Inspection on 04/05/06 for Elmwood Nursing Home

This inspection was carried out on 4th May 2006.

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

Other inspections for this house

Elmwood Nursing Home 06/05/09

Elmwood Nursing Home 07/06/07

Elmwood Nursing Home 30/11/05

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 Key Unannounced Inspection 4th May 2006 10:15a 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.V287793.R01.S.doc Version 5.1 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.V287793.R01.S.doc Version 5.1 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 Care Home 60 Category(ies) of Dementia - over 65 years of age (0) registration, with number of places Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 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. 30th November 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 for space. There are lounges and dining rooms on each floor and each floor has its own facilities including bathrooms, showers, kitchenette and office. There is a lift serving all floors. The Home has nearly completed its transition to providing nursing care (and not ‘residential’ care) for all residents. Although Elmwood is a large building this does give service users ample space to circumnavigate the corridors in a safe and comfortable way. Fees as May 2006 are from £500 to £800; additional charges are made for personal requisites; additional charges for extra care will be by negotiation with the funding body. Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This visit was conducted on 4th May 2006 and included the distribution of 75 questionnaires to relevant parties including residents, their relatives, care managers, health care professionals and all staff in the home. The visit was from 10.15 am until 7.30 pm and most service users were given the opportunity to talk to the inspector; several relatives were visiting on this day and they most helpfully commented on the procedures for admitting new residents. Comments were also received from a Dentist, Chiropodist, General Practitioner and a visiting Nurse assessor. From the new owners, Southern Cross, a project manager and a senior administrator were on site and contributed to the inspection of this care home. The contribution of those involved is acknowledged. In addition to the observations made on 4th other information held by the Commission was also reviewed as part of this inspection report. What the service does well: What has improved since the last inspection? What they could do better: In summary, the improvement required of this home is to consolidate the inhouse management team and to introduce systems that will ensure good standards can be met consistently. To this end the new manager aims to introduce a management team comprising ‘heads of units’ or ‘team leaders’. Each will carry greater accountability for their own area of responsibility catering, administration, maintenance, nursing care and so forth. Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 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 Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. New service users are being admitted only on the basis of a full assessment undertaken by people trained to do so and this involves the service user or, in some cases, their representative, so residents know that their needs have been fully assessed and can be met in this home. Residents and relatives are not being given an up to date copy of the home’s Service User Guide and Brochure so they do not have the information needed to make a decision about using this home and what services they might expect. EVIDENCE: Relatives of recently admitted residents say that the arrangements for the admission were very supportive but they would have preferred to get more information about the home and its services. Relatives confirmed that they made a visit to the home prior to the admission being arranged and the admission itself went smoothly. Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 9 A senior Nurse or the Deputy visits prospective residents to assess their care and nursing needs and to ensure the referring professionals, either hospital staff or care managers have provided enough background information for a decision to be made about the suitability of admission. A sample of case files were checked and the Deputy was interviewed to confirm that these initial assessment and histories are in place. Areas of strength are the initial assessment and visits by the family to the home but an important area requiring improvement is the need for more information to be given to service users and their families; this section, covering choice of home, is therefore assessed as adequate and a requirement is made to ensure all service users have a copy of the guide and that it is up to date, including for example changes to the ownership and management of the home and contains al the information listed in standard one. Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 10 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 8 9 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning, the provision of health care and the procedures for dealing with medication are adequate so as to ensure the social, and health care of service users can be met. EVIDENCE: During the inspection residents were given the opportunity to comment on the care provided, relatives and visiting health professionals were also invited to comment upon the quality of care provided as judged by their visits and the response of staff to their assessment and examination of residents. Relatives were invited to comment about how well they thought their relative/resident was being looked after. Care Managers were also invited to comment on how the home is meeting assessed needs. An entirely new set of care plans, assessment and observation records are being introduced again to this home and the staff have made good progress in transferring information to the new documentation. One example of insufficient detail being drawn from the assessment that should have been included in the care plan was noted. This involved risks associated with a possible relapse in Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 11 mental health if medication was not taken regularly and consistently. The care plan and risk assessment must include this risk and the contingency plans if non-compliance and relapse is identified by nursing staff. The home has in place procedures for ensuring the safe management of medicines. This includes, where appropriate, support and risk management for service users who wish to be responsible for their own medication so that they may do so safely but in this home all service users appear to need the close support and supervision of staff to ensure they take their prescribed medication. No problems were identified whilst checking medicines and administration charts. When providing personal care staff are ensuring service users’ privacy and dignity is being maintained most of the time so that service users feel their right to be treated with respect is upheld - but some lapses were noted during this visit. For example service users who wish to remain partially undressed were not supported in their need for privacy by having their bedroom door closed; staff were using plastic aprons instead of linen protectors (or the nice blue cotton napkins which were seen to be left to one side in the dining room). Such lapses impinge upon the residents’ right to be supported in a more thoughtful and attentive manner that will preserve their dignity. There was no indication that this home could not meet service users health care needs. Areas of strength are the comprehensive range of care plans documents, which cover all aspects of health ands social care, and the positive feedback from visiting professional about how the home is meeting residents’ needs. Medication procedures appear satisfactory. Matters requiring improvement are the need to translate identified risks, such as non-compliance with medication, into the care plans and risk assessment so that staff can monitor this area of care. Staff must also be more attentive to the dignity of residents. So this section, about health care, is assessed as adequate. Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 12 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): 12 13 14 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The daily routines in this home are reasonably flexible, within the constraints of a large service. Service users are being supported and encouraged to maintain links with family, friends and to exercise choice and control over their lives in so far as they wish and are able to do so. Service users are receiving a wholesome, appealing diet in a congenial setting in accordance with their recorded requirements and preferences. EVIDENCE: Residents in this home are very dependent as a result of their dementia; their capacity to control their lives and make significant decisions and choices is therefore somewhat constrained. The initial assessment and information provided by family and friends helps staff gauge residents’ wishes and preferences. Staff were observed going about their daily tasks and relatives were invited to comment upon the quality of life experienced by residents in this home. The care plans are also an important tool in identifying residents expectations and a sample were checked to see if social and cultural needs are identified and not just physical/health needs. An ‘activities coordinator’ is employed full time to lead in social, recreational and celebratory events so as to ensure residents are occupied for at least part of the day. During this visit she was fully engaged in meeting and greeting Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 13 residents and family members and her presence appeared most welcome bringing a little fun and liveliness to an otherwise rather quiet and passive lifestyle for residents. A number of residents are from minority ethnic groups, Italian and Caribbean for example. There are several men as well as the many women in the home and service users represent a variety of religious beliefs and cultural backgrounds. Relatives confirmed that staff try to recognise these difference, for example matters of language or gender preferences and some residents maintain links with the community by attending day centres geared to their cultural backgrounds. The new manager and project manager demonstrated a clear understanding of the need to be aware of individual’s lifestyles, their wishes and their family’s expectations. The manager seeks to take account of language differences, choices for meals, time for religious observance and so forth. The home clearly provides a warm welcome for visitors and this was confirmed by the many people who called to the home during this inspection. Some residents can still manage to make visit to their family and some attend day centres away from the Elmwood. It was noted that several residents have spouses, husbands and wives, to whom they have been married in excess of 40 years. Separation from their life-long partner was clearly very sad and two such wives discussed just how mixed were their feelings when their partner had to be admitted to Elmwood. This point was discussed in some details with the managers and they hope to be able to provide special arrangements for spouses to visit and spend time with their husband/wife with more privacy than is now available. This may include a visitor’s room, which is lacking at present, and possibly a guest room for overnight stays. Simple matters such as a small dining