information, including through assessments of prospective residents, helps to establish whether the home will be suitable for meeting their individual needs, before anyone moves in permanently. The home does not provide intermediate care. Evidence: People said they had had enough information about this home before they chose to move in. We asked someone quite new to the home what they thought of it. They replied, Its rather marvelous; they explained that they had been disappointed by another home they had stayed at, and thus had a trial stay at Elmwood before deciding to live there. Other people told us they had spent time weekly at the home to join in with the homes life - before moving in when the new extension was completed. Others had had the home recommended to them. Care Homes for Older People Page 11 of 32 Evidence: One person surveyed said the manager had gone to see them when they were in hospital, to discuss their care needs, and had also collected the person when they were due to move in. The manager confirmed all prospective residents are assessed before they are admitted to the home, to make sure their needs can be met if they then move in. The detailed assessment we looked at had been carried out by the manager, although information was also sought from Social Services Care managers where relevant. A staff member told us that the manager met people before they moved in, whenever possible, and then discussed with staff any considerations, relevant staff training needs, etc. A professional confirmed these arrangements usually ensured that the right service was planned and given to individuals. Another said the home had a nice culture and ambiance, and people settled in quickly. The AQAA said everyone had a contract. This was reflected in surveys from people who lived at the home, although one commented that their contract was out-of-date. Care Homes for Older People Page 12 of 32 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The various arrangements for planning care and support ensure that individuals get care they need in a way that suits them, although some lack of written detail may lead to inconsistencies in the care and support offered. Peoples healthcare needs are met through positive multi-disciplinary involvement and good management of their medications. Care and support is offered in such a way as to promote peoples rights to privacy and dignity. Evidence: There was a plan of care for each person living at the home, focusing on the individuals preferences and particular needs. Risk assessments formed part of the care plans, ensuring staff would be aware of any risks associated with aspects of peoples daily lives and the care they needed. Most had been reviewed recently, and changes had been made to care plans as individuals needs had changed. It is good practice for staff to sign and date any such alterations they make to care records, which we saw hadnt always been done. Two people admitted to the home since our last visit confirmed that the manager had discussed their care plan with them. Care Homes for Older People Page 13 of 32 Evidence: One care plan hadnt been altered during a time when the person needed more support because of health problems; nor did it include the walks they told us they now enjoyed around the homes grounds because they didnt go out so much, or the local group they attended. They didnt currently need much help with these activities, but they valued them greatly. Another care plan said the person liked to go to church but not which one or whether the person was being enabled to attend a church service; it was noted that they had impaired sight, but this was not reflected in their care plan. There was nothing in individuals care plans in relation to what help they might need in an emergency such as a fire. People surveyed said they usually or always got the care and support they needed. Those we spoke with were happy with the care and support they got from the care staff and also in other ways. One person said that the chef always provided them with alternatives with regard for a particular dietary requirement they had on health grounds. Someone told us the home had raised their bed, to help them get in or out more easily. Another person was expecting a community nurse to visit them, following a recent fall. Information received from the home since our last inspection indicated the issue of falls was addressed properly. During our visit, we noted some people had had specialist assessments, overseen by community nurses, to help prevent falls and bone fractures. Most surveys from people living at the home were very positive about the medical attention they received generally. Professionals thought the home was good at working with them in monitoring people, reporting any problems people had promptly and acting to improve peoples health, etc. They confirmed that specialist advice they gave was then included in peoples care plans, and that peoples medication was managed appropriately. One commented that the home worked well with the community nurses to give people very good care at the end of their lives. Staff surveys reflected that they were aware of Equality and Diversity considerations, and those we spoke with had a good knowledge of the particular care individuals needed or wanted. Visiting professionals identified that staff showed understanding of peoples diverse needs, including that they made appropriate decisions if they could no longer meet individuals needs. Community nurses were involved in care where required - ensuring people got flu vaccines, for example. There was detailed written information relating to their visits to individuals, promoting continuity of care. We saw timely referrals had been made to Care Homes for Older People Page 14 of 32 Evidence: other professionals such as GPs and Community Psychiatric Nurses. Care notes showed people had had eye tests by an optician recently. Asked how the service could improve, there was only one suggestion in professionals surveys. This was to obtain some more basic care equipment, such as pressurerelieving cushions and mattresses or electrically-operated beds. At our visit, a professional told us that the home listened to suggestions, and that some specialist beds had been obtained. However, they too thought some more equipment would