Inspection on 24/05/05 for Elmwood Nursing Home

This inspection was carried out on 24th May 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 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 Nursing Home 06/05/09

Elmwood Nursing Home 07/06/07

Elmwood Nursing Home 04/05/06

Elmwood Nursing Home 30/11/05

Elmwood Nursing Home 27/01/05

Elmwood Nursing Home 10/05/04

Similar services:

Clovelly House Residential Home Ltd

Cherry Orchard Nursing Home

Coppermill Care Centre

Fountains Care Centre (The)

Eleanor Palmer Trust Home

Elmstead House

Bridgeside Lodge Care Centre

Dalemead

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

CARE HOMES FOR OLDER PEOPLE Elmwood Care Centre 32 Elmwood Road West Croydon Surrey CR0 2SG Lead Inspector Michael Williams Announced 24 May 2005 th 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 Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Elmwood Care Centre Address 32 Elmwood oad, West Croydon, Surrey, CR0 2SG 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) 020 8689 4040 020 8689 4141 Huighfield Care Homes No. 3 Ltd Mrs Elizabeth Trigg Care Home 60 Category(ies) of Dementia - over 65 years of age (0) registration, with number of places Elmwood Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 39 nursing and 21 non-nursing service users. Date of last inspection 27/1/05 Brief Description of the Service: Elmwood Care Centre is a purpose built care home providing both personal and nursing care. The home is situated in West Croydon and is near to shopping centres and transport. The service user’s accommodation is situated on the ground, middle and top floors. There is a lower ground floor accommodating the kitchen, laundry, plant machinery and offices. There are 46 single bedrooms and 7 double rooms. The majority of bedrooms have ensuite toilets and the manager states all bedrooms meet the new National Minimum Standards [NMS] for space. There are lounges and dining rooms (communal spaces) on each floor and each floor has its own facilities including bathrooms, showers, kitchenettes and offices. There is a lift serving all floors. The top floor is designated as providing personal (residential) care, the other two floors provide nursing care but the person in charge told the inspector that the home is planning to extend nursing care to all three floors. Although Elmwood is a large and complex building this does give service users ample space to circumnavigate the corridors in a safe and comfortable way. Elmwood Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. No services users responded to the CSCI questionnaire but ten relatives did, as did 3 visiting doctors, a tissue viability nurse and one care manager. The feedback gives a mixed picture with many positive points such as the friendliness of staff and the comfort of the premises; there were also a number of more critical observations for example about practical matters such as mislaid clothing. A general theme emerging from the feedback and from the inspection was communication within the home. Not all staff have a good grasp of written and spoken English and not all staff have the skills and initiative to communicate effectively. This affects communication within the staff team and means contact with visitors is not always as effective as it might be. The home has recently changed owners and senior managers and there was every indication the management will work on these points. What the service does well: 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 Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 6 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 Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 7 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, 3, 5. Service users and their representative are given information in advance of admission to ensure they are able to make an informed choice. Assessments are undertaken to evaluate service user needs prior to admission to ensure the home will be able to meet service user needs if admitted. EVIDENCE: Information is provided in the form of the home’s Statement of Purpose and the Service User Guide. Visits to the home are arranged. Contact is also encouraged to ensure relatives in particular, who assess the home on behalf of prospective service users, are satisfied that the specific needs of the service user can be met. The assessments, compiled into the form of service user case notes, include general information about each service user, details of their background medical and social history and comprehensive details of specific areas such as nutrition, skin care, medication and so forth. Service users, with their representatives, assist in the compilation of these case notes. Elmwood Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 8 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, 10. Social care and health care needs are assessed prior to admission and are recorded in the case files, these are reviewed and revised at regular intervals to ensure staff are able to meet service users’ care needs. No service users are able to deal with their own medication so nursing staff deal with all the medication in the home. Staff have been reminded since the previous inspection of their responsibility to treat service users with respect. EVIDENCE: Samples of service users’ case files were examined. These files demonstrate that service users have a comprehensive plan of care. It was evident that service users and their relatives have been encouraged to be involved in the process of drawing up these plans of care. Service users are rarely able to selfmedicate. Service users confirmed that staff respect their rights to privacy and dignity when receiving care and support. Service users have access to community based health services including General Practitioners, hospital clinics, chiropody, optometry and specialist nursing service such as the ‘tissue viability’ service (for skin care). Whilst no errors in the administration of medication were identified it is recommended that medication profile is filed in the medication folders so as to be available at the time of administering medication. Elmwood Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 9 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) 12, 13, 14, 15. Service users are supported to keep social contacts and community contacts. In so far as service users are able they are given choices and this includes choices about the range of meals provided and how they spend the day. EVIDENCE: Relatives are satisfied that the home can provide a lifestyle commensurate with expectations. This is a nursing home providing for the needs of service users with dementia so they are very dependent and vulnerable. The exercise of choice and control of their daily lives is inevitably restricted but within those constraints the home offers a typical range of choices such as choice of meals, of activities, the time they rise and retire to bed, where and with whom they sit each day. Relatives were in the home and confirmed that they, and other community representatives such as church representatives and school volunteers, are welcomed into the home. Whilst the service users could not give a clear account of the meals provided and whether or not they enjoyed the food their relatives confirmed that a wholesome range of food is provided. The manager