CARE HOMES FOR OLDER PEOPLE
Sutton in the Elms Nursing & Residential Home Leicester Road Sutton In The Elms Leicestershire LE9 6QF Lead Inspector
Lesley Allison-White Unannounced Inspection 8th August 2006 10:30 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 Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.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. Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Sutton in the Elms Nursing & Residential Home Address Leicester Road Sutton In The Elms Leicestershire LE9 6QF 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) 01455 286577 01455 286578 DRE Group Limited Mrs Angela Margaret Lonsdale Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39), Physical disability (10), Physical disability of places over 65 years of age (10) Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. No person under 55 years of age who falls within category PD may be admitted to the home . No person to be admitted to the home in categories PD or PD/E when 10 persons in total of these categories/combined categories are already accommodated in the home. To be able to admit the named person of category PD named in variation application number V24401 dated 6 September 2005 13th November 2005 3. Date of last inspection Brief Description of the Service: Sutton In the Elms Nursing Home is a purpose built modern property designed to accommodate up to 39 people over the age of 65years. The home is registered to admit up to 10 people with physical disabilities who are over 55 years of age. The property is situated in a rural village of Sutton Elms which is near to Broughton Astley village. This area can be easily reached via the M1 motorway and main routes. The rear of the property offers ample parking spaces and views of the countryside. All areas of the premises are accessible for people with mobility impairments. The statement of purpose and service user guide and the current inspection report are available for new residents. (This is information about how the home is managed and the facilities provided.) The inspection report is available on request to New residents. Fees range from £407.00 to £613.00 per week. Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by the Commission for Social Care inspection is on outcomes for residents and their views of the service provided. The inspection took place on a Tuesday. It took eight hours to complete. This home provides care for up to thirty-nine residents, there were thirty seven residents in the home on the day of inspection, falling within the category of old age or with a physical disability. Discussion was held with three residents. However other residents were observed in their daily routine. Three residents were spoken with in great detail. One resident’s relative was spoken with and two friends of another relative. The primary method of inspection used was “case tracking”. This involved speaking to the residents who use the service provided, looking at two residents care plans, making observations, talking to three residents in detail and observing care practices. All the required key standards were inspected during this visit. There were no areas of concern raised by the last inspection report. The Registered Manager was on duty during the inspection. What the service does well:
Residents’ case tracked during this inspection had their assessed needs documented in their care plans. There was evidence of other outside professional judgments, which formed part of the assessment process. Standard 6 was not assessed as the home does not provide intermediate care. The Registered Manager is to be commended on her prompt action to a complaint that she has dealt with which could potentially put a resident at risk. The Manager informed all the relevant parties including (the Commission for Social Care Inspection Unit) and other Agencies as per policy and procedure. The home employs an activities person. One resident said that when the activities person is there they take part in quizzes or skittles, which they enjoy. “Last year some people went to watch an ice skating event over the Christmas period, very enjoyable.” The culture and diversity needs of the residents were through the activities groups or through religious observance. One resident told the inspector that
Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 6 they took Communion at the home and were able to enjoy listening to the Sunday worship on the radio in their room. Bedrooms were seen. Residents had personal items of furniture and photographs in their rooms. The rooms were spacious. One resident told the inspector “ I am not bored, I am not neglected all the care team are very pleasant, patient and understand my needs. At night I am turned every 2 hours and the carers are kind enough not to disturb me when I fall asleep which I like. I have nothing but praise for the staff.” Families and friends visit whenever they want to. The inspector was at the home until late evening and this was evident. A sample of the home’s quality assurance questionnaire of the service done in February 2006 was seen. Comments included: “Staff are always friendly and approachable. I feel the total standard of care is A1 and would recommend the care home to future families” “Mum has been with you since day one and I cannot fault your service and care at all. Keep up the good work. Many thanks to you all for all that you do”. What has improved since the last inspection? What they could do better:
Two Residents perceived a staff shortage affecting care received. One resident said that “staff are always very busy they will knock the door then enter they do not always wait for an answer”. The Registered Manager was able to demonstrate sufficient staff on duty at all times. Two residents felt that they were not always party to decisions made about them. Sutton In the Elms has a visiting agency service operated by Age Concern. The Registered Provider may wish to review or extend this process. The Registered Provider (s) should review medication practices. The Registered Provider (s) should ensure all Staff files are checked. Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 7 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. Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.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 Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.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 at least once during a 12 month period. 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. No resident moves into the home without having their needs assessed and assured that these will be met. EVIDENCE: As part of this key inspection process three residents were case tracked. Other residents and visitors also spoke to the inspectors. Residents’ case tracked during this inspection had their assessed needs documented in their care plans. There was evidence of other outside professional judgments, which formed part of the assessment process. Standard 6 was not assessed, as the home does not cater for intermediate care. Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.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 at least once during a 12 month period. 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. The Registered Provider(s) are successful in delivering appropriate care to individual residents. EVIDENCE: The three case files examined showed that there were individual plans of care that gave instructions to staff about the care needs of residents. Risk assessments were carried out and in the care plans. Health care needs were clearly identified and potential areas of risks such as pressure sores had been identified and successfully monitored and treated. Staff monitored residents identified as being at risk of falling. Care plans (a written plan of how care is to be given) were in place and up to date. Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 11 Residents who spoke to the inspector said that when they were ill the Doctor was called to attend to them and all other medical appointments were dealt with by the home. One resident told the inspector “ I am not bored, I am not neglected all the care team are very pleasant, patient and understand my needs. At night I am turned every 2 hours and the carers are kind enough not to disturb me when I fall asleep which I like. I have nothing but praise for the staff.” Two Residents perceived a staff shortage affecting care received. One resident said that staff are always very busy they will knock the door then enter they do not always wait for an answer. None of the residents spoken to formed special friendships with any one but explained that their friends or family were always welcome. One resident told the inspector “bath days are allocated and there does not feel like there is much choice.” The Registered Manager was able to demonstrate sufficient staff on duty at all times. Moving and handling practice was observed. Footplates were used but not always in some cases, this was justified. The inspector looked at the staff rota in detail. (See Section on Staffing) Quote from a relative. “The care that my relative has here is very good. The home is well run, it is clean, and people are looked after. There are no funny smells.” The system for administering medication was checked and found to be satisfactory for the residents’ case tracked. One case tracked Medication trail demonstrated two amounts of the same tablets were found in one container. The storage of controlled medication has the potential to cause some confusion due to putting together separate issued amounts. It is however noted that a separate accountable record is kept. Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.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 at least once during a 12 month period. 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. The home succeeds in meeting the identified daily and social needs and the outcome is positive for the residents. EVIDENCE: The home employs an activities person who comes into the home on a regular basis. One resident said that when the activities person is there they take part in quizzes or skittles, which they enjoy. There was a detailed copy of an event programme. Comments received from relatives and residents spoke with were mostly positive. One person spoken with indicated that they would prefer to see better use of the field at the back of the home and more stimulating activities. The culture and diversity needs of the residents were through the activities groups or through religious observance. One resident told the inspector that they took Communion at the home and were able to enjoy listening to the Sunday worship on the radio in their room.
Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 13 Two of the residents, who the inspector saw, had either poor vision or were in bed all day and although they had televisions in their rooms, talking books, (stories that you listen to on tape) could be an activity that they may enjoy. A hairdresser visited the home and attended to residents who requested the hairdressers. Residents who spoke to the inspector were able to explain the choices that they made they chose what the preferred to wear, what food they preferred and told the inspector that the they were told about the home by their families and were not disappointed by the choice. One resident was found a more suitable room where they could enjoy walking outside to enjoy the weather when it was fine. Families and friends visit whenever they want to. The inspector was at the home until late evening and this was evident. The care staff served meals: lunchtime was observed. Both dining areas of the home were used. It was satisfactory and some of the residents received an alcoholic beverage with their meal, it was a residents’ birthday. The Registered Manager explained that alcohol is offered for every mealtime if the resident wishes and if their medical condition allows. Everyday there are two choices of starters, main meals and sweets. On the day of inspection this was seen and everyone enjoyed the meals. Comments on the meals were “ The food here is very good!” Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.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 inspected at least once during a 12 month period. 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. There are policies and procedures for dealing with complaints and protection giving protection to the residents. EVIDENCE: Residents were able to state with whom they would talk about a complaint and felt reassured that it would be dealt with. The Registered Manager recently dealt with a complaint promptly; in this way residents are protected. The Registered Manager informed all the relevant parties including the Commission for Social Care Inspection Unit (CSCI) and other Agencies as per policy and procedure. The Commission for Social Care Inspection has not received any complaints since the last inspection report. Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are provided with a safe, hygienic and comfortable environment. EVIDENCE: The lounges and other communal areas were clean. A bathroom that the inspector saw had specialised equipment, including an assisted bathing chair. The room was spacious, clean and tidy. Individual residents had their own wheelchairs as necessary. Bedrooms were seen. Residents had personal items of furniture and photographs in their rooms. The rooms were spacious. All areas were clean and hygienic. Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Provider(s) has a recruitment procedure, which has not been fully implemented and therefore does not fully protect the residents. EVIDENCE: Examination of the staffing rota indicated that it was normal practice for seven to eight staff to be on the rota during the daytime. It was noted that on occasions weekend cover fell below seven or eight staff on day duty. There was no evidence, that this to date has unduly effected care. The Registered Manager is aware of the situation and is taking steps to correct this situation. Staff who spoke to the inspector spoke about some of their achievements. One staff member spoke about the difference the National Vocational Qualification (NVQ) in care had made to their practice and was now preparing to commence a higher level of NVQ. Others said they were waiting to start their NVQ training in September. Staff spoke about their induction process of three months, and about working with other more senior staff for a up to two weeks. No formal Moving and Handling training had been given to the newer care staff, but this was in progress along with other training the Registered Manager explained. Staff explained that there was no process of formal or recorded supervisions. The
Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 17 Registered Manager confirmed this and explained that this was a job that would be done. Staff files were checked. It was noted in two of the files that there was one reference only, and the home had not completed the paper work for overseas staff prior to staff starting work at the home. Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The Registered Provider ensures that the home is being run in the best interests of residents. EVIDENCE: The Registered Manager was able to provide evidence of good financial practice relating to residents living at the home. Residents’ personal finances are managed either by residents who are able, or by their relatives. Other records relating to Health and safety are kept up to date. A sample of the home’s quality assurance questionnaire of the service done in February 2006 was seen. Comments included “Staff are always friendly and
Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 19 approachable. I feel the total standard of care is A1 and would recommend the care home to future families”; “Mum has been with you since day one and I cannot fault your service and care at all. Keep up the good work. Many thanks to you all for all that you do”. The Manager told the inspector that they had started an activities committee to which residents were invited. Residents that attended it told the inspector that they enjoyed being part of it. Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 20 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 x 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 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 x x 3 Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? None 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. 1. Refer to Standard OP9 Good Practice Recommendations The Registered Provider (s) should review medication practices ensuring that controlled drugs are correctly managed. The Registered Provider (s) should ensure all Staff files have two written references relating to their permanent employment. 2. OP29 Sutton in the Elms Nursing & Residential Home DS0000001927.V306973.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Leicester Office The Pavilions, 5 Smith Way Grove Park Enderby Leicester LE19 1SX National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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