be beneficial, since the community nursing services could not always provide equipment immediately. The home has some responsibilities, following local agreements on equipment provision in care homes. Professionals who commented thought medication was generally handled well. The manager agreed to seek written confirmation, from health professionals, for dose changes in relation to a certain medication that has to be regularly reviewed; at present, staff relied on a phoned message. The pre-admission needs assessment for one person stated they wanted to selfmedicate. When we spoke to them, they said staff managed their medication for them and they were happy with this arrangement. Their care records showed that they had indeed been self-medicating on first moving to the home, with a risk assessment for this appropriately carried out and signed by the person. Since then, the records had been updated, explaining the change and showing the person had been fully involved in this decision. Medications received into the home were being recorded, as recommended at our last inspection, as were unwanted items returned to the pharmacy. We found controlled drugs were stored safely, with appropriate records kept of stocks and administration. Peoples care plans included a monthly review of their medications, and people we spoke with were satisfied with how the home dealt with their medication. People living at the home felt their privacy was respected, and they were addressed appropriately when staff spoke to them. Some told us they had a key for their door. One person said they were enabled to bathe themselves independently on days when they felt they could do so. We saw staff knocking before entering rooms. Visiting professionals confirmed this attention by staff to privacy and respect, including it in their comments on what the home did well, along with saying that staff Listen to clients. Care Homes for Older People Page 15 of 32 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at the home have their social care needs met on the whole, including through good links with the local community and visitors. Support is offered in a way that promotes choice and flexibility. Meals offered provide choice, variety and fresh ingredients, served in pleasant surroundings, meeting both nutritional and social needs. Evidence: The AQAA said the home had increased outings since our last visit, including to plays, the garden had been developed, and the home aimed to serve excellent food. They employ activities staff to improve the activities and the meeting of individuals social needs. When we arrived, we saw the weeks activity programme by the Visitors signing in book. This included two films, two bus trips, an exercise session, a Knit and natter group, and a quiz. Most of these occurred on weekdays; one person we spoke with wished there was more planned for week-ends. Someone told us they had enjoyed a get together for drinks earlier in the week - this Care Homes for Older People Page 16 of 32 Evidence: was the homes recent Pub Club outing. We were told that the Pub Club provided a third outing every week, with venues chosen that had suitable access for those going along. People we met told us they enjoyed the outings, Bingo sessions, painting group, the quizzes and using the garden. We saw a computer was now available in the library room, which one person said the handyman had helped them learn to use. Care staff we spoke with said they were allowed to spend time with individuals for a particular activity, or support small groups, such as two people who enjoyed painting. During our visit, the gardener ran a quiz, with a small group keenly taking part. Someone told us the gardener helped her to keep up her interest in gardening; she showed us an indoor garden which enabled her to enjoy the hobby all year round. The majority of surveys from people living at the home were positive about the homes provision of activities, saying there were always activities arranged that they could take part in - an improvement since our last inspection. Two people replied Sometimes instead. One of these said deafness prevented them from participating more but that activities provided were excellent. People we spoke with were also content, and most said they didnt get bored. One person, who said they sometimes got bored, said they read to their peers and still enjoyed painting. We noted that the care plan for someone new to the home did not yet include their interests, past occupation, etc. A record was kept of who had attended each activity, although it did not evaluate individuals enjoyment of the occasion and was separate from other care records. Unusually, visiting professionals also commented on the social activities provided at the home, as something the service does well. They thought people were usually supported to live the life they chose, and that staff were sufficiently skilled and motivated to respond to peoples diverse needs. One remarked that residents were always cheerful. We spoke with someone who belonged to a church before their admission, who confirmed church services were held at the home for anyone to attend. Some people that we spoke with had lived locally before moving to the home, and went out to meet up with friends. One person said they came and went from the home as they wished, including going out in the evenings. Visitors we met felt welcomed, and free to visit at any time. The home endeavoured to give people as much choice and control of their lives as Care Homes for Older People Page 17 of 32 Evidence: safely possible. Bedrooms were personalised with peoples own possessions. Other examples are given elsewhere in this report - in relation to personal finances, and freedom to come and go, for example. People surveyed said the staff listened and acted on what they said, although one added, Sometimes. When talking to staff about complaints, one said if someone raised a concern with them, they would ask the person if they were happy for the staff member to speak to the manager about the matter, before doing so. The great majority of surveys from people living at the home said they usually or always liked the meals provided. One added, The food is plentiful and of excellent quality. Someone new to the home told us they didnt think they had specifically been