Inspection on 07/06/07 for Elmwood Nursing Home

This inspection was carried out on 7th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 04/05/06

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 7th June 2007 11:15a 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.V342404.R01.S.doc Version 5.2 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.V342404.R01.S.doc Version 5.2 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 www.schealthcare.co.uk Southern Cross Care Homes No 3 Limited 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) Mrs Shola Adedugbe Care Home 60 Category(ies) of Dementia - over 65 years of age (60) registration, with number of places Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 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. 4th May 2006 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 £544 to £750; additional charges are made for personal requisites and some personal care such as chiropody and dentistry; additional charges for extra care will be by negotiation with the funding body. Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. To monitor all aspects of care have visited this home three times since the previous ‘key inspection’ these visits were made on 24th October 2006 and 7th March 2007 as well as an extended visited on 7th June 2007. During these visits we ‘tracked’ the care provided to a small number of residents and cross checked information by examining the documentation supporting care, observing the meals provided, checking the arrangements for medication, for handling money, and the records of complaints and accidents. Staff providing care were interviewed, and where possible the inspector met with relatives as well as interviewing or observing the residents themselves. Questionnaires were also distributed and written feedback has been noted. We also took account of information provided by the home and other agencies since the previous inspection in March 2007. The home is moving from poor towards a good rating. What the service does well: What has improved since the last inspection? What they could do better: A number of matters that need attention were identified, some will be requirements whilst others are recommended for action. The Commission will propose modifications to the registration certificate and if accepted by the Home their Statement of Purpose and Guide will need refinement to make clear the criteria for admission. These documents will also need to include any proposed changes to the funding of dental treatment – we are advised the PCT [Primary (health) Care Trust] may introduce charges for dental treatment to some residents and this will need to be made clear in the statement of purpose and guide. Staffing also requires some improvement, typically the ratio of nurses to patient in any nursing home should be approximately 1:10; so, for Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 6 Elmwood a 60-bedded home with patient accommodated on three floors, a minimum of four nurses is indicated (and this is in addition to the nurse/manager) as an improvement on the current three most days. The care plans are now very detailed and include a wide range of assessment forms and a multiplicity of care plan goals. These goals often include the very proper objective to gather more information about a residents’ needs and preferences from family and friends; if this is to be followed through then staff need to be proactive meeting or contacting relatives to gather that information and staff then need to act upon it – some relatives say this is not always the case. We were advised by some family members that they felt the home did not always follow the advice and instructions they left for staff about how their mother/father was to be supported. Visitors also advised us that there is frequently a strong odour; sometimes this seems to be a smell of stale urine whilst other times a strong smell of cleaning chemicals – both they say is rather over-powering and unpleasant. We note that the manager is seeking to resolve this by laying laminate flooring in some locations to improve hygiene and reduce malodours. Another area that commentators would like to see improved is the reception area; in particular the door-bell gives no indication that it is working and although it appears to be an intercom’ it is not used as such so visitors, including the inspector, are kept waiting until someone arrives to open the door – this does not give a good first impression. For a home of this size a proper reception and receptionist should be considered or an improved intercom’ with camera and remote door release as second best. The home uses a particular pressure-relieving mattress (to reduce or help in the treatment of ‘pressure sores’) but nurses were not always clear about how they operate – particularly when they have a variable pressure control mechanism – so further training in this area is indicated. In respect of the kitchen and catering, the home has employed a new chef who is very keen to improve the range and quality if food for residents. The kitchen itself is in need of thorough cleaning and refurbishment; the floor is not entirely clean especially the corners and the floor to wall junctions; tiles are missing and the larder-room is excessively hot and needs more effective ventilation. The over-cooker vents also need to be more robust and this is planned for. The chef is new to care home catering and so it is recommended that he undertake further training relevant to the resident group he is cooking for (The Food Standards Agency provides guidance such as “Food served to older people in residential care”). The general environment still needs improving. It is acknowledged that some areas have been repainted and the awful bathroom is now quite acceptable and usable, but the home still needs freshening up. We are advised that the owners are well aware of this and have plans to improve the quality of the environment. 