CARE HOMES FOR OLDER PEOPLE
The Elms 2 Arnolds Lane Whittlesey Cambridgeshire PE7 1QD Lead Inspector
Lesley Richardson Key Unannounced Inspection 11th September 2007 11:20 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 The Elms DS0000024301.V345832.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. The Elms DS0000024301.V345832.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service The Elms Address 2 Arnolds Lane Whittlesey Cambridgeshire PE7 1QD 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) 01733 202421 01733 205584 www.bupa.co.uk BUPA Care Homes (CFC Homes) Limited Tracey Lynne Colley Care Home 37 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (35), of places Physical disability (2), Physical disability over 65 years of age (33) The Elms DS0000024301.V345832.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. One named male person under 65 years of age with physical disabilities (PD) for the duration of their residency only Thirty three persons over the age of 65 years with physical disabilities (PD(E)) for the duration of Condition 1 27th October 2006 Date of last inspection Brief Description of the Service: The Elms is a large converted and extended house, situated in a residential area close to the centre of the market town of Whittlesey. It provides care and support, including nursing care, for up to 35 older people. There are 31 single and 2 double rooms; 17 of the single rooms and both of the double rooms have en suite facilities. Resident accommodation is on two main floors, with two further split levels from the upper floor. The upper floor is accessible by stairs or lift, the split levels are accessible by stairs with chair lifts. There are a variety of communal areas available to service users, the smaller areas being on the upper floor. In additional to the en suite facilities there are 12 toilets and 5 bathrooms. All of the areas for communal use are accessible to service users with limited mobility. An enclosed garden surrounds the home and provides a safe environment for service users to enjoy the mature garden. The town centre of Whittlesey is a 5 to 10 minute walk from the home. A range of fees charged for accommodation at the home is available at the home. Copies of previous CSCI inspection reports are also available in the home for people wishing to read them. The Elms DS0000024301.V345832.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This was a key inspection of the service and it took place over 5 hours as an unannounced visit to the premises. It was spent talking to the manager and staff working in the home, talking to people who live there and observing the interaction between them and the staff, and examining records and documents. Information obtained through returned questionnaires from people who live in the home, and relatives and visitors has also been used in this report. Six questionnaires were returned from relatives and visitors, and 15 from people living in the home. All the requirements from the last inspection have been met. There have been no further requirements or recommendations made as a result of this inspection. This is an excellent service. What the service does well:
There has been a big improvement in many areas at the home since the last inspection and this is clear when entering the building. People living at the home said they like it, staff are polite and always willing to do things. Information about the home is provided before people move in and people said they also receive a contract. Procedures for medication administration are followed, medication is given out as it is prescribed and records are completed to say this is done. The home uses the Gold Standards Framework recommended by the Department of Health when they care for someone coming to the end of their lives. This means that people are cared for in the way they would like at this time in their lives. Relatives and visitors are welcome at any time to the home, one visitor said, “always made welcome, staff are nice and polite and willing to do things if asked. I can visit in private”. The home helps to keep people in touch with their relatives and tells relatives when issues arise that they should know about. Three quarters of relatives who returned surveys said the home supports their relative to live as they want. Most people like the meals that are provided, there is always a choice and snacks are available at any time. Procedures are available for complaints and concerns and staff know how to respond in these situations. People at the home know who to speak to if they are not happy for want to complain, and they say that staff usually listen and act on what they are told. People visiting the home also know how to make a complaint, but say there has not always been an appropriate response in the past. There haven’t been any complaints or allegations made in the last year. The Elms DS0000024301.V345832.R01.S.doc Version 5.2 Page 6 Recruitment checks are carried out before new staff members start working at the home. They are given induction training, which includes required moving and handling and fire training, before working with people. Other training is also given to make sure staff can meet the needs of people at the home. Nearly 50 of non-nursing care staff have got a national vocational qualification in care. Quality assurance surveys are carried out every year at the home, where people are asked what they think of the care and the environment in which they live. The last survey showed most people were happy with they home and only a very few areas that needed improvement were identified. The manager developed an action plan to show how these areas were going to be improved. Money that is kept and transactions that are made on behalf of people at the home is documented on a central computer. Interest is paid on this money and this is also recorded. The whole system is audited every year. Records are also kept of the health and safety checks that are carried out, which means the home can show if things are in good working order and what they have done to repair problems. What has improved since the last inspection?