asked about their dietary likes/dislikes yet, but they were asked daily about what they would like to eat. Others told us they spoke to the cook to arrange an alternative to what was being offered on the menu; one person said the chef spoke to everyone. Someone said The chef is magnificent - he had ensured the person got a diet they could eat after they had had a major dental procedure. They also said the staff knew their favourites, appreciating this especially where biscuits and drinks were concerned. Another said the chef cooked what people fancied, and he had produced lovely food at Christmas We saw meals were covered whilst they were taken around the home to individuals. People told us that 2-3 vegetables were offered daily, and that fresh fruit was offered each lunchtime, when people could take as much as they wanted. They had enjoyed courgettes and beans from the homes garden in recent times; during our visit, apple crumble was served that had been made with home-grown apples. Homemade cake was served later in the day. Someone living at the home told us that a vegetarian dish was usually included in the daily menu. Care Homes for Older People Page 18 of 32 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints system that people feel confident about using if they need to. They are also safeguarded in various other ways, protecting them from harm or abuse. Evidence: We have not received any complaints about this service in the last year. The AQAA told us the home had had one complaint, which they upheld. Everyone surveyed said they knew how to make a complaint or who to speak to if they were not happy. One added that the procedure was displayed in the home. People we spoke to in their bedrooms had copies of the procedure, which the manager confirmed would be updated with our latest contact details. Professionals surveys also indicated they had not had any complaints, and that the home usually or always responded appropriately if any concerns were raised with them. People living at the home told us Mr Sadeghi or the manager came round regularly, making themselves available to listen to any concerns or suggestions. One said If you mention anything, its dealt with promptly. Another said they knew where the office was and they could always go in to talk to senior staff. They said they had spoken to management when they thought a staff member had been rude, and once when they had been kept waiting. They confirmed Care Homes for Older People Page 19 of 32 Evidence: that these issues had been dealt with to their satisfaction, and had not arisen again. Staff surveyed said they knew how to respond if someone had concerns. One went on to say that they would report the matter to the manager or home owner, who would then meet with the person to discuss the concern in private. There have not been any safeguarding referrals in relation to this home since our last inspection. The AQAA said all staff had read the homes updated Safeguarding policy. We saw this included issues such as restraint, as well as the telephone numbers for external agencies whom staff could contact if they had concerns. People we asked felt safe with staff or safe at the home, with one adding No-one shouts at you here. Staff we spoke with were clear about their responsibility to report bad practises if they witnessed them, saying they would go to senior staff and had access to information about other people or organisations that concerns could be reported to. One said they would explain to any individuals making allegations of abuse that they, the staff member, had a duty to report the allegation so that people could be properly safeguarded. We saw an additional witness signature was obtained for one persons personal monies record, on occasions when staff felt the person had less capacity to fully understand what they were signing for. This allowed the person to remain involved in their personal affairs, whilst safeguarding their financial interests. Care Homes for Older People Page 20 of 32 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have homely, well maintained accommodation that is adapted for their needs, and they will benefit from action being taken to ensure it remains clean throughout. Evidence: People we spoke with were satisfied with their private accommodation - the heating, lighting, hot water supply, etc. Bedrooms reflected peoples lives to date, their interests, etc., being furnished with pieces of their furniture, pictures, etc. The home has a library and dedicated hairdressing room. Lounge and dining areas were spacious and sunny on the day of our visit, with pleasant views. Some bedrooms had direct access to garden areas, which were level and had new seating arranged so that people could enjoy the views. One person said that the owners had carried out lots of alterations to the home. A new extension has been registered since our last visit. A new Jacuzzi bath was being fitted at the home, after Mr Sadeghi, Responsible Individual, researched into the popularity and usefulness of such baths. The AQAA had indicated there was an ongoing refurbishment/replacement programme for carpets, fittings, etc. Senior staff confirmed this included a bath with a surface damaged by the bath hoist. We were told that bedrooms were redecorated when they were vacated, if a repair was needed, or if staff Care Homes for Older People Page 21 of 32 Evidence: reported an issue. Mr Sadeghi confirmed that the homes hard wiring would be checked when it was due in November 2008. People living at the home thought there were enough aids and adaptations for their needs. We saw dining chairs were adapted to make them easier for people to use them independently. Grab rails and raised toilet seats were provided. Automatic door holders were in place around the home, so that people could safely have their door held open if they wished; those we asked confirmed the door was released when the fire alarm sounded in regular tests carried out by the home. People living at the home told us odd jobs and repairs were attended to quickly. A bath hoist had recently been replaced. Some servicing of equipment was carried out by the homes handyman. Mr Sadeghi was satisfied as to the individuals competency, in view of their previous experience, to carry out this work, and told us that manufacturers were