table and two comfortable chairs should be available in bedrooms for partners to meet and spend time together. The home might consider offering escorts for spouses to make home visits. Although standards in this section appear good the new manager is aiming to further improve this area, for example, by reviewing nutritional needs and improving the menus. On the day of this visit fruit was readily available in each unit and a snack tray is an innovative way of offering extras for residents who may not eat well at set meal times. The manager also aims to improve social and recreational activities in the home. Areas of strength include clear and detailed care plans, with wishes and preferences identified; choice is offered where possible; meals are satisfactory and contact with family and friends is encouraged. One suggested area for improvement is the facilities for families to spend time together including a visitor’s room for private use and for visiting professionals to meet their clients in private. This section, about choices in daily life, is therefore assessed as good. Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 14 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 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a clear and simple procedure for dealing with complaints so service users’ are confident their concerns will be dealt with promptly and effectively. To ensure vulnerable service users are safeguarded from abuse the home has written policies and procedures about the protection of service users and their property; this includes procedures for passing on concerns to the relevant authorities including the Commission. EVIDENCE: Several complaints have been dealt with by the Commission in the last six months including examples of very poor care practices; problems of hygiene, including complaints about smell in bedroom and mice infesting certain areas. The home has recorded two other complaints dealt with by internal complaints procedures. The complaint about poor care was dealt with under the local authority’s procedures for protecting vulnerable adults and the staff member concerned was dismissed. The new manager intends to provide an open and ‘listening’ atmosphere she says - so that residents and their representatives will feel free to raise concerns without fear of reprisal or that they will be ignored. The home has in place a complaints procedure overseen by senior managers in the new organisation. It still has the procedures issued by the local authority to all local care homes (and is available on the local government, Croydon, web site). Areas of strength are the positive attitude of the new manager towards matters of complaint and the organisational procedures for dealing with any complaints. The new manager and new systems have yet to be tested but appear sound so this section, about complaints and protection of service users, is assessed as good. Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 15 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 22 23 24 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Décor is not to a high standard but is adequate and no hazards were identified so service users are living a comfortable and safe environment that is reasonably clean and hygienic. EVIDENCE: During several tours around the home it was noted that the home was reasonably clean and was smell free and was comfortably warm at the time of inspection (which was conducted on warm Spring day). The faulty heating system was back in almost full working order although some areas of piping, in the ground floor lounges for example, may still be blocked and will need to be cleared or replaced otherwise some areas of the home may not be kept at a comfortable temperature. The outgoing manager had used consultants to advise on redecorating areas of the home so as to assist in the orientation of service users by the use of Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 16 colour, texture, lighting and the layout of fittings and furniture. This work is still ongoing. As before, there are a number of matters requiring attention. The home is showing signs of wear and tear throughout, such as, old worn out linen (towels and bedding); discoloured paintwork in bedrooms, damage to woodwork especially door frames and where wheelchairs strike walls and doors; faulty equipment such as loose toilet seats and stained ceilings due to water damage. 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. Some residents bedrooms were rather Spartan and lacked homeliness, it appears staff have done little to help residents personalise their rooms and make them more attractive. Several bedrooms are shared facilities and the home should therefore have visitor’s rooms so residents can meet family, friends and visiting professional in private. The manager was pleased by the fact that new residents and their relatives have commented that the home is free of malodour. The home has a range of aids and adaptations for residents who are frail and have mobility problems these include grab rails, raised toilet seats, raiseable bed (Hi-Lo beds), lifting hoists and so forth. Staff have pointed out that the home needs a ‘standing hoist’ because this would be the safest and most comfortable way to lift residents to a standing position. Wheelchairs are apparently also a cause for concerns staff say because the foot-rests swing too freely and strike residents’ legs whilst they are getting in or out of the wheelchair. The manager has agreed to review aids and adaptations. Areas of strength are the ongoing improvements to standards of hygiene and to the décor in various parts of the home; the general layout gives space to wander and the existing facilities, aids and adaptations, for service users are reasonable. Matters recommended for or requiring improvement are the poor standards of décor and homeliness in some bedrooms and facilities bathrooms are poor; there is a need to review aids and adaptations; the heating is not entirely without problems and the mice, a source of several complaints, have not been entirely eliminated; a visitors’ room is strongly recommended - so this section, about the environment, is assessed as adequate. Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 17 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 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The number of staff employed and their skill mix are appropriate to the assessed needs of the current service users in this home – so this will ensure that their needs can be met. Not all the required recruitment procedures were confirmed as being in place so as to protect service users. The home is revising the staff induction, training, support and supervision regime so service users will be assured that staff are competent in their jobs in future. Once all these systems are confirmed as being in place this will ensure service users are ‘safe in their hands’. EVIDENCE: On the day of inspection there were 57 service users and now only two are ‘residents’ who do not require nursing care. The ratio of nurses and carers will need to be re-assessed now this transition to nursing care is near completion. The manager has been asked to submit proposals to increase nursing levels to meet increased needs. On 4th May there were 5 Qualified Nurses, 4 are 1st Level and one an Enrolled Nurse and there were 9 care assistants to cater for the needs of the 57 service users. In addition there were catering, administration, domestic and maintenance staff and the manager, although a Nurse she is supernumerary. The manager confirmed that Nursing staff levels will need to be revised as agreed with the Commission when the transition arrangements were put in place by amending the registration certificate. Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 18 The previous owners arranged for police checks, Criminal Record Bureau (CRB) to be held in the home but the new owners only send a memo confirming receipt of the check. Southern Cross will need to confirm with the Commission’s Croydon Office that it has the required formalised agreement to hold staff records centrally with specific arrangements to make them available for inspectors making site visits. Until this is confirmed it cannot be established that recruitment practices are safe for service users, that is, for each member of staff there is a police check, or in exceptional circumstances a ‘POVA1st’ [Protection of Vulnerable’ list] check in place. It was also noted that references are not always clear as to the source and the author; for example, they are not being stamped by the organisation giving the reference and in one instance it was clear the two references had come from colleagues and not managers of the care homes given as referees. In some cases it was not clear that a full history of employment had been provided by the prospective employee. Staff confirmed that they have received some training either in this establishment or in other similar care settings but Elmwood, having changed owners, is reorganising the training programme and will be offering a set list of training courses for all staff depending upon their role. Not unexpectedly therefore it cannot be confirmed that all staff have received all the training that might required; nor was it confirmed that 50 of care staff (other than Nurses) have an NVQ [National Vocation Qualification] at level two or above. Because this home has in recent years been the subject of a number of complaints, preceding the change of ownership, the manager sees the updating of training for all staff as an important element in turning this from an adequate to good home. In general, and at the time of inspection, it cannot be confirmed with any certainty that residents are ‘safe in staff hands’ but staffing appears adequate. Areas of strength are the moral of staff, their positive motivation and support for the new owners and manager; the enthusiasm of the new manager and her senior managers to make this a good home. Matters requiring improvement are the recruitment procedures and confirmation training is underway for all staff - so this section, about staff, is assessed as adequate. Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 19 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 35 37 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The ethos of the new owners and the managers appointed to run Elmwood Care Centre contend that the home is to be run in the best interests of the service users. The manager cannot be confirmed as ‘fit to be in charge’ until her application for registration is fully evaluated. A Southern Cross Administrator was on site to audit accounts and to confirm that the handling of residents’ will be safely managed by the new company. The health, safety and welfare of staff and service users is being protected. EVIDENCE: This home has had several new owners, new responsible individuals, several new managers and acting managers and changes to deputies – all in a few years. The latest manager appointed to run the home appears to be very skilled, with a lot of experience and commitment to transforming Elmwood Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 20 Care Centre from an adequate to a good care home and her enthusiasm is commended. The appointment of a Project Manager to help her in the first few months is also commended – given the failure of previous managers to make a success of this home despite considerable enthusiasm and personal commitment. The new manager intends to develop a team of unit heads for the various departments in Elmwood, Catering, Housekeeping, Administration, Maintenance, Nursing