has also arranged for specialist meals, such food styles from other nations, will be provided when requested. Elmwood Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 10 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, 18. The new owners have introduced a different complaints system to ensure that all complaints will be dealt with in a methodical and timely manner. The home has clear procedures for training staff and advising both staff and the service users themselves about how vulnerable are to be protected from harm. EVIDENCE: A record of complaints is in place and shows that a number of concerns and complaints have been dealt with by the home. No complaints arose during the course of the inspection but a number of observations were made in the CSCI questionnaires. These include practical matters about maintenance and the need to give greater attention to service users’ clothing and other personal possessions (which are getting mixed up). Several visitors to the home raised the issue of staff’s ability, or inability, to communicate effectively with visitors about the service users they are visiting. In contrast to these concerns which were discussed with the manager, several complimentary questionnaires were sent to the CSCI by appreciative relatives. The CSCI is recommending that the home’s manager is given scope to decide which complaints can be dealt with informally and internally and which must go to the company’s headquarters or to other agencies such as the Social Service Department or CSCI or Police. Unless an informal, internal stage is included relatives may feel deterred from making ‘official’ complaints. Elmwood Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 11 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, 26. Although this is a rather large home with 20 service users on each of the three floors it is nevertheless safe and reasonably homely for its size. It was clean and tidy and no hazards were identified. However maintenance of bathrooms, call bells and lock must be attended to ensure the protection of the service users. EVIDENCE: This is a purpose built care home and is subject to ongoing refurbishment. It was clean and comfortably warm at the time of inspection. A relative asked for room to be redecorated and plans for this are already underway. The manager is of the opinion that some carpets will need to be replaced and she has also confirmed that consultants have advised on redecorating areas of the home so as to assist in the orientation of service users by the use of colour, texture and the layout of the fittings and furniture. Elmwood Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 12 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, 30 The numbers and skill mix of staff at present met the needs of the present service user group. However the new owners will need to be revised this if they decide to change the homes registration The recruitment process is not robust and there are some staff who require further training is needed to ensure their competency and the protect service users. EVIDENCE: The owners intend to change their registration category to nursing care throughout the home although registration can be modified to enable existing ‘residential’ service users to remain in the home. During the transition phase the manager ensures that there is a qualified nurse on each of the three floors. This will require a revision of staffing levels and the range of qualifications required when the application is received by the CSCI. The home was unable to confirm that some of the existing staff have completed police (Criminal Records Bureau, CRB) checks and fresh applications are being made for these staff. The home will also need to review its procedures for renewing and updating CRB checks. The manager advises the CSCI that she is introducing an external trainer to ensure all staff are adequately trained in all aspects of care because she acknowledges the comments of visiting doctors and nurses that “in some instances the staff team do not seem to have a clear understanding of the care needs of service users” and that “staff do not always communicate clearly and work in partnership” with the doctors. It is acknowledged that the Care Manager’s response was more positive and she was satisfied with the overall care provided. Elmwood Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 13 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) 31, 32, 33, 37, 38. The home is managed so as to ensure the health and well being of the service users and no health and safety hazards were identified. EVIDENCE: The new manager was appointed to improve the running of this home and she would acknowledge that there is work to be done to raise standards in many areas. Many of the questionnaires from relatives, doctors and nurses demonstrate confidence in the new manager despite some critical comments about the home. Clear and positive leadership is now in place and a central tenet of the home is the care and welfare of the service users. In respect of records, the new manager has inherited a number of inadequate records including staff records and a requirement is made in respect of police checks. No safety hazards were identified during the inspection. Elmwood Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 14 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 2 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 2 x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 2 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 3 3 3 x x x 3 3 Elmwood Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 15 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 29 Regulation 19(1to 6) Requirement Staff: The manager must ensure that applications for police, Criminal Records Bureau checks are made in respect of all staff. The manager must also take legal advice in respect of those staff who fail to comply with the company’s policies and the Care Standards Act and Regulations in respect of checks required to ensure the protection of service users. The timescale for action was 30th May 2005 and extended. Staff: If nursing care is to be provided on the 2nd floor then an application for a variation to registration must be submitted to the CSCI. This is an outstanding requirement for 30/6/04. Maintenance: some damaged areas noted; such as a digital lock, bath panels, loose call bell, damaged walls and so forth. Timescale for action 30/7/05 2. 4 6 30/7/05 3. 19 23(2)b 30/7/05 4. Elmwood Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 16 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. Refer to Standard 16 9 Good Practice Recommendations Complaints: it is recommended that in informal, internal stage to handling complaints is included in the new complaints proecdures. Medication: it is recommened that the medication profile of each service user is put with the medication charts so as to be readily accessible when giving medicines. Elmwood Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 17 Commission for Social Care Inspection CSCI 8th Floor Grosvenor House 125 High Street, Croydon CR0 9XP 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 Care Centre G53-G53 S19025 Elmwood V188038 240505 stage 0.doc Version 1.30 Page 18 - 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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