contacted to address more complex tasks. Labels on small electrical items showed they had been tested for safety within the last year. The great majority of those surveyed said the home was always clean and fresh, one adding, Feels like home. One person, however, thought this needed further investigation. At the start of our visit, we noted some carpets looked newly stained; they were cleaned during the day, by the housekeeping staff, without us raising the matter. The home throughout was free of malodours. People we spoke with around the home had different views on the levels of cleanliness. Some people said their furniture was moved for thorough cleaning of bedrooms, whilst others said theirs was not, and we found evidence to support this. The variation in standards appeared to be a training or supervision issue, which Mr Sadeghi said would be addressed. Additionally, a new cleaner was about to start employment to cover for someone now on long-term absence. The AQAA said most staff had had training on infection control. Those we met had a good general knowledge of how to prevent the spread of infection, which we saw them putting into practise. This included appropriate washing machine programmes for different types of laundry, which we saw were being used accordingly. The well equipped laundry looked clean and tidy. Care Homes for Older People Page 22 of 32 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff recruitment practises, daily staffing levels and staff training are such that, currently, people living at the home are safely supported and cared for. Further staff training would help to ensure peoples changing needs will be met in the future. Evidence: People living at the home described staff as Very, very nice, Cheerful, and very helpful. Professionals surveys included Caring staff - well led, Friendly welcoming home with excellent care staff. When we arrived, the manager was on duty with 3 senior care assistants, 3 care assistants, a cleaner, cook, assistant cook and a gardener, to look after 36 people. We were told that ancillary staff were employed at week-ends as well, so care staff could concentrate on helping people rather than on non-care duties. Most people surveyed said staff were usually or always available when they needed them. Two said sometimes instead, one adding Staff shortage is a problem. One person we spoke with thought that the home had not employed enough people overall, to allow for covering staff holidays and sickness. Whilst staff surveys were positive about the home, three referred to staffing shortages due to staff sickness, two adding that these were always covered (by staff or the manager working extra shifts). The Care Homes for Older People Page 23 of 32 Evidence: AQAA said the home had tried to improve staffing levels, and no agency staff had been used in the previous 3 months. Some people living at the home - who were positive about the staff team otherwise told us staff didnt have much time to chat, that they were occupied, or they only saw the staff when they were carrying out tasks. One person thought there were too few staff, especially at night. However, they went on to say that staff were very kind (as others told us), that they were not at all neglected, and they felt they lived in the best home around. Two people speaking from personal experience said people were given a lot of attention if they needed it (when ill, etc.), with staff very good at popping in and making extra checks at such times. They said people were not neglected but they felt the home could do with more staff at times. All but one person confirmed that meals, their newspapers and medications were given out on time, with call bells answered in a reasonable time. When we arrived the various areas of the home looked orderly, and staff - whilst occupied - were unhurried in their work with people. We did not see them simply chatting with people much, but people we met looked well cared for. The AQAA had indicated that people living at the home, though all over 80 years of age, were relatively able. Staff confirmed this during our visit, and we were told that all but one person were up during the day. A visiting professional thought there were enough staff around whenever they visited. Care staff were responsible for dealing with the laundry but told us that they had enough time for this. Staffing matters were discussed with Mr Sadeghi and Mrs Fitch, who were aware of the observations made but who were experiencing difficulty in recruiting suitable staff to work at the home. They agreed to monitor matters closely. A newer member of staff described their induction, when they observed their colleagues for some time in their care-giving role before then being supervised by a senior carer in giving care themselves. Their knowledge was developed at the same time through training videos on various care topics. A record had been kept of their progress. Training for staff was ongoing and all staff were encouraged to undertake a recognised care qualification. At this visit, 12 of the 15 care staff were trained to NVQ Level 2 or above - an excellent achievement. One staff who had just obtained an NVQ Level 2 commented that it had helped them in meeting peoples diverse needs. We noted that the staff training programme included medication and safeguarding, but little on conditions that people living at the home might have, such as those associated Care Homes for Older People Page 24 of 32 Evidence: with old age. Some people we spoke with identified that certain staff could benefit from more training on aspects of communication, whilst other staff were very skilled, which we discussed with the manager. A health professional told us that they had given staff training on diabetes. The care qualification most staff currently had gave them a sound basis for looking after people properly, and a staff survey included that the manager gave staff training as they needed it. However, it would be prudent to include updating on care-related topics in the annual training programme, so that peoples changing needs will be met if their condition alters. Newer staff described their recruitment, which indicated the home had used appropriate procedures. We looked at the files of three staff recruited since our last inspection. These all had required