Inspection on 13/02/08 for St Elmo Care Home

This inspection was carried out on 13th February 2008.

CSCI found this care home to be providing an Good service.

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

St Elmo Care Home 25/07/06

St Elmo Care Home 25/10/05

St Elmo Care Home 17/05/04

Similar services:

St Vincents

Hamilton House

The Cotswold Home

Newbeech House

Newbeech House

Winton House

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE St Elmo Care Home Gorley Road Poulner Ringwood Hampshire BH24 1TH Lead Inspector Tim Inkson Unannounced Inspection 04:00 13 February 2008 th 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 St Elmo Care Home DS0000062111.V357004.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. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service St Elmo Care Home Address Gorley Road Poulner Ringwood Hampshire BH24 1TH 01425 472922 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) St Elmo Care Home Ltd Mrs Marese Carol Mary Pitman Care Home 23 Category(ies) of Dementia - over 65 years of age (23), Old age, registration, with number not falling within any other category (23) of places St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 25th July 2006 Brief Description of the Service: St Elmo is located in a residential area close to local amenities and about half a mile from Ringwood town centre. It provides residential care for up to 23 older people, many of who have dementia. Bedroom accommodation is located on the ground and first floors of the building and a spacious passenger lift provides access to the latter. There are 19 single rooms and 2 shared/double rooms. The home is fitted with a variety of aids and adaptations to enable people living there to move about more independently. The communal rooms included a large bright and airy lounge dining room with distinct areas for the respective activities and there is wheelchair access to the home’s garden from the lounge area. People wishing to live in the home or for whom arrangements are made to do so by relatives or other representatives are given written information about the home and the service that it provides and are also invited to visit the home. A copy of a report of the most recent inspection of the home carried out by the Commission for Social Care Inspection (“us/the Commission”) is made readily available in the home. At the time that this site visit was carried the home’s fees ranged from £480 to £540 a week and this did not include the cost of podiatry/chiropody, hairdressing, and toiletries. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This site visit was part of the process of a key inspection of the home and it was unannounced and took place on 13th February 2008, starting at 08:55 and finishing at 16:00 hours. During the visit accommodation was viewed including bedrooms, communal/shared areas and other facilities. Documents and records were examined and staff working practice was observed where this was possible without being intrusive. Most of the people living in the home had dementia and meaningful conversation was very difficult but a number of individuals were able to express their opinions about day-to-day life in the home. Because of this limitation the views of relatives and friends of people living in the home were important and the opportunity was taken to speak to visitors to the home during the site visit. Staff were also spoken to in order to obtain their perceptions of the service that the home provided. A period of time was also spent observing a small group of people in the home’s lounges/dining area in order to gain some insight into how people living in the home were treated and responded to one another, staff and the home’s environment. These observations were followed up by discussions with the registered manager of any significant matters that were noted. The time spent observing the home’s daily life and staff care practices indicated that staff were very patient, empathetic and they always asked individuals questions rather than making decisions for them about what help they wanted. People were encouraged to be active, but could also sit quietly if that was their wish. At the time of the inspection the home was accommodating 22 people and of these 5 were male and 17 were female and their ages ranged from 86 to 104 years. No individual was from a minority ethnic group. The home’s registered manager was present throughout the visit and was available to provide assistance and information when required. Some people living in the home, their relatives and advocates as well as health care professionals in contact with the home, were canvassed for their views about the home using questionnaires, before the site visit took place. Their responses were taken into consideration when producing this report. Other matters that influenced this report included. An Annual Quality Assurance Assessment completed by the registered manager in which she set out how she believed the home met and planned to exceed the National Minimum Standards (NMS) for Care Homes for Older People and evidence to support this. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 6 A “Dataset” containing information about the home’s staff team, and some of its managements systems and procedures. Information that the Commission for Social Care inspection had received since the last fieldwork visit made to the home on 25th July 2006, such as, complaints and statutory notices about incidents/accidents that had occurred. What the service does well: What has improved since the last inspection? The environment had been greatly improved with more communal/shared space available for people living in the home to use providing them with more choice and comfort. The management of medication had been made more robust with better record keeping and the implementation of practices that ensured that medicines were looked after safely on behalf of people living in the home. Staff working in the home had received training about safeguarding vulnerable adults to ensure that they knew what action to take if they suspected or knew that any person living in the home was being abused. Thorough checks were carried out before any new staff started work in the home to ensure that they were suitable to work with vulnerable adults. This was to ensure that as far as reasonably possible people living in the home were protected from the risk of harm. Staff received training in fire safety and the recommendations and requirements of the local fire and rescue service were acted on by the home. This was to ensure that as far as possible people living there were protected from the risk of harm from fire. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 7 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. The summary of this inspection report can be made available in other formats on request. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 8 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 St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 9 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): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home and their relatives/representatives were confident that the home could meet their needs. This was because the help that individuals required was identified before they moved in to ensure that the level of support and care they required could be provided. EVIDENCE: A sample of the records of 4 residents was examined including those concerned with the actions that the home took to identify the help and assistance that people needed. There was evidence from the documents examined and discussion with people living in the home and or their relatives that admissions to the home of the individuals had all been planned and involved staff working in the home that had appropriate knowledge and skills. The home’s registered manager said that either she or the home’s deputy manager usually carried out the assessments of the needs of people wishing to move into the home. She said that the process included, both visiting people who wished to live in the home where they were accommodated as well as the individual visiting St Elmo’s before they moved in. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 10 Where an individual had moved into the home through arrangement made by the adults services department of a local authority, a copy of that department’s assessment of the person’s needs had been obtained by the home. There was documentary evidence that assessments of individuals’ needs were reviewed at least every month and revised as necessary when a person’s circumstances changed. The home does not provide intermediate care St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9, and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health, personal and social care needs were met. The home had plans of care that individuals, or someone close to them, had been involved in making. People unable to manage their own medication were supported by the home to manage it in a safe way. Individuals’ right to privacy was respected and the support they got from staff was given in a way that maintained their dignity. EVIDENCE: In the AQAA the home stated among other things the following about how it promoted the personal and health care needs of people living in the home: “We provide good personal care to the residents which we can evaluate through our daily care records, care plans, nutrition records ... The staff are experienced and we provide training and follow up to ensure all the care needs are met. These include health and oral hygiene, pressure care, mobility, stimulation, psychological health, nutrition, medication and access to specialist services … We have started a key-worker system and a new nutrition programme to allow us to monitor various aspects of care …The staff have a good reputation in the community … they understand the needs of dementia in St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 12 the home …” These statements were supported by what was found and observed during the site visit and from information obtained from a range of sources. The care plans were examined of the same sample of 4 residents as in the section above i.e. “Choice of Home”. The documents seen were based on the information obtained from assessments that the home carried out in order to identify what help the individuals needed. Assessments had been carried out of potential risks to residents arising from things such as poor mobility and the need to transfer individuals and poor appetite i.e. moving and handling and malnutrition. The plans examined set were succinct and did not always include much detail of what actions staff had to take to provide the support and assistance each person required. One plan referred to the inability of an individual to make his needs known but discussion with care staff indicated that they were able to interpret non-verbal clues from the actions and expressions of the person. It was stressed that these details needed to be recorded to ensure that anyone unfamiliar with the person could provide the help that was required by referring to such information. The home’s registered manager acknowledged that there was a reliance on the fact that the staff team was very stable with a low turnover and that they were all familiar with and knew the needs of the people living in the home. She agreed to ensure that much more detail was included in written plans of care. She also acknowledged that they needed to ensure that the use of all equipment by individuals was included in the documented care plans e.g. pressure