Inspection on 30/11/05 for Elmwood Nursing Home

This inspection was carried out on 30th November 2005.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Elmwood Nursing Home 06/05/09

Elmwood Nursing Home 07/06/07

Elmwood Nursing Home 04/05/06

Elmwood Nursing Home 24/05/05

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 Nursing Home Elmwood Nursing & Residential Home 32 Elmwood Road West Croydon Surrey CR0 2SG Lead Inspector Michael Williams Unannounced Inspection 9:30 2 December 2005 nd X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elmwood Nursing Home DS0000019025.V269965.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 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 Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Elmwood Nursing Home Address Elmwood Nursing & Residential Home 32 Elmwood Road West Croydon Surrey CR0 2SG 020 8689 4040 020 8689 4141 elmwood@highfield-care.com 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) Southern Cross Care Homes No 3 Limited Mrs Elizabeth Trigg Care Home 60 Category(ies) of Dementia - over 65 years of age (0) registration, with number of places Elmwood Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. A maximum of 10 service users aged from 40 to 65 in the dementia service user category. A maximum of 20 service users in the care home only service category. 24th May 2005 Date of last inspection 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 users 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, kitchenette and office. There is a lift serving all floors. The top floor is designated as providing either nursing or non-nursing care, the other two floors provide nursing care. The long term plan is for the home to extend nursing care to all three floors. Although Elmwood is a large building this does give service users ample space to circumnavigate the corridors in a safe and comfortable way. Elmwood Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Once again there have been changes to the management of Elmwood Care Centre - it is now owned and managed by Southern Cross, a large company that has many care homes across the country. The management team have confirmed that they would like to see improvements to Elmwood such as a review of training for staff, refreshing the décor and integrating administration. This inspection was the second planned inspection for the year 2005-2006; other inspection visits have been made to follow up complaints sent directly to CSCI. This visit was used specifically to check requirements made on previous visits. If key standards were fully met in previous inspections they were not reassessed on this occasion. 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 Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 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 Outcomes Statutory Requirements Identified During the Inspection Elmwood Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 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 the following standard(s): 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: The key standards in this section were not reassessed on this occasion but were confirmed as met in 2005 in the manner indicated by the judgement above. Elmwood Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 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 the following standard(s): 7 Social care and health care needs are assessed prior to admission and are recorded in their individual care plans; these are reviewed and revised at regular intervals to ensure staff are able to meet service users’ needs. No service users are able to deal with their own medication so nursing staff deal with all the medication in the home. The staff treat service users with respect and ensure their privacy. EVIDENCE: The key standards in this section were not reassessed on this occasion but were confirmed as met in 2005 in the manner indicated by the judgement above. The new owners are introducing their own care planning formats and the staff are getting used to using these documents. It was noted that assessments are in place but risks identified are not translated into risk assessments forms as provided for in the new system. Without an effective plan to address risks service users’ well being may be adversely affected and could lead to harm. A requirement is made to ensure known risks are clearly documented and an effective plan to deal with hazards is put in place and made known to all staff. No errors in the administration of medication were identified on this occasion. It was previously recommended that a medication profile for each service user is filed in the medication folders so as to be available at the time of administering medication and this is now in place. Elmwood Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 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 the following standard(s): 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 so as to meet their expectations of the home and services it provides. EVIDENCE: The key standards in this section were not reassessed on this occasion but were confirmed as met in 2005 in the manner indicated by the judgement above. Elmwood Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 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 the following standard(s): 16 The new owners have introduced a different complaints system so as to ensure that all complaints will be dealt with in a methodical and timely manner. The home has clear procedures for dealing with allegations of abuse, so service users will know they are to be protected from harm. EVIDENCE: Not all the key standards in this section were reassessed on this occasion but were confirmed as met in 2005 in the manner indicated by the judgement above. It was however recommended that the manager ensure that the complaint procedure was not so formalised as to deter service users and others from complaining. The manager confirms that complaints will be received in an informal and flexible manner from any source – however the response will, in most cases, include a reply from a Director of the company so as to ensure all complaints are monitored by the organisation at Director level. No complaints arose during the course of this inspection but since the last inspection a number of complaints were dealt with by the CSCI and they include a range of concerns about the presentation of meals, about staffing levels, about the personal care provided to service users and about rodent control and requirements were made about these matters. During the course of this inspection those requirements were seen to have been complied with. Whilst no formal complaint was made about the failure of the heating system the CSCI visited Elmwood Care Centre to ensure that adequate alternative arrangements were in place pending its repair. Elmwood Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 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 the following standard(s): 19 The layout of the home and the manner in which it is being maintained are reasonably satisfactory, this ensures it is a clean, safe and comfortable environment for the service users. However maintenance and décor of bedrooms, bathrooms and other areas must be attended to so as to ensure the continued comfort of the service users. EVIDENCE: The home was clean and comfortably warm at the time of inspection. The faulty heating system was back in full working order by the time inspectors left the premises. The manager has used consultants to advise 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. There are however a number of matters requiring attention. The home is now showing signs of wear and tear throughout, such as, old worn out linen (towels); discoloured paintwork in bedrooms, damage to woodwork especially door frames, faulty equipment such as toilet seats and stained ceilings due to water damage from rooms above and so forth. It is acknowledged that the new owners intend sending in their estate surveyors to assess the work needed to bring the home back to a reasonable standard of maintenance and décor. Elmwood Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 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 consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 28 29 30 The home has adequate numbers of staff and staff recruitment procedures, induction, training, support and supervision regime are in place, so this will ensure staff are competent in their jobs – this ensures service users are in safe hands at all times subject to the provisos listed below. EVIDENCE: The owners intend to change the registration category to nursing care throughout the home. Meanwhile the registration conditions allow for the transition, so ‘residential’ service users can remain in the home so long as their needs can be met. During the transition phase the manager ensures that there is a qualified nurse on each of the three floors. 