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. The summary of this inspection report can be made available in other formats on request. Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 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.V342404.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 1, 3: Quality in this outcome area good. 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 most cases, their representatives, so residents know that their needs have been fully assessed and can be met in this home. EVIDENCE: The Commission is revising the registration certificates of care homes in order to clarify the category of residents and the criteria for admission; this will require the home’s statement of purpose and residents’ guide to be modified so as to give clearer information to prospective residents about whom the home caters for. All new residents receive a full comprehensive needs assessment before admission this is carried out by staff with skill and sensitivity. The service is efficient in obtaining a summary of any assessment undertaken through care management arrangements, and insists on receiving a copy of the care plan before admission. These are then translated into the home’s in-home formats. For individuals whom are self funding, the assessment is undertaken by a Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 9 qualified member of staff. Individuals are supported and encouraged to be involved in the assessment process. Information is gathered from a range of sources including other relevant professionals, and with the individuals agreement (when is possible), relatives’ observations are taken into account. We are advised that all residents receive a Contract to which they (or their representatives) have agreed, it gives clear information about fees and extra charges which is reviewed and kept up to date. This information is meaningful, and can be provided in appropriate languages and formats, such as large print, or in translation if requested. The documents are also explained to individuals, so they fully understand the information but in many instances residents having failing memories and rely upon those around them to act in their best interests. We are advised that dental charges may be introduced by the PCT [Primary (health) Care Trust] and so residents will need to be advised that this may become a new charge in addition to fees and other extras such as private chiropody. Areas of strength include the information and assessment provided at the point of admission and matters needing attention include the modification of the statement of purpose and user guide to reflect changes in the registration certificate if and when agreed by the home; and the inclusion of information about changes in dental charges. So this section, about choice of home, is assessed as good. Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7 to 11: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The arrangements for care planning, the provision of health care, including end of life care, and the procedures for dealing with medication are all satisfactory so as to ensure the social, and health care of service users can be met. EVIDENCE: Personal healthcare needs including specialist mental health, nursing and dietary requirements are clearly recorded in each resident’s very detailed care plans. These give a comprehensive overview of residents’ health needs and act as an indicator of change in health requirements, for example a sudden change for the worse or an improvement. Residents have access to healthcare and clinics; staff make sure that those residents who are well enough are encouraged to be independent although in Elmwood this is rather limited. Residents have regular appointments and visit local health care services. The health care needs of residents unable to leave the home are managed by visits from local health care services, including general practitioners, nurses and specialist such as the ‘Tissue Viability Nurse’ for skin care. People who use services have the aids and equipment they need and these are well maintained to support both people who use services and Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 11 staff in daily living. However one nurse was not entirely familiar with the pressure relieving mattresses the home uses, as it is the home’s mattress of choice used throughout the home it is recommended that al staff and particular nurses are given guidance on the control settings so that each mattress can be set to the correct pressure for each resident. Staff have access to training in health care matters and are encouraged and given time to attend courses on specialist areas of work. The aims and objectives of the home reinforce the importance of treating individuals with respect and dignity and to this end staff are working to clear and robust practices when caring for individuals who have terminal illnesses. The organisation’s revised care plans contain clear information about the individual’s wishes, choices and decisions as their health deteriates. Care staff are receiving additional training and guidance in the good management of the care of the dying with the support of palliative care nurses to ensure they work constantly monitor pain, distress and other symptoms to ensure individuals receive the care they need. During the dying process there are arrangements in place, which enable family and friends to stay and help with the care with the agreement of the resident. Family members advised us that they felt well supported when a relative recently died in the home. Staff will support both the family and the homes’ other residents during the bereavement process. The home seeks out guidance from the local hospice about best practice in the care of individuals who are dying so they can learn from best practice. Areas of strength include the exceptionally good care planning formats and the progress towards improving end of life care and matters requiring improvement include the recommendation to follow up care plans ideas such as speaking to relatives to gather vital information about a resident’s wishes and preferences (and then of course to act upon that information) and the need for nurses to be clearer about the equipment (mattresses) used to aid residents so this section, about care, is assessed as good. Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12 to 15: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. 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. Meals are wholesome and nutritious so as to ensure residents are well nourished. EVIDENCE: Residents are supported to enjoy as full and stimulating lifestyle as their condition will allow. This is however inevitably limited by the residents increasing frailty and forgetfulness (caused by various forms of dementia). For the most part residents are entirely dependent upon staff initiating activities and keeping them occupied during the day. On this occasion we found staff were with the residents in the various lounges and this is an improvement on previous inspection visits when residents were seen to be left unattended for lengthy periods. The home’s care plans include the expectation that staff will seek the views of the residents and relatives so as to gauge what activities and entertainments will be of interest to residents. We did not see a great deal of evidence of residents leaving the home to attend community events – unless this was Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 13 arranged by family members. Whilst the home would strive to ensure routines and activities are resident focused, flexible, regularly reviewed, and quickly changed to meet individuals changing needs this aspiration is somewhat restricted by the dependency of residents and the size of the home – there are twenty residents on each floor so much of the time residents sit in serried ranks, quiet and somnolent. Despite our observations about how sleepy and quiet residents appeared the activity coordinator works very hard to occupy residents and does so in very imaginative ways; she ensure residents celebrate personal anniversaries and birthdays and helps them enjoy national days both religious and social, Christmas, Easter, Eid, Diwali, Purim, St Valentine’s, St George’s Day and so forth. The home also celebrates other social events such as marriages and the births amongst visitors and staff. This provides ample opportunities for residents to enjoy the day or give more thoughtful consideration to life events. Given the considerable frailty of residents the outcomes for residents is reasonably positive, and there is some evidence that they are content with life in Elmwood. During this inspection visit we checked the kitchen and catering arrangements. The home has employed a new chef, he is new to catering in a care home but has lost of experience in other settings and is keen to improve the quality of meals in Elmwood. (The Food Standards Agency and Age Concern provide a lot of useful information about nutrition for elderly people.) The kitchen records were in good order including temperature records and meals served and food hazard analysis. The home provides and homely and varied set of menus which seem very popular with residents when we observed the midday meal beings served. The chef provides a variety of meals reflecting different cultures. The care plans and assessments include nutritional assessment and weight charts to monitor residents’ well being. On this occasion we were impressed to see staff asking – at the time of service - each resident what they wanted to eat from a choice of Liver and bacon or Cottage Pie. It is commendable, and to be expected, that staff were present throughout the meal to support and assist residents eat their chosen meal. The kitchen itself was however rather dirty and poorly maintained in some areas, the floor in particular is in need of thorough cleaning and tiles were broken/missing; the larder-room was very warm and needs proper and effective ventilation, a fan would be of little use here. The chef thinks an extra refrigerator would help food management and stock rotation. Areas of strength include the assessment of residents’ needs and wishes and the laudable aim to consult relatives about this; the activities person is commended for her unrelenting energy and enthusiasm and it is clear residents enjoy her company and her ideas for activities; the new cook also brings a fresh enthusiasm to improve catering in the home. Matters needing attention include the need to follow up care plans objectives and actively seek to consult with family and friends to develop care plans that are meaningful and individualised. The kitchen is in need of through cleaning and refurbishment. This section, about daily life, is assessed as good. Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 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. EVIDENCE: The service has a complaints procedure that is clearly written and easy to understand. It can be made available on request in other formats such as translation or large print to help anyone living at, or involved with, Elmwood to complain or make suggestions for improvement. The complaints procedure is supplied to everyone living at the home and is displayed in a number of areas within the service such as the reception area. Residents and others involved with the home understand how to make a complaint and are clear about what will happen if a complaint is made and visitors confirmed this was the case. The home keeps a written record of complaints and this includes details of the investigation and the action taken by the home’s manager or more senior managers in the company. We were advised that unless there are exceptional circumstances the service tries to respond within the agreed timescale, typically within 28 days. The policies and procedures for Safeguarding Adults are available and give clear specific guidance to those using them. We interviewed staff working at the service to check that they know when incidents and allegations of abuse need external input and who to refer the incident to, that is local Social Service Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 15 Department. There are a low number of referrals (because there are very few such incidents, rather than a lack of understanding about when incidents should be reported). The outcomes from any referral are managed well and, whenever possible, issues are resolved to the satisfaction of all involved. Training of staff in the area of protection is regularly arranged by the Home and again we confirmed with staff directly that this is the case. Other training around dealing with physical and verbal aggression is also made available to staff as needed and advice is frequently sought from visiting health professionals including psychiatrists and General Practitioners. Areas of strength include the guidance to be found in the statement of purpose and resident guide, the history of proper referrals (to Social Services and the Commission) when the need arises. As no matters requiring improvement arise in this section, about complaints and protection, it is assessed as good. Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19 and 26: Quality in this outcome area adequate. This judgement has been made using available evidence including a visit to this service. The layout of the home and the manner in which it is being maintained means that this is a safe, comfortable and suitable environment for the service users. There were however a number of matters requiring attention and they are outlined below. The premises are being kept reasonably clean and hygienic but not entirely free from offensive odours even though the home does have systems in place to control the spread of infection. EVIDENCE: The home provides a physical environment that meets the needs of the people who live there. Those residents and relatives that choose Elmwood say they like the layout, which allows residents to wander freely around the corridors in a safe and comfortable way. Elmwood is comfortable but not a homely property, it is quite large at 60 beds on three floors. It has a programme to improve the decoration, fixtures and fittings but there is slippage of timescales and maintenance has been reactive rather than proactive. Elmwood is large building and there always appears to be some areas in need of attention; the kitchen for example on this occasion is in need of upgrading. Some bedrooms Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 17 have been repainted and whilst this is not as homely as wallpapering it is adequate, clean and fresh. The front entrance is not as attractive as it might be; there are more weeds than grass on the front ‘lawns’ and hanging baskets are being stolen making the manager’s task to beautify the area rather frustrating. (I suggest the front car parking spaces are removed, a small picket-fence is used to enclose the front area and seating placed here to give a more attractive and inviting presentation, and the large Southern Cross sign might be reduced to a smaller sign mounted on the wall – this would all help to provide a clear boundary and reduce vandalism). Relatives have commented, and we observe, that what appears to be an intercom at the entrance does not work as such so one cannot be sure if the doorbell is working at all until someone eventually arrives to open the door. We are told that this does not give a good first impression. A sixty bedded, and very busy, nursing home would justify a receptionist but there isn’t one. Residents in Elmwood can personalise their rooms and this point is included in care planning. We observe that the home is generally fairly clean, warm, well lit and there is sufficient hot water. There has been some consultation with service users about the décor, especially for their own rooms. However we note that all doors are the same colour with no attempt other than pictures on bedroom doors, to differentiate between bedrooms, bathrooms, and other facilities such as storerooms, clinic rooms and kitchenettes. En-suite facilities (toilets) are available, and all bathrooms are accessible to all people using the service. The home has not been subdivided into small group living for the residents so each floor has a single large lounge and a separate café-style dining room. This means residents are cared for in very large groups and is self-evidently rather institutional. The home is generally clean and tidy, but we noted and visitors commented upon the unpleasant malodour to be smelt from time to time – some visitors found the smell of cleaning chemical a little overpowering at times. The manager intends having vinyl laid on floors susceptible to ‘spillage’. Hygiene equipment is available including sluices and washing machines with a sluice cycle; clinical waste appears to be managed appropriately. The manager explained with some relief and satisfaction there are no more mice, or other unwelcome rodents, living in the home. Areas of strength include the open and safe layout of the home; the range of facilities and the improving decor and matters requiring improvement are the front entrance; the malodour; the continuing need for refurbishment and redecoration and the improvements needed in the kitchen (referred to in the previous section). This section, about the environment, is assessed as only adequate. Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 18 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27 to 30: Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number of staff employed and their skill mix are nearly appropriate to the assessed needs of the current service users in Elmwood Care Centre – so this will ensure that their needs are mostly being met. The required procedures are in place to ensure recruitment of staff protects service users. The home has a staff induction, training, support and supervision regime in place so service users can be assured that staff are competent in their jobs. The recruitment, training and support of staff will ensure service users are ‘safe in their hands’. EVIDENCE: Residents can have increasing confidence in the staff that care for them. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the people who use the service. Staffing levels are no longer fixed to rigid formulae but the former registration authority recognised that 1 nurse is required for every 10 residents, a ratio of 1:10. In Elmwood there are only three qualified Nurses (plus the Nurse/manager) for 60 residents. As this is a home that needs to maintain improvements if it is not lapse into a poor home as it has done in the past we are requiring, as minimum, four Nurses to be on duty weekdays – until it has established itself as a home that can consistently achieve at least a good standard overall. Staff members undertake external qualifications beyond the basic requirements, for example they are being trained and guided in the good management of ‘end of life’ care, that is, the care of the dying. Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 19 Managers encourage and enable this and recognise the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. People who use the service report that staff working with them are very skilled in their role, and are consistently able to meet their needs. Elmwood is now ensuring that all staff receive relevant training that is focussed on delivering improved outcomes for residents. The service sees training as a vital competent in the quality of care provided and in improving staff moral. Staff report to us that they are supported, through training, training and supervision meetings, to meet the individual needs of residents. Elmwood now has in place a good recruitment procedure that clearly defines the process to be followed. We checked a number of record this year to confirm that this procedure is followed in practice with the service recognising the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals. Staff recruited confirm that the service was clear about what was involved at all stages and was robust in the following of its procedure and this included checks on immigrant workers some of whom need visas and work permits and these are in place and checked by Elmwood or the managing organisation. There have been problems related to staff absences and how such absences are covered and how staff are dealt with if they do not appear for work as expected; this issue produced a recent (but anonymous) complaint about staff cover. Staff meetings take place regularly. Supervision sessions are regular and staff say they find them helpful. Areas of strength include improved recruitment and training and day to day supervision of staff by manager and matters requiring improvement are need for more nursing staff on each weekday shift and further training in the use of equipment such as pressure relieving mattresses. So this section, about staff, is now assessed as good. Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 20 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. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 32, 33, 35, 37 and 38. Quality in this outcome area good. This judgement has been made using available evidence including a visit to this service. The manager is registered with the CSCI as a person competent to run this home in accordance with its stated aims and objectives and to do so in the best interests of the service users. The home is reasonably well managed, including finances, and is mostly safe for residents but with several changes of owner, regional managers and home manager this home needs to consolidate improvements and demonstrate that improvements can be sustained to justify a higher rating than adequate. EVIDENCE: The manager is qualified and has the necessary experience to run the Home and is aware of and works towards the basic processes set out in the National Minimum Standards. In the case of the corporate provider (Southern Cross) the manager has a fair understanding of the organisation’s strategic direction Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 21 and an awareness of its financial planning systems and how the business plan for the running of the home fits into the organisational structure. The manager is aware of the need to keep up to date with practice and continuously develop management skills, although it may be difficult to attend regular formal training courses as this is a large home that needs high level of management input to move towards improved standards. This home has had many owners and managers in the past ten years and now needs an extended period of consolidation if it is to make improvement from merely adequate to good or even excellent standards of service and then go onto demonstrate that it can maintain high enough levels of service – this will take time. Elmwood care Centre is undoubtedly developing better services for residents but does not yet have a strong in-house management team of “Heads of Departments” (catering, maintenance, administration, clinical/social care and housekeeping for example). The manager is now ensuring staff are properly trained and now many are generally competent and knowledgeable to care for the residents but the manager would concede that she inherited a number of staff who are or were