information in them, such as evidence of identification, two references and police checks obtained before people started working at the home - an improvement since our last visit. Care Homes for Older People Page 25 of 32 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Management systems help to protect and promote the best interests of those living at Elmwood, although aspects of safe working practises need attention, to ensure the health and safety of everyone at the home. Evidence: Mrs Fitch, the manager, has been in post since 2000. She has successfully completed the Registered Managers Award and regualrly updated her training since. She had a sound understanding of the needs of those in her care, and was clearly respected by them. Staff and visiting professionals felt the manager was excellent, and that the owners were very committed to the home and to providing a good service to individuals. Requirements and recommendations made following our last inspection have been addressed. In surveys, one person living at the home commented specifically on the managers helpfulness, and a health professional was positive about her leadership skills. People Care Homes for Older People Page 26 of 32 Evidence: living at the home that we spoke with thought the home was very well run. A visiting professional confirmed the home ran just as smoothly at week-ends as in the week. Staff confirmed they had one-to-one supervision sessions with a more senior staff member to discuss their work, any training needs, etc. We saw a copy of our last report on the home available in the staff room. People told us residents meetings were still held 6 monthly. One person said that anyone could raise any issues here. Another felt people didnt speak up, but added that Mr Sadeghi asked for peoples opinions about anything specific that arose. We were shown the results of the homes latest quality assurance survey, which were to be shared with people at the next residents meeting. It had covered topics such as maintenance, activities, cleanliness, and the qualities of the different staff groups. Consequently, a bathroom had been identified for redecoration, and Scrabble and gardening opportunities were to be increased. One person told us they had not completed the survey given to them because any complaints were sorted out at the time, and they could make suggestions at any time. Most people were billed in arrears for any personal expenditure, being charged at cost price for toiletries, hairdressing, etc. provided in the home. An itemised invoice was sent out to individuals, with related receipts available at the home for inspection, on request. We checked the monies of two people that were held by the home at individuals requests. Cash balances matched the written records, and the individuals had signed the records, with a second witness signature also obtained. This addresses a recommendation made at our last inspection. There was relatively little in the AQAAs self-assessment section about the homes safe working practices, although the home had identified that some staff updating on this matter was overdue. When we visited, we were told the manager was taking steps to remedy this. She was able to confirm that there was always a first aider on duty. Although thermostatic valves have been fitted to baths, we found one bath tap ran water hotter than recommended limits for safety. We were told that staff always checked bath water temperatures before assisting anyone into a bath, but a risk still existed - such as to anyone who might run a bath independently. Mr Sadeghi agreed that records would be kept of monthly water temperature checks to monitor scalding risks better. An uncovered radiator that we checked was not being used. There is an on-going programme of covering radiators to prevent scalds, and most are now protected. Access to an extinguisher had been obstructed by stored furniture, which the manager Care Homes for Older People Page 27 of 32 Evidence: said she would address promptly. There was a lack of information about individuals needs to properly inform the homes fire risk assessments. We advise that the home contact the local fire authority for further advice as necessary, with regard to this or any other fire-related matters. An Environmental Health Officer had visited in October 2008, and found everything satisfactory. Window restrictors were in place where we checked at random. Risk assessments were in place for individuals, in relation to the need for window restrictors in their bedrooms. We discussed the need to consider other factors in these assessments also. Care Homes for Older People Page 28 of 32 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 32 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 7 It is recommended that all care plans and related daily care notes are kept up-to-date and have sufficient detail to ensure people will receive consistent individualised care or support over time. It is recommended that staff sign and date any alterations or additions they make to care records. It is recommended that you continue to develop the leisure and recreational opportunities for individuals in line with their interests and enjoyed activities, through initial consultation and ongoing review with each person. It is recommended that there are effective systems in place for monitoring and ensuring cleanliness in all areas. It is recommended that regular updating on care-related topics (such as the conditions experienced by people for whom the service is provided) are included in the ongoing staff training programme. It is recommended that regular water temperature checks are recorded, to evidence that the control measures originally put in place to prevent scalding risks are still in place, with action taken as necessary to maintain their effectiveness . Page 30 of 32 2 3 7 12 4 5 26 30 6 38 Care Homes for Older People 7 38 It is recommended that the on-going programme of covering radiators to prevent scalds should be continued speedily to its conclusion. It is recommended that all staff receive timely updates on safe working practices, to protect the health and safety of everyone at the home. 8 38 Care Homes for Older People Page 31 of 32 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). 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