relieving aid, and that the use of such equipment was clearly linked to risk assessments e.g. pressure sore risk assessment. Where care plans examined referred to the use of equipment or how a specific need was to be met this was observed to be available, provided or in place e.g. “walks with stick; needs help at meal times”. There was evidence from documentation and discussion with individuals, that wherever possible they and/or their representatives had been involved in developing the plans and had agreed with the contents. Records also indicated that risk assessments and care plans were reviewed at least monthly and daily notes referred to the actions taken by staff to provide the needs set out in those plans. Care plans examined were not simply task focussed. They were person centred and identified very specific likes and dislikes of the persons concerned and discussion with individuals indicated that these were promoted. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 13 Staff spoken to knew the needs of the individuals whose records were sampled and they were able to describe the contents of the care plans. Comments from people living in the home and relatives/representatives about the abilities of staff the care and support that they provided included: “I can wash and dress myself. I prefer to be left to cope but sometimes I call for help with the bell and on the whole they are very good”. “My mother is here and it is very good. She is very well looked after. The staff are charming”. “They treat people living there with care and respect” (relative). “The staff are conscientious and look after everyone well” (relative). “They care for my mother in a kind and compassionate way”. Responses in questionnaires returned by relatives of people living in the home indicated that 91 believed that the home always gave the support or care to their relative that they expected or agreed and 9 usually. The percentages and responses were the same to a question about whether they thought the staff had the skills to look after people properly. Records examined indicated that a range of healthcare professionals visited the home and that arrangements were made for treatment for service users when it was necessary. Care plans indicated how the specific needs of people were met for things such as foot care and oral hygiene. Individuals and relatives said that people received treatment from among others, doctors, podiatrists and opticians. The home’s registered manager said that they had developed good working relationships with healthcare professionals and this was confirmed in responses received from 8 whose views were canvassed. All i.e. 100 were of the view: • The home communicated clearly and worked in partnership with them. • There was always a senior member of staff on duty to confer with. • They were able to see their patient in private. • Staff demonstrated a clear understanding of the care needs of people in the home. • People’s medication was appropriately managed in the home. • The overall care provided by the home was satisfactory. One commented, “The staff always appear attentive and appropriate care always appears to have been given”. The home had written policies and procedures concerned with the management and administration of medication. Medication was kept in locked room. In the room it was kept in a metal medicine trolley. Controlled drugs were stored securely and appropriately. A St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 14 sample audit of controlled drugs indicated that that the relevant records were accurate and up to date. The home used a monitored dosage system with most prescribed medication in blister packs. All staff that were responsible for giving out medication had attended appropriate training in the Safe handling of medication. Good practice noted during the fieldwork visit included: • The dating of some medicine containers when they were opened to ensure they were used safely There was a locked refrigerator used for storing some medicines. The temperature of the refrigerator was not being routinely recorded and checked to ensure that it was working effectively. The home’s registered manager said that a system for doing so would be implemented immediately. At the time of the fieldwork visit no person was managing all of his or her own medication. The importance of offering people the opportunity to do so based on an assessment of their ability/competence and recording the outcome of the assessment was part of a general discussion about the principles of the Mental Capacity Act 2005, the management of medication and the rights of people living in the home. There were 3 requirements concerning the management of medication imposed on the home arising from the last key inspection that was completed on 25th July 2006. These were that a record must be made of medication entering the home to ensure that an audit of medication could be done. That out of date medication must be disposed of and all medication must be kept securely. All these matters had been addressed and the home had implemented systems to ensure that such omissions would not occur again. This included regular quality audits of all management systems and procedures in the home including the management of medication. There was also evidence that monthly visits to the home by a person representing the home’s owner also included a check of the effectiveness of the management of medication. People spoken to during the site visit confirmed that staff promoted their privacy and dignity and were polite and respectful and knocked on their bedroom doors and waited for permission before entering. This important aspect of life in the home was assisted by the fact that most bedrooms were single. There was screening provided in the two rooms that were shared. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home were able to choose their own life style, social activities and maintain contact with families and fiends. Social, cultural and recreational activities generally met individuals’ expectations. The food provided was healthy, varied and nutritious and according to the choices and preferences of those living in the home. EVIDENCE: In the AQAA the home stated among other things the following about how it promoted supported people to exercise choice and control over their own lives: “We offer an activities programme to suit the needs of the residents.We try to dovetail it to suit the levels of dementia.We have allocated a staff member to do actvitities on a regular basis twice a week … Our new programme includes Interact which are a company specially designed to cater for the needs of the elderly and those with dementia …and have proved to be very interactive and sucessful with the residents … Relatives and friends are welcome at all times … We have a religious service monthly … these services are greatly enjoyed by the residents …Our sensory equipment is part of our activities profile as we use it to promote stimulation”. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 16 Observation and discussion with people living in the home, relatives and staff confirmed the statements in the AQAA and also indicated that the home’s routines were very flexible and the service it provided was based clearly around the needs and wishes of those living there. People chose when to get up and go to bed and where to eat i.e. either in their rooms or the communal dining room. The member of staff whose responsibilities included organising activities was on duty at the time of the site visit and was observed decorating/painting the nails of a number of women. She expressed enthusiasm about her role and engaged with people living in the home in a relaxed and respectful manner. People spoken to appreciated the activities that were organised and which they could participate if they wished and some chose not to. “We have the padre from the Church on a Tuesday and we have a communion service and most people attend … yesterday we had an entertainer and various young ladies do things like quizzes and shuffleboard and things, to stir us up physically and mentally …”. “I spend most of the day in my room, I like classical music and I have my computer although I don’t use it much now”. The home had installed multi-sensory equipment in the lounge and the manager said that it was mainly used in the evenings and it helped calm people who became agitated and restless at that time of the day. People living in the home and visitors that were spoken to during the site visit confirmed that there were no restrictions and visitors said that that they were always made welcome. The home did not manage the financial affairs of anyone living there. Individuals were able to bring personal items into the home including furniture and it was apparent from discussion and observation during a tour of the building that many people had taken some trouble to personalise their bedroom accommodation. There was a lot of information readily available in the home about local advocacy and other services. Sensitive information that the home held about individuals was kept secure and the home had written policies and procedures about maintaining confidentiality and the right of people to se information kept about them. The menus and records of food provided indicated that the food was nutritious and there was a wide range of meals provided and an alternative could always be provided to the main meal of the day. Individuals’ food preferences, St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 17 dislikes, food related allergies and their nutritional and dietary requirements were recorded in their care plans. The information was also readily available in the home’s kitchen. The menus were prepared on the knowledge that the staff knew about individuals’ preferences. Fresh ingredients were used in the preparation of meals and home made cakes and fresh fruit were among the food items seen during the site visit. Special diets and individual and special needs were catered for e.g. soft and diabetic. People spoken to said that they received 3 meals a day and could have drinks and snacks at other times. Comments about the food provided were all positive and included the following: “The food is very good, some things I like better than others and it is nourishing”. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 18 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. If people had concerns with their care, they or people close to them knew how to complain. Any concern would be looked into and action taken to put things right. The care home safeguarded people from abuse and neglect and took action to follow up any allegations. EVIDENCE: The home had a written policy and procedures about how complaints could be made about the service that it provided. A copy was clearly displayed in the home’s entrance hall. People living in the home and visitors spoken to during the site visit were confident about raising any concerns. A record of complaints made to the home was kept that detailed the issue, and set out any agreed action to remedy the matter and its outcome. There had been 5 complaints made to the home in the previous 12 months and all had been resolved satisfactorily. We received no complaint about the home during the same period. The home had written procedures available concerned with safeguarding vulnerable adults. These were intended to provide guidance and ensure as far as reasonably possible that the risk of people living in the home suffering harm was prevented. Staff spoken to said that they received training about protecting vulnerable