Inspection on 12/07/05 for The Elms

This inspection was carried out on 12th July 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

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

Other inspections for this house

The Elms 12/11/08

The Elms 02/10/07

The Elms 04/07/06

The Elms 29/11/05

The Elms 15/11/04

The Elms 23/04/04

Similar services:

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Southfields

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

CARE HOME ADULTS 18-65 The Elms 1 Elm Gardens Hythe Kent CT21 5PY Lead Inspector Julian Graham Unannounced 12 July 2005 9:30 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 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 Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationary 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 H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Elms Address 1 Elm Gardens, Hythe, Kent, CT21 5PY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01303 230131 Lothlorien Community Ltd (a wholly owned subsidiary of Craegmoor Group Ltd) Care Home only 4 Category(ies) of Learning Disability x 4 registration, with number of places The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: none Date of last inspection 15/11/04 Brief Description of the Service: The Elms is registered to provide accommodation and personal care for up to four people who have a learning disability. At the time of this inspection four people were in residence. The Elms is located in a quiet residential area within three quarters of a mile of the town centre and sea front. The house is a substantial property in an elevated position with the accommodation arranged on two floors. All of the Residents have their own bedrooms. There is ample garden space for use by residents. Hythe is a small town and has a selection of shops, cafes, entertainment, public amenities, and public transport links.The registered providers are Craegmore Healthcare. The Registered Manager,Mrs Wanstall, no longer manages the Home. The home is currently being managed by Gillian Waghorne. The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection of The Elms which started at 09.45 and took place over six and a quarter hours. The inspector met and spoke with three of the residents during the visit. As on previous occasions, the fourth resident chose not to speak with him. One of the residents was spoken with in the privacy of her bedroom. This person was a little under the weather and said she was “a bit fed up”. The manager is currently liaising with Social Services regarding the possibility of this person wanting to move from The Elms into a new home. The inspector met with the other two residents in the lounge. They looked relaxed and well cared for, and where they were able to they indicated to the inspector that they are happy living in the home. The inspector spent time with the manager and spoke with three staff members, two of whom in private. A tour of the premises was undertaken, which included three of the residents’ bedrooms and the communal areas. Some records were examined, including care plans and two staff files. The inspector wishes to thank the residents, manager and staff for their welcome and assistance during the inspection. What the service does well: What has improved since the last inspection? The home has worked hard to build up the confidence of one of the residents, who in recent weeks has been spending more time with the other residents The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 6 and staff, and going out more. There was also reference to “improved verbal communication” in this person’s care plan. Another resident is being supported to radically alter a medication regime that is resulting in fewer seizures and a better quality of life. Medication is now being kept securely in a new cabinet, new fire doors have been fitted, and residents have the bedroom furniture they want. Staff are receiving structured induction training and are accessing a range of external training courses. 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 Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Standards Statutory Requirements Identified During the Inspection The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users’ know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 The company’s pre-admission needs assessment form is detailed and comprehensive and forms part of a clear pre-admission process. This in turn informs the care planning system. EVIDENCE: There have been no admissions to the home for some time now. However, previous inspections have confirmed that comprehensive pre-admission needs assessment forms are in place, and are called Outcome Based Evaluations. The needs of any prospective residents would be assessed using these forms which would enable the home to judge the person’s suitability for admission. The needs of all the residents currently living in the home have been re-assessed within the past twelve months using this form. The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate, in all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 6,7,8,9 There is a clear and comprehensive care planning system in place. Residents are supported to make decisions and are offered opportunities to participate in the life of the home. EVIDENCE: Three care plans were examined and these were very clear and comprehensive and cover a wide area of individual need, ranging from accessing the community to cooking the evening meal. There was evidence of two monthly evaluation and review. There is a section on “things I would like to do” which residents have been supported to complete. A number of long and medium term goals have emerged from this list. It is a recommendation of this report that one or two of these goals for each resident are prioritised for specific attention, broken