All of the requirements and recommendations made at the last inspection have been met and improvements have been made in these areas. The home has recently started using a new assessment and care planning system. This means that there is much more information about people before they start living at the home and in the records kept for staff to care for them. The information written in care plans is very detailed and it gives the person reading it a very good idea of what the person is like, what they like and how they like things to be done. It also gives staff very clear information about advice from health care professionals, like other ways of measuring weight loss apart from simply weighing a person. The number of activities that are available to people has increased and they are able to spend time doing these things or doing something else if they want. Meetings have been arranged with people at the home to talk about activities and what they would like to have available; a film club has been started and outings are organised and several people enjoyed a trip to the coast this year. Comments from people living at the home include, “bed bound, like to listen to my cd’s and watch TV. I do get up for Holy Communion” and “went to the seaside, had great time”. There have been repairs and redecoration to most parts of the home, which hasn’t been a total refurbishment, but has made a big difference to the feel of the home. Door frames and wall corners have been repainted and covered to make sure further damage is limited, peeling window frames have been repainted and there are no more offensive smells around the home. More work to improve the home is being planned.
The Elms DS0000024301.V345832.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. The Elms DS0000024301.V345832.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 The Elms DS0000024301.V345832.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): 1, 2, 3 and 6 Quality in this outcome area is good. The home has adequate information about people before they live there. This means they are able to make a decision about whether the person can be properly cared for before moving into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager or deputy manager carries out assessments before people move into the home. Further assessments are obtained from health and social care teams and provide additional information so the home is able to say whether it has the staff with the skills and experience to properly care for someone moving in. Two thirds of people who returned surveys said they have a contract with the home and all but one person said they received enough information before moving into the home. The home does not provide accommodation specifically for intermediate care or for rehabilitation purposes.
The Elms DS0000024301.V345832.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): 7, 8, 9, 10 and 11 Quality in this outcome area is excellent. Care is provided in a person centred way that makes sure people are able to say what they want and get it. Health care is monitored and responded to, so that people can still choose to participate in everyday events. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has recently started using a new assessment and care planning system. Although all the information relevant to each person’s care has always been available in one folder, the new system divides care into broad sections. Care plans and associated risk assessments are kept in respective sections, which provides an easy guide to staff and makes it clear why some care has to be given in a particular way. Each person in the home has an individual folder with this information. Care plans are written in great detail and give a sense of who the person is, what they are like and what they like and don’t like. For example, one person’s care plans include information about preferred positioning in bed, television
The Elms DS0000024301.V345832.R01.S.doc Version 5.2 Page 11 programmes and what staff should do to make sure this person is able to drink as independently as possible. Another person is unable to say what she wants or doesn’t want, and the care records tell staff how her behaviour would indicate when she doesn’t like the food, what food she doesn’t like and how an assessment to assess weight loss should be carried out as she is not able to sit in a weigh chair. People in the home have access to health care professionals and there was information in records seen to show referrals to dieticians, speech and language therapists, physiotherapists and other professional are made. As commented on in the previous paragraph this information and advice is recorded and becomes part of the care plan for that person. Everyone returning surveys said they have access to medical advice and support when they need it. The home has started using the Gold Standards Framework to better meet the needs of people and their relatives during the period towards the end of their lives. Medication administration records are completed correctly and tally with medication stored for people in the home. The register detailing controlled drug medication is also completed correctly. This means staff at the home follow the right procedures when giving out medication. Staff members are polite, and they speak to people with respect. Most people who returned surveys said they receive the care and support. Relatives and visitors to the home also said the home gives the care that is expected and keeps them up to date with any issues that arise. The Elms DS0000024301.V345832.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): 12, 13, 14 and 15 Quality in this outcome area is excellent. People living in the home are involved in developing activities they will take part in, choosing meals and having contact with friends and relatives. This means they are able to choose as much as possible how they live while at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home provides an activities programme that has been developed with people living there and includes games, entertainment in the home and trips out. These include projects to put photo albums together, a film club, gardening and dominoes competitions. People living at the home said there are usually activities that they can take part in. Individual life histories and social interests are recorded in care plans and those seen showed a considerable amount of detail about lives and what people want while they live at the home. People who do not want to take part in organised activities are able to spend time doing what they want to in a place that suits them. One person said although they are confined to bed most of the time they are able to get up for Communion and like to spend time listening to music or watching television. Religious services are available in the home.