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 (although it is noted they did have checks from their previous employers made immediately prior to their move to Elmwood Care Centre). The manager advises the CSCI that the new owners are introducing their own programme of training for all staff to begin in January 2006 and she acknowledges that during the course of this year doctors and nurses have commented 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 Social Service Care Manager was satisfied with the overall care provided in Elmwood. On the day of inspection there was a qualified nurse on each of the three floors and they are assisted by three care assistants on each floor. At night there are 3 nurses and four carers for the home. Three relatives, who visit regularly, were on site during this inspection and they were full of praise for the caring and hardworking staff team. Elmwood Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 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 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31 32 33 34 35 36 37 38 The home is managed by a competent person and is run in the best interests of service users so as to ensure so far as practicable their safety and well being. EVIDENCE: The new manager has had time to establish herself as the leader of a very diverse team of workers and she aware that staff vary somewhat in their skills and contribution to the home. She is still working to bring out the best in these people and to hone them into a good team of workers. Some staff have been dismissed having failed to provide the quality of care required of them. Given the size of this home and its history of changes and difficulties the owners may wish to consider strengthening the management team – at least in the interim - for example by providing two deputies to deal with the transition to new systems and improve the support and supervision of staff so that training is translated into best practice. There is little doubt that the manager sees the welfare and best interests of the service users is central to the running of the home and she is clearly disappointed when shortcomings are identified. Elmwood Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 Page 14 The inspector met briefly with a regional representative of the owners (Southern Cross) who explained their plans to provide a new training schedule for all staff and address some of the shortcomings in the structure of Elmwood. She also confirmed that Elmwood is backed by a large organisation that is financially viable and is in a position to invest in improvements in this particular care home. The supervision of staff in their day to day work is perhaps an area that might be strengthened; whilst they are given formal supervision at periodic intervals their day to day practice has not always been as good as it might be and has led to the dismissal or resignation of some staff this year. This suggests the need for closer scrutiny and better modelling of best care practices by suitably qualified and experienced deputies or team leaders. Record keeping formats and policies are again in transition – the new owners are inevitably bringing in their own documentation but this will be an exchange of best practice, old and new systems. A sample of records were checked and found to be acceptable including fire safety checks, record of complaints, accidents, incidents (Regulation 37), Director’s monthly visits (Regulation 26), medication and so forth. The staff have been monitoring room temperatures (whilst the heating system was under repair) and these records were difficult to understand. It was also noted that risk assessments forms had not been completed when an indication of risk had been identified. The manager is respectfully reminded that any records, policies or procedures introduced by the new owners must comply with statutory requirements and must be specific to the home. A number of hazards were identified and must be dealt with promptly; old beds stored in a stairwell; intumescent strip on bedroom door dislodged; fire warning panel functioning but has a fault; heating had broken down and CSCI will require confirmation that it remains in full working order (having been repaired on the day of inspection); bathroom contained prescription items that are clearly designated for one service users and so should not be accessible to others. Other than these specific points the home is well run and seems to be a safe and comfortable environment for services users. Elmwood Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 Page 15 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 X X X X X X X STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 3 3 3 2 2 1 Elmwood Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 Page 16 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 OP29 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 timescale for action was 30th July 2005 and has been extended because some staff are on long term leave which has delayed some checks. Fire safety: intumescent strip on bedroom door not in place and must be fixed in place. Fire Safety: old beds stored in stair wells and must be removed. Maintenance: some damaged areas noted: bath panels; dirty paintwork; damaged woodwork; water damage to walls and ceilings; loose and damaged toilet seats; old and worn-out towels. A revised action plan must be submitted to the CSCI outline a plan of action to address these matters. Care Plans: detailed risk assessments, including a clear action, must be completed when the assessment of service user identifies a specific risk. DS0000019025.V269965.R01.S.doc Timescale for action 30/03/06 2 3 4 OP38 OP38 OP19 23(4) 23(4) 23(2)b 30/01/06 30/01/06 28/02/06 5 OP37OP7 15(1)(2) 30/01/06 Elmwood Nursing Home Version 5.0 Page 17 6 OP38 23(4) 7 OP30 18 Fire safety: the CSCI must be kept informed of progress in repairing the fault in the fire warning panel (but it is noted that the fire warning system is fully functioning). Staff training: a revised schedule of training for staff must be submitted to the CSCI. 30/03/06 28/02/06 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 Refer to Standard OP36OP32 Good Practice Recommendations Management: it is recommended that during the transition to new ownership the company consider strengthening the management team in this home, a second deputy is suggested. Elmwood Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 Page 18 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 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 Nursing Home DS0000019025.V269965.R01.S.doc Version 5.0 Page 19 - 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. 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