Inspection on 22/09/05 for Elmwood House Nursing Home

This inspection was carried out on 22nd September 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 no outstanding requirements from the previous inspection report, but made 4 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Elmwood House Nursing Home 17/09/09

Elmwood House Nursing Home 03/09/07

Elmwood House Nursing Home 02/08/06

Elmwood House Nursing Home 23/01/06

Elmwood House Nursing Home 17/11/04

Elmwood House Nursing Home 25/05/04

Similar services:

Hillside

Applegarth

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Jubilee Villa Care Home

Thornham Grove

Beech Lodge

8 Thorndale Road (Homefield College)

Hunter`s Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOME ADULTS 18-65 Elmwood House Nursing Home Elm Street Hollingwood Chesterfield Derbyshire S43 2LW Lead Inspector Ray Coonan Unannounced Inspection 22nd September 2005 10:00 Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 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 House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 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 Adults 18-65. 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 House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Elmwood House Nursing Home Address Elm Street Hollingwood Chesterfield Derbyshire S43 2LW 01246 477077 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) Elmcare Limited Mrs Susan Patricia Durrant Care Home 40 Category(ies) of Learning disability (40) registration, with number of places Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. LD Learning disability not falling within any other category Date of last inspection 17/11/04 Brief Description of the Service: Elmwood House provides care for up to 40 young adults with learning disabilities (some of whom also have physical disabilities). The home is organised in four houses, each having 10 beds, being The Lodge, The Villa, The Cottage and The Penthouse. There is 75 single room accommodation and 25 shared. Each house has separate lounge and dining facilities, together with suitably equipped bathroom and toilet facilities. There are no en suite bedrooms. Kitchen and laundry facilities are centralised. There is a small kitchen in the Cottage, which service users can access under supervision to prepare snacks and drinks. There is also a ‘white room’ located in the Cottage, having snoezelen equipment in situ. The Registered Manager has the support of a Deputy Manager, both of whom are Registered Nurses Learning Disabilities, together with a team of Registered Nurses. Each house has its own care staff team, with Registered Nurses currently working across two houses. There is access for each service users to outside healthcare professionals, including that of routine health care screening and also specialist needs as well as advocacy services. A variety of activities are organised on a daily basis both in and outside the home. As well as accessible sitting areas externally, a workshop area has been developed at the rear of the premises and garden areas are used for growing vegetables and fruit as well as keeping hens and ducks. One bed in the home is used for a rolling programme of respite care for a small number of named service users who regularly receive this care in the home. Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Inspection took place over a period of just under seven hours on the 22nd September. A full tour of the premises took place and the manager, Sue Durrant, was present for the majority of the inspection visit. There was the opportunity to meet many of the residents though some were out on day activities or away on holiday. There was also the opportunity to have discussions with several care staff members. A variety of documentation was examined during the visit, including care plans, policies and procedures, medicine administration records and training records. What the service does well: What has improved since the last inspection? What they could do better: There remains some areas of medicine administration that require attention. Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 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 House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): The standards in this section were not assessed on this occasion. EVIDENCE: Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9. The care of residents is planned and delivered in a purposeful and thorough way with their individual capacities, needs and preferences clearly assessed. Residents’ preferences and independence are promoted within a framework of detailed risk assessment. EVIDENCE: Each resident had an individual care plan and a sample of these was examined in detail. Overall they were satisfactorily organised and informative, providing a real sense of each resident’s individual personality. Capabilities and needs were assessed around daily living activities and there was clear evidence of involving the resident in the development with sections on ‘what is important to me’ using visual representation to gauge particular views and preferences. Care plans were suitably detailed and contained clear instructions and guidance for staff. There was also evidence of plans being regularly updated and reviewed. Discussions with care staff indicated that they were comfortable with the organisation of care plans and found them accessible. Resident’s files also contained a wide range of related risk assessment information in such areas as behavioural/psychological issues, matters affecting physical health such as skin integrity, nutrition and mobility, and also Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 10 any risk that might involve general health and safety and social activities. Risk assessments were also monitored appropriately. Care is delivered through a named nurse and key worker system and staff spoken to were aware of their responsibilities and had a good awareness of individual residents. Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14 and 17. Residents have a generally stimulating environment with their individual developmental skills and needs suitably assessed and enhanced through the provision of regular wide ranging activity programmes and leisure opportunities. Residents are provided with satisfactorily balanced meals that encompass any specific dietary requirements. EVIDENCE: Activity records and reports for residents are maintained at the Home and a wide range of programmes have been developed. Care plans contain information on residents’ interests, skills, strengths and social developmental needs. Links have been developed with several community resources such as Chesterfield College, Gamelea Farm, and local churches. Local community education classes are also accessed by some of the residents as well as specific resources such as the ‘First Movement’ project. Regular day outings and trips are arranged, the Home having its own transport. At the time of the inspection several residents were away on a Holiday in Blackpool, accompanied by staff. Care plans contained reports on holidays taken by residents. The Home itself has a generally busy atmosphere. Examples of residents, craft and artwork and holiday photos are used to decorate rooms and corridor areas. Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 12 Individual residents and communal areas have music, DVD and video equipment. Programmes for daily developmental activities around the Home are in place. An activities coordinator is also employed to work intensively with a small group of residents throughout the week. These residents use a room with a snoezalan facility on a regular basis and engage in specific craftwork using a variety of materials and textures. The Home’s rear gardens have been used to develop a workshop facility, allotments, and space for keeping and rearing hens, ducks and geese, with several residents participating regularly in supervised activities in these areas. Catering arrangements were examined at this visit and menus viewed. These were of a good nutritional standard with suitable variety. A list of residents’ preferences was kept and it was stated that alternatives to the main meal were provided though not necessarily recorded. Special dietary needs were catered for and nutritional assessments were maintained on care plans. The kitchen area was well organised and storage arrangements satisfactory. Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Residents had their personal support and health care appropriately monitored and actively promoted, including any specialist needs. Arrangements for the administration of medication were generally satisfactory though there remained some issues to act on. EVIDENCE: Care plans examined demonstrated that the physical and emotional health needs of residents were assessed in detail and kept under review. Staff spoken with who had been responsible for the care of those individuals was familiar with their needs and inputs required. Staff also stated they received appropriate guidance and support regarding the medical needs of residents. Complex and specialist needs were well documented within individual care records, with care formulated within a framework of risk management. Inputs from outside healthcare professionals were provided for individual service users in accordance with their assessed needs and via GP referral. Consultancy advice and review was received from Ash Green Hospital for people with learning disabilities. Assessment information was also documented in terms of individual’s capacity to consent and make informed decisions. There was evidence of careful preparation and support and recognised documentation in respect of consent Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 14 to treatment. Details of staff training in respect of any invasive treatment procedures were also maintained. There were no residents administering their own medication. Arrangements for the administration and handling of medication were looked at. Many of the requirements from the previous inspection had been dealt with including a review of policies and procedures. Storage arrangements were generally satisfactory and the Home is cutting back on amounts of medicines stored. However, it was noted that one cupboard of medicines contained a bottle of nail polish remover. Separate storage and records were in place for controlled drugs, including temazepan. It was also noted that the labels on some applications such as crèams stated “as directed by the prescriber” without any specific instructions. Administration records were satisfactory. Medicines were administered to residents using two trolleys. It was noticed that a lot of medicines for different residents were crammed together into the side of each trolley as they would not fit into individual compartments. This increases the risk of mix-ups in administration. Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 23. The protection of residents from abuse has been enhanced by the implementation of staff training programmes in this area. EVIDENCE: The Home had relevant policies and procedures in place. Since the last inspection specific rolling training programmes regarding the protection of vulnerable adults has been provided at the Home. It was also stated that two staff had done a trainers course in this area so as to provide internal courses in the future. Staff spoken to confirmed that they had received relevant training and had a satisfactory awareness of protection issues. They also said they felt adequately trained and supported in respect of restraint issues and working with violence and aggression. Clear recording processes and procedures were in place regarding any such incidents and examples were viewed. Records of any incidents of restraint were viewed and staff confirmed that they are aware of these processes. The records were satisfactory though there was no formal notes regarding the debriefing of staff in such circumstances. Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 16 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, and 29. Residents benefit from a comfortable and well maintained environment that is adapted to their specialist needs and provides appropriate individual personalised space. EVIDENCE: A full tour of the premises was undertaken. The Home was generally clean, hygienic and satisfactorily maintained. Decoration of the various units was said to be ongoing and since the last inspection new furniture had been purchased for the Penthouse and Lodge areas. Some corridor carpets had been replaced and a new bathroom suite installed in The Villa unit. Décor throughout the Home was of a satisfactory standard and planned to meet residents’ tastes and needs. The kitchen area in The Cottage unit was in need of freshening up and work surfaces required attention. Communal areas in each ‘house’ were of a suitable size and comfortably furnished. Several resident bedroom areas were viewed at the inspection. Again these were of a satisfactory size, appropriately furbished and mostly highly personalised by residents, many with individual lighting arrangements and colour schemes. Recorded assessments have been made regarding the use of bedroom door locks. Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 17 The Home had satisfactory bathroom and toilet facilities with special equipment such as Parker baths to assist those residents with physical and mobility difficulties. The Home was suitably resourced with adaptations such as hoists, handrails and grab rails to assist mobility and lifts were also available. A call/alarm system was also in use. It was said that there were two residents using hearing aids though a loop system had yet to be fitted. The Home is conveniently located for local amenities and bus routes to the town centre. Externally there are garden/sitting areas that are accessible to residents and generally well maintained. Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 18 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32 33 and 35. Residents’ interests and care needs are appropriately provided for by a staff group that have a clear understanding of their roles and receive relevant and structured training opportunities. EVIDENCE: Staffing rotas were viewed and these were satisfactory with appropriate levels maintained and flexible deployment to promote resident activities. The rota includes two qualified nursing staff each shift, though this number will have to increase to four by 2007. Staff members spoken with were clear about their roles and responsibilities and felt they had satisfactory communication systems with other staff. Staff confirmed that they received a good range of relevant training opportunities and had attended basic mandatory care courses such as moving and handling, food hygiene and first aid. A comprehensive training programme has been developed and this includes general courses such as Valuing People and Front of House skills as well as more specific areas such as epilepsy, cerebral palsy, nutrition and diabetes. A high proportion of staff have completed NVQ training including the manager who has recently completed the NVQ level 4 in care and management. Individual training records are maintained. Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 19 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): Standards in this section were not assessed on this occasion. EVIDENCE: Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score X X X X X Standard No 22 23 Score X 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 3 X 3 X Standard No 24 25 26 27 28 29 30 STAFFING Score 2 3 3 3 3 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 X 16 X 17 Standard No 31 32 33 34 35 36 Score 3 3 3 X 3 X CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Elmwood House Nursing Home Score 3 3 2 X Standard No 37 38 39 40 41 42 43 Score X X X X X X X DS0000002055.V250907.R01.S.doc Version 5.0 Page 21 NO 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 YA20 Regulation 13 Requirement Timescale for action 30/11/05 2. YA20 13 3. 4. YA20 YA24 13 23 The Home must purchase larger medicine trolleys in order to facilitate the safe administration of medicines. Labels on medicines such as 31/10/05 creams must have clear instructions as to their application Only medicines must be stored 31/10/05 in the cupboards in the Clinic room. The kitchen area in The Cottage 30/11/05 area must be repainted and work surfaces repaired. 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 YA17 YA23 YA29 Good Practice Recommendations Records should be maintained of any alternatives provided to the main menu of the day. Records should be kept of any staff debriefing following incidents involving restraint. The Home should assess the need for a loop system to DS0000002055.V250907.R01.S.doc Version 5.0 Page 22 Elmwood House Nursing Home assist residents with an hearing impairment. Elmwood House Nursing Home DS0000002055.V250907.R01.S.doc Version 5.0 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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. 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