not highly skilled nor well motivated – though some were and remain so. One recent anonymous complaint was about the management of the home and complained about a lack of sugar and continence (inco’) pads– both sugar and pads are now in ample supply (and easily obtainable when supplies are short). This complaint perhaps indicates there is still a level of dissatisfaction or disenchantment amongst a few staff members. Good leadership will resolve such staffing malcontent in due course of time. The service is planned to be user focused, to take account of equality and diversity issues, and generally works in partnership with families of residents and professionals. It is commendable that staff speak a number of languages and there are both male and female carers. However few staff are from the same mainly English background as residents. The home has a Statement of Purpose that sets out the aims and objectives of the service. The manager is improving and developing systems that monitor practice and compliance with the plans, policies and procedures of the home and is supported in this by regular visits from senior managers in Southern Cross. The manager is aware of the need to promote safeguarding and uses the organisation’s health and safety policy to meet health and safety requirements and legislation – the latest reflecting no-smoking legislation. Both the local manager and senior managers in the organisation have identified areas where they need to make, or are already making, improvements and they have an action plan for undertaking the work. This includes areas such as the introduction of new documentation - care planning and their proper implementation; staff training and support and in particular the day to day supervision of their practice and absenteeism; improvements to the environment and maintenance – there is another new maintenance person replacing the last person who left after only a short period of employment in Elmwood. It was disappointing to hear that he was unable to cope with the workload when we advised Elmwood they should increase support in this area (Recommendation 4 in my report of March 2007). I also informally suggested, Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 22 but did not make a recommendation, for additional management support for a limited period to ensure the new manager would be able to cope with the many improvements required to bring this home to a reasonable standard. Our checks of a sample of records, care plans, staff records, accidents, resident money, complaints, senior manager visits, kitchen records and fire safety checks, show that records are generally up to date and in good order. No serious health and safety matters were identified during our visit in June 2007 and the home is commended for keeping the home safe for residents. Areas of strength include the assertive moves towards improvement with strategies in place to do so but this is a home with a record of poor practice and incompetent management so a period of good leadership and investment by the new owners is needed to demonstrate it is worthy of an overall rating of good for the foreseeable future. Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 23 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 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 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 X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X 3 X 3 3 Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 24 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. Standard 1. OP1 Regulation 6 Requirement Information: The home must amend the statement of purpose and resident guide so as to provide residents with any proposed changes to dental charges. Hygiene: the home must maintain the home in a clean and hygienic state so as to reduce malodour that would be offensive to residents and visitors. Kitchen: the kitchen must be thoroughly cleaned and suitable equipment provided so as to ensure residents can be provided with safe and suitably wholesome meals. Staffing: For day time shifts 8 am to 8 pm there must be a minimum of four qualified Nurses; and there must be 10 carers. This remains outstanding from 30/03/07 but was subject to further negotiations. Staff training: nurses must be given further guidance on the correct use of equipment and in particular the correct settings for pressure-relieving mattresses. Timescale for action 30/08/07 2 OP26 23(2)d 30/07/07 3 OP15 OP26 23(2)d 30/07/07 4 OP27 18 30/07/07 5 OP30 18 30/07/07 Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 25 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 OP1 Good Practice Recommendations Statement of purpose: it is recommended that once negotiation is complete and the registration certificate is amended to remove unnecessary condition that the statement of purpose and resident guide be amended. 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. Ongoing recommendation. Bedrooms: it is recommended that the home help and support residents to personalise their bedrooms. This is an ongoing recommendation. Reception: It is recommended that a receptionist is employed or suitable arrangements made to receive visitors promptly by a person able to assist visitors when they arrive. Maintenance: It is recommended that the maintenance person be given extra help to maintain the fabric of the building to a higher standard. 2 OP13 3 4 OP24 OP27 5 OP19 Elmwood Nursing Home DS0000019025.V342404.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Croydon, Sutton & Kingston Office 8th Floor Grosvenor House 125 High Street Croydon CR0 9XP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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.V342404.R01.S.doc Version 5.2 Page 27 - 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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