The Elms DS0000024301.V345832.R01.S.doc Version 5.2 Page 13 Relatives and visitors to the home said they are able to visit when they want and a private area, either in someone’s own room, or another area in the home. The home helps people keep in touch with relatives and friends and contacts relatives if issues arise. Most relatives thought the home supported people to choose how they want to live each day. One person visiting during the inspection said she is always made welcome, staff are polite and willing to do things if asked. One person living at the home said, “I get asked daily from a menu sheet what I would like, if not on offer they always accommodate me”. Most people said they like the meals and there is a choice of 2 or 3 main courses each day. Information about dietary preferences (likes and dislikes) and what a person might need to help them eat is recorded in care records. For example, one person’s care plan tells staff they should provide a straw so that person can drink when they want to and not have to rely on staff to give them a drink. The Elms DS0000024301.V345832.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): 16 and 18 Quality in this outcome area is good. The systems in place for protection and dealing with complaints are good and make sure people living at the home are protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has corporate complaints and protection policies and procedures, which are available in the home. People living in the home, relatives and visitors who returned surveys, and people during the inspection said they know how to make a complaint and would know who to approach if they were concerned or not happy with something. However, some relatives said complaints that have been made in the past have not always been responded to appropriately. 80 of people in the home said staff listen and act on what they have to say. The home has not received any complaints in the last 12 months and there have been no safeguarding incidents. Staff members receive training in the protection of vulnerable adults and this includes information about local guidelines. Although staff members gave appropriate responses to questions about safeguarding, there was some hesitation about also reporting incidents only involving people living at the home. This should be reinforced, so that all incidents are dealt with in the same way and are reported to outside agencies dealing with these incidents. The Elms DS0000024301.V345832.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. Recent work at the home means it is a safe and pleasant place for people to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home feels very different when compared to the last inspection. There has been some maintenance work at the home since the last inspection; door frames and window frames have been painted, scuff marks from walls and stains on ceilings have been removed and there is a general feel of a well maintained home. Offensive odours at the last inspection are no longer present and the home appears bright and airy. The manager said permission has been obtained to have the window frames replaced. This has taken a number of years as the home is in a conservation area. People living at the home said it is fresh and clean. There is access to a large enclosed garden, which is used by people living at the home.
The Elms DS0000024301.V345832.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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. Recruitment procedures, staff training and staffing levels are enough to make sure people are safely and properly cared for. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Staff members said there are usually enough staff on duty for them to be able to meet people’s needs quickly. People at the home who returned surveys said staff are usually available when they are needed and one person said during the inspection, “(staff) come very quickly if the bell is rung, they may not immediately do what is needed but they make sure everything is ok”. Staffing levels during the inspection were adequate and call bells were answered promptly. There is a registered nurse on duty at all times. Three staff files were looked at to check recruitment procedures are followed properly and required checks and information is obtained. This has been done for all three of these staff members. Although there are some issues with references and information in application forms that the home should follow up and question. For example, making sure references are from staff with management responsibility for the applicant, and making sure answers given in interview match statements made in the application form. The Elms DS0000024301.V345832.R01.S.doc Version 5.2 Page 17 New staff members receive induction training that includes required health and safety training. Additional training is available in areas identified by people’s needs. One staff member said she has received basic dementia care training and the activities co-ordinator has attended a training conference specifically aimed at providing activities for people living in care homes. Information provided before the inspection shows that just over 40 of non-nursing care staff have a national vocational qualification at level 2 or above. Relatives returning surveys said they thought staff members usually have the right skills and experience to meet people’s needs. The Elms DS0000024301.V345832.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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Records and checks are kept to show the health and safety of people living in the home is protected, their opinion is sought and that helps the home run in their best interests. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager has been working at the home for almost two years and is registered with the Commission for Social Care Inspection as manager. She is a nurse registered with the NMC and completed the registered managers award in 2005. It is clear there has been a significant change in the home since the last inspection. Staff demeanour, cleanliness of the home environment and the general feel around the home shows the manager has worked hard to improve the way the home runs and responds to the people who live there.
The Elms DS0000024301.V345832.R01.S.doc Version 5.2 Page 19 A quality assurance survey was last carried out in December 2006 and the published report is available in the home. The manager has completed an action plan that shows how the few issues that were identified are being addressed. People at the home said there are residents’ meetings that they can attend if they want to. Staff meetings are also held and staff members said this gives them the opportunity to raise concerns and issues. Staff and people living at the home are also involved in other meetings and committees around the home, like a health and safety committee and an activities meeting. A newsletter is published every month and sent to everyone at the home, keeping them up to date with events and things that have happened. People going to live at the home are given information about how the home takes care of their money and the procedures for debiting an account. Statements are sent on a monthly basis, detailing incoming and outgoing transactions, and any interest earned. Although all money is placed into the same account, each person using the system has a separate written account and record on the computer. The system undergoes an independent audit every year. Information shows maintenance checks and service visits are completed at the required intervals. Fire equipment records, personal appliance testing and hoist/lifting equipment maintenance certificates were looked at during the inspection and show these are completed at the required intervals. The Elms DS0000024301.V345832.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 3 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 4 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 4 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 2 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 The Elms DS0000024301.V345832.R01.S.doc Version 5.2 Page 21 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 The Elms DS0000024301.V345832.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Hertfordshire Area Team CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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
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