down into separate steps where necessary, and properly actioned and monitored. This will give residents a greater chance of work being done to actually meet the goals. As required from the previous inspection, the communication needs of residents are being detailed in the care plans. There was evidence within the care plans that residents are being supported to make decisions. One resident, for example, has signed a declaration that she does not want to go on holiday this year. Another resident has signed that she is in agreement with having cot sides fitted to her bed in order to prevent her falling The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 10 out of bed should she have a seizure at night. There was an entry in a care plan to “respect her decision” regarding whether or not to receive visitors. One resident is indicating she might like to leave The Elms. The manager is in contact with social services to explore this further. Residents have the opportunity to attend a meeting every couple of months or so and receive information on matters such as new staff working in the home. Residents are given opportunities to participate in routine household chores, and all have “house” days when they are supported in cleaning their rooms. One resident was observed clearing the mats from the dining room table following lunch. Two residents have varying degrees of involvement in preparing meals. A resident said she makes her own breakfast every day. The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 11,12,13,14,15,1617 Personal development is promoted in the home. Some outings to the wider community are taking place, although these could be increased to the benefit of residents and to meet individual requests. EVIDENCE: Staff demonstrated awareness of residents’ individual communication needs, including the use of communication boards for one resident. A greater and more consistent use of the makaton sign language to assist this resident in communicating more effectively is recommended and which will require staff training. Each resident has an activity schedule and these were viewed by the inspector. Some residents attend sessions at the company’s vocational facility located nearby. Other activities include swimming and horse riding. A sample of daily records were viewed and there was little evidence that residents are going out on trips to places of interest very much. The manager said that residents last went out for a meal in May this year. Whilst residents access some local facilities, these are largely confined to the local shops and swimming pool. A more proactive approach towards making use of a wider use of local amenities and going to see places of interest is recommended . This The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 12 will enable residents to lead more interesting and less routine lives. One resident is being supported by staff to go to church regularly. Links with residents’ families are being appropriately supported and maintained. One resident has a friendship with a resident in another home, and whilst contact does occur, the home is encouraged to take a more pro-active approach towards facilitating meetings in accordance with the resident’s wishes. The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 18,19,20 Residents receive sensitive personal support and their healthcare is promoted. The security of medication has improved, but some medication practices still require improvement. EVIDENCE: Residents were looking very nicely presented with their clothes, hairstyle and appearance reflecting their personalities. Staff who were interviewed demonstrated understanding of the need to respect residents’ dignity and privacy. Residents are enabled to access healthcare professionals as required. One resident, for example, is being supported in gaining access to up to date information and advice regarding altering her medication regime to control her seizures. The arrangements for the control and administration of medication were examined, and the systems are generally sound. A new medication cabinet has been purchased as required from previous inspections, thereby improving security. Two matters requiring attention from the last inspection have not been addressed. These include: handwritten entries are not being signed and countersigned, and there is no local written procedure for the ordering, receipt and recording of medication. On this inspection, it was noted that some medication taken on leave is being transferred from its original container into a secondary container, and there is no written policy to ensure the safe management of this arrangement. The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 14 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 23 Not all staff have sufficient understanding of the need to protect residents from abuse, thereby putting residents at risk. EVIDENCE: The home has written policies and procedures on adult abuse and whistle blowing and four staff have attended training on adult abuse since the last inspection. One of the staff interviewed, however, and who attended the training, demonstrated extremely poor understanding of the rationale behind protecting residents and of the need to report any allegations irrespective of whether she thinks the resident making the allegation is telling the truth. The home is required to ensure that all staff fully understand, follow and are empathetic towards the home’s adult abuse policies. The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 15 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 24,25,26,27,28 The standard of the environment is good within the home providing residents with an attractive, comfortable and homely place to live. EVIDENCE: A tour of the premises revealed good standards of hygiene and cleanliness and the home was free from offensive