adults and an examination of staff training records confirmed this. They were also able to demonstrate an awareness of the St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 19 different types of abuse and the action they would take if they suspected or knew that it had occurred. A requirement had been imposed as a result of the last inspection of the home that staff must be aware of the procedures to follow in the event of an allegation or suspicion of abuse in the home. It was apparent from the evidence obtained during this site visit that this had been addressed. Bed rails were being used to prevent one person from falling and injuring himself. The care plan for the individual concerned did not include a risk assessment or evidence that agreement had been obtained from any interested parties for their use or as the least restrictive and most appropriate way of eliminating or reducing the risk of harm to him. The registered manager said that when she had started work in the home they were being used for the person concerned and it had been an oversight on their part that their use had never been recorded or reviewed. The home’s written policy and procedure concerning the use of restraint did not include much detail. The home’s registered manager said that a risk assessment would be completed without delay and permission sought for the use of bed rails obtained and recorded. She also said that the home’s policy would be reviewed and improved based on information set out in a recent publication produced by “the Commission” about restraint. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 20 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): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home’s environment was comfortable, safe and well maintained. The home’s procedures and staff practice ensured that as far was reasonably possible residents were protected from the risk of infection. EVIDENCE: During the period between since the last key inspection of the home had been completed and this site visit, the premises had been extended and improved. A passenger lift had been installed and the communal rooms extended and greatly improved with the construction of a large conservatory. The AQAA described how the premises had been improved: “The residents now have a large, well lit and airy dining area. The area has several round tables and chairs and allow for social interaction. Prior to renovation we only had a single table that allowed for 8 residents to sit down. The conservatory is large, well lit and opens onto the garden, this allows the St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 21 residents a more communal area to be seated and offer a beautiful aspect onto the garden area. The conservatory is large and roomy and allows for more room for visitors. Prior to the new build there was not enough adequate space in the lounge for the amount of residents and some residents stayed in their rooms. This now only happens through choice. The new lift has reduced the risk of the previous dangerous stairs into a well accommodating glass lift. This has allowed for easy access for the residents to come downstairs. Prior to the build we had a narrow staircase with a stair-lift and a couple of the residents found it frightening to negotiate. All our residents are now able to come downstairs without any fears. Some of our rooms have been refurbished with new furniture, bed, lockers, lighting, bedding etc to enhance well- being and pleasure. The home and these rooms have been fully carpeted thus upgrading the facilities. Residents are welcomed to bring in their own furniture and personal belongings to allow them to personalise their rooms. The newly landscaped garden is now accessible from the conservatory and allows access for all residents to the garden. This was not possible before due to the cumbersome layout. The new landscaping includes several benches and areas for seating. The residents often have tea in the garden in the good weather. Our new bathroom now boasts a ceiling hoist, parker bath and disabled toilet. This allows for a user-friendly environment for the residents’ that is safe and secure. The bathroom has greatly enhanced the environment for the residents”. The local fire and rescue service had inspected the home on 15th January 2008 and indicated that there were some matters that required attention. The home’s registered manager produced documentary evidence that a specialist fire safety consultant had subsequently visited the home and updated the home’s fire risk assessment and would be carrying out other remedial work that had been identified in the report. The local environmental health officer had visited the home on 9th July 2007 and items identified as a result of that visit had been remedied. At the time of the fieldwork visit the exterior and interior of the premises, its décor, furnishings, fittings and equipment were in good repair. There was an isolated area of unpleasant odour and there was a rational explanation for this. The home’s registered manager and staff responsible for cleaning were aware of it and were managing its cause. Responses form all the people living in the home that completed questionnaires indicated that they believed that the home was fresh and clean There were a number of features in the home that helped to promote the independence of people living in the home or ensured that they could receive help from staff in safely and with dignity. These included: Railings in some corridor areas St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 22 Assisted bathing facilities and level access shower A new passenger lift Hoist and slide sheets for transferring and assisting people with poor mobility and weight bearing difficulties Signage and symbols to help people orientate themselves The home had comprehensive procedures in place concerned with infection control and all staff working in the home had completed relevant training. It was noted that in accordance with best practice all communal WCs that were seen were provided with liquid soap dispensers (that were full and working) and paper towels. Protective clothing was readily available and staff were observed using gloves and aprons appropriately. The home’s laundry was appropriately sited. It was clean and well-equipped and effective procedures were in place for the management of soiled laundry items. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 23 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): 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People had safe and appropriate support as there were enough competent staff on duty at all times. They had confidence in the staff at the home because checks had been done to make sure that they were suitable to care for them. Peoples’ needs were met and they were cared for by staff that had received relevant training and also had support from their managers. EVIDENCE: The staff working in the home comprised: • 16 care staff • 2 cooks • 1 housekeeper • 2 cleaners • 1 kitchen assistant Out of the team of care assistants 13 (81 ) had obtained a recognised relevant qualification i.e. National Vocational Qualification (NVQ) to at least level 2 in care. The remaining care staff were working towards NVQ level 2 and some others in the team towards NVQ level 3. At the time of the fieldwork visit the care staff rota setting out the minimum number on duty in the home at any time was as follows: 08:00 to 14:00 14:00 to 20:00 20:00 to 08:00 4 3 2 wakeful St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 24 The home’s registered manager and deputy manger worked alternate weekends and one or both were always on duty were from Monday to Friday in addition to the minimum number of care staff. The staff team was stable and the turnover was low. Only 3 part time staff had left employment at the home in the 12 months prior to the site visit and no agency or temporary staff had been used during the same period. The reason for the low staff turnover was reflected in the comments made by staff when describing what it was like to work in the home. All spoke very positively about the working in the home, of their colleagues and assisting the people living there and they also expressed particular enthusiasm about training and development opportunities: “Our training has been extremely good and I have successfully gained knowledge” “We have appraisals and supervision regularly throughout the year”. “Occasionally we have staffing problems with regard to covering shifts when staff are on holiday. However we are a good team and people cover to help out”. People living in the home and their relatives spoken to as well as responses received from the latter in questionnaires indicated that they believed that staffing levels were satisfactory and that the staff were skilled and competent. “Whenever I have dropped in there have always been staff in the lounge with the residents”. Documents examined of the most recent member of staff to be employed by the home indicated, that all the necessary pre-employment checks to ensure that they were suitable to work with vulnerable adults had been completed before they had actually started work in the home. A requirement arising from the last inspection of the home completed on 25th July 2006 was that all such checks had to be completed before new staff began work. It was apparent that this matter had been addressed. Ther was evidence from documents examined and discussion with members of staff that all new staff received comprehensive induction training and health care assistants completed a common induction standards programme that satisfied the requirements of the training body for the social care workforce i.e. Skills for Care (previously the Training Organisation for Personal Social Services [TOPSS]). Staff training needs were identified through appraisals and individual supervision sessions and documentary evidence of regular supervision was St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 25 seen. Staff spoken to confirmed that they participated in regular individual supervision sessions. The home’s registered manager kept a central record of all training that staff had completed and could identify readily the training needs or requirements of any individual in the home’s staff team. She was very committed to ensuring that home’s staff team had the opportunity to develop their skills and knowledge. This was reflected in their enthusiasm for learning that was obvious when talking to them and also by a number of staff working in the home that had received wards both from colleges through which the training was arranged and from care industry trade associations. Responses in questionnaires returned by care staff indicated that 100 of the respondents thought that they received training that was relevant to their roles, helped them understand the individual needs of people living in the home and kept them up to date with new ways of working. The same percentage felt that they had the right support, experience and knowledge to meet the different needs of people. Comments in the questionnaires about what they thought that the home did well included: “Training is abundant”. “We are trained to do the job. It is very happy here”. It was clear from talking to staff that not just those providing physical care received training in subjects that helped them understand the needs of people living in the home. A member of staff who was responsible for cleaning the building said, “I have done dementia because we talk to the residents as well”. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 26 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): 31, 33, 35 and 38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home’s registered manager provided effective leadership There were systems and procedures in place for monitoring and maintaining the quality of the service provided, supporting staff and promoting the safety and welfare of everyone living and working in the home. EVIDENCE: The home’s registered manager had been in her post and responsible for the day-to-day operation of it for some 4 years. She had been a registered nurse for 30 years and her previous post had been clinical facilitator in a large private hospital. She had obtained a recognised qualification (The Registered Managers Award) in October 2006 that indicated that she had the skills and knowledge considered necessary to enable her fulfil her role. She ensured that she kept up to date with developments by attending relevant training courses and seminars. The home’s deputy manager who started working at the home at about the same time assisted her. The deputy manager was also St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 27 experienced having worked in other care homes and she had also had obtained the registered managers award. From discussion with the registered manager, observation and discussion with staff, people living in the home and visitors it was evident that the registered manager was; knowledgeable; organised; highly motivated; enthusiastic; approachable; and she kept up to date with developments in social care. Comments from staff, people living in the home and relatives about the registered and deputy manager were all positive and included the following: • • • • • • • “ …I can talk to Marese she is very professional …”. “… If I don’t understand things I speak to the managers, they are so easy to talk to and explain it in a way that I understand …”. “She is brilliant, she has taught me a lot and she makes sure that the standards are high and that everything is done properly …”. “… They are very good, easy to approach if you have problems … they are very good and know what they are doing … ”. “… She is lovely … not just work, if you have a personal problem you can go to her …”. “… The ladies in charge I think they are wonderful …” “ … The managers are efficient, especially Marese and they get things done …”. The home had system in place for monitoring the quality of the service that it provided based upon the regular use of questionnaires to obtain the views of people living in the home and other interested parties. The outcomes of surveys were published and readily available. There was evidence from documents examined and discussion with members of staff that meetings for the home’s staff team were held regularly. As a result of such consultation and the responses the home received in questionnaires some things in the way the home was run had been changed and these were set out in the AQAA: “Our activities programme has been improved … We have a staff member who now attends to the activities … We have commenced a Key-worker system to ensure certain areas are attended to e.g. laundry, marking of clothes, improving personal care … We are in the process of starting Life Stories in a photographic form- to enable us to recognise and understand the lives of our residents … We liaise with other multi-disciplinary teams e.g.- district nurses, pharmacy etc and use their input to improve our service …designating certain times for the district nurses to visit to enable efficient and effective care to be given to the residents … carried out refurbishments in the Home to provide St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 28 improved facilities and improved living and working environment for residents and staff. .. These area large conservatory, a large dining area, hairdressing facilities, treatment room, new bedroom, staff room and toilet, new bathroom refurbishment, new boiler room, pantry, laundry and landscaping the garden. We have also refurbished several rooms with a complete package of furniture, bed, bedding and curtains as well as new carpets, commodes, bedside lights etc ...”. There were a range of written of policies and procedures available that staff said helped to inform their working practice. There was evidence that they were reviewed and updated as necessary. A representative from the company that owned the home visited it at least once a month. A report was completed of findings and observations made during such visits and copy was made available to the registered manager. There had been 5 requirement made as a result of the last key inspection of the home on25th July 2006 and all had been remedied. The home did not look after any money on behalf of anyone living there. Records examined indicated that the home’s equipment, plant and systems were checked and serviced or implemented at appropriate intervals i.e. stair lift and bath hoists; fire safety equipment portable electrical equipment; hot water system; etc. Staff spoken to said and records examined, confirmed that that they attended regular and compulsory fire and other health and safety training. The home’s registered manager was an accredited manual handling trainer and there were bath hoists, and other equipment available in the home that promoted safe working practices. St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 29 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 4 X N/A X X 3 St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Hampshire Office 4th Floor Overline House Blechynden Terrace Southampton SO15 1GW 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 St Elmo Care Home DS0000062111.V357004.R01.S.doc Version 5.2 Page 32 - 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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