Care and so forth. The key ingredient is that each head will take more responsibility for the smooth and efficient running their department. This appears to be a sound approach and is commended. However, at the time of inspection, the manager had been on site just one week, the owners are new to Elmwood and the existing team of staff appears, so far, not to have achieved the high standards that will be expected of them in future. It was not possible to confirm that this is a well run home, run in the best interests of the residents and is a safe place to live. The conjecture is that the new manager will demonstrate within a few months that it is a competently run home and the Commission will monitor this. An auditor was on site to confirm that arrangements are in place to safeguard residents’ monies. The auditor will recommend some minor changes to existing systems to ensure this remains the case, such as the submission of authenticated invoices for services rendered to the home or residents (hairdressing and chiropody for example). Record keeping is in transition as the new owners bring in their own documentation and record keeping procedures. Those records checked at the time of the visit include Accidents; Incidents (Regulation 37); owners’ monthly visit/reports (Regulation 26); complaints; staff files and residents’ case files. In general recording keeping is satisfactory. In respect of health and safety, and in particular fire safety, it was noted that several doors have broken door closers. The home will also need to confirm with the local Fire Safety Authority (the LFEPA) that some bedroom doors, for example those on the ground floor do, or do not require automatic door closers. Staff have requested a maintenance check of wheelchairs and the provision of a standing hoist so a recommendation is made to review equipment used for moving and handling (residents). Areas of strength include the new managers’ commitment to raising standards plus the generally good feedback from residents, relatives, health professionals and the enthusiasm of staff. Administration, record keeping, is to an acceptable standard. The home is generally clean and safe and décor is fair (but not in good order). Matters requiring improvement include the need to register the manager; ensure that recruitment is safe, including arrangements for the Commission to inspect records; some safety matters such as fire doors need attention - so this section, about the management of the home, is assessed as adequate. Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 21 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 2 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X 3 3 3 X 2 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 2 3 X 3 X 3 2 Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 22 Are there any outstanding requirements from the last inspection? YES 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 OP1 Regulation 5(1),(2) and (3) Requirement Timescale for action 30/07/06 2 OP7 15(2) 3 OP10 12(4)a 4 OP19 23(2)b Service User Guide: The home must bring up to date the service user guide and provide a copy to each resident and a copy to the Commission. Care Plans: service users’ plans 30/07/06 of care must be kept under review and where important matters identified in the original assessment, such as risks associated with mental health relapse, have not already been included then such risks must be incorporated into a revised plan of care. Dignity: Staff must ensure that 30/07/06 the privacy and dignity of service users is maintained, so far as reasonable, at all times; including the use of suitable table linen and napkins and privacy in bedrooms. Maintenance: Bathrooms and 30/07/06 toilets must be maintained to a good standard including cleaning of all areas and replacement of broken items such as toilet seats, wall tiles and bath panels. Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 23 5 OP26 23(2)j 6 OP29 19(5)d(i) Hygiene: whilst acknowledging the home was free of malodour some areas remain dirty including bathrooms and some bedrooms walls. The stained ceilings are also unsightly. The home is to be kept clean. Staff: The manager must ensure that applications for police (Criminal Records Bureau) checks are made in respect of all staff and those checks are made available in the home for inspection by the Commission. This remains an outstanding requirement from the previous owners 30/5/05. Staff training: The home must put in place a training programme that will ensure staff training meets the requirements of standards 28 and 30 including an induction programme and arrangements for 50 staff to achieve NVQ at level 2 or above. Fire safety: Fire doors must be maintained in full working order including door closers and magnetic doors holders where they are fitted. 30/07/06 30/07/06 7 OP30 18(1)c, I and ii 30/07/06 8 OP38 23(4)c(i) 30/07/06 Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 24 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 OP13 Good Practice Recommendations Visitors’ room: it is recommended that provision is made for a visitors’ room so that residents may meet family friends and professional visitors in a private setting that is not their bedroom. Standards 13:2 and 20:2 apply. Aids & adaptations: It is recommended that the home review its aids and adaptations including wheelchairs and hoists to ensure they are meeting the needs of service users; A ‘standing hoist’ is suggested as an additional aid. Bedrooms: it is recommended that the home help and support residents to personalise their bedrooms. 2 OP22 3 OP24 Elmwood Nursing Home DS0000019025.V287793.R01.S.doc Version 5.1 Page 25 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.V287793.R01.S.doc Version 5.1 Page 26 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!