odours. The home is domestic is style and size and has sufficient space for the four residents living there. The written audit of residents’ bedrooms showed that items of furniture requested by residents have been purchased. Residents’ bedrooms viewed were very homely and comfortable. New curtains for the lounge and dining rooms and which were chosen by the residents have been purchased and are awaiting to be hung. These two rooms are also shortly to be redecorated, the inspector was told. Bathrooms and toilets were clean and suitable for the residents living in the home. The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 35 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,33,34,35,36 The Elms has a reasonably settled staff team which is of benefit to the residents. Recruitment practices are sound, and staff are generally being well supported and supervised. One staff member is not clear as to her role and responsibility which potentially puts residents at risk. The management of a staffing issue relating to the deployment of staff was unsatisfactory. EVIDENCE: Staffing levels are satisfactory, although the manager said that the shortage of staff who can drive is affecting how often the residents can go for trips out. The manager must ensure that staff do not work a waking night shift either followed or preceded by a day shift. The health, safety and welfare of residents must not be compromised to allow staff to work extra shifts. Four of the eight staff, including the manager, who work in the home are from an eastern European country. Whilst the inspector was able to speak with two of these staff during the inspection and noted that their spoken English is adequate, the home must ensure that the staff team reflects the cultural composition of the residents; and also that at all times there are staff who can communicate with residents in their first language. The files of the two newest staff members were viewed and these showed that sound recruitment practice is being followed. Staff are being enabled to access a range of training courses, including autism, First Aid and moving and handling. It is a recommendation of this report that the staff training matrix is amended to show the dates the The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 17 courses were undertaken and that the individual staff training records give a clear chronological account of the training undertaken. The manager said staff are receiving formal one to one supervision, although the records in support of this were not viewed on this occasion. The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 37,38,39,41,42 The management of the home is mostly satisfactory, and the residents are benefiting from the manager’s open approach. However, more attention is needed to ensure the protection of residents through checking of staff’s understanding of key areas, and ensure the sound deployment of staff that does not compromise the needs of residents. EVIDENCE: The manager has worked hard to meet the majority of the requirements made at the previous inspection. The processes of managing and running the home appear honest and transparent. See also Standards 23 and 33, regarding protection of residents and deployment of staff. Given the small size of the home, the views of residents are mainly sought informally on a daily basis, but also in formal residents’ meetings. Several suggestions from residents from these meetings have yet to be acted upon, however. It has also been a while since the last relatives’ feedback questionnaire. The home has done well to receive the Investors in People Award recently. Verbal assurance was given by the manager that environmental risk assessments have been reviewed; and no The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 19 obvious health and safety hazards were noted during the inspection. The fire alarm system is being tested regularly and there is a current fire risk assessment. Staff are overdue for fire safety training, however, and the fire procedure needs reviewing. Records are being maintained to a good standard. The manager is awaiting confirmation of the date she will commence the Registered Manager’s Award. The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x 3 x x x Standard No 22 23 ENVIRONMENT Score x 1 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 3 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 3 3 3 3 3 x 3 Standard No 11 12 13 14 15 16 17 3 3 2 2 3 3 3 Standard No 31 32 33 34 35 36 Score 2 x 2 3 2 x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Elms Score 3 3 2 x Standard No 37 38 39 40 41 42 43 Score 2 3 2 x 3 3 x H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 21 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 20 Regulation 13 Requirement With regards to medication: a) all handwritten entries in MAR charts to be chedked and signed by two staff. (timescale of 23/04/05 not met) b) written local procedures for the ordering and receipt of medication to be available. (timescale of 16/01/05 not met) c) policy on taking medication on leave to be available. Manager to ensure that all staff fully understanding and embrace the need to protect residents from abuse and to know and carry out the procedure to follow in the event of any allegation or suspicion of abuse. No staff to work a waking night shift either followed or preceded by a day shift. Manager to ensure that at all times there are staff on duty who can communicate with residents in their first language. Fire training for all staff to be kept up to date. Timescale for action a) 12/07/05 b) and c) 12/09/05 2. 23 13 19/07/05 3. 4. 33 33 18 18 13/07/05 19/07/05 5. 42 13 12/08/05 The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 22 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. 2. 3. 4. 5. Refer to Standard 6 14 35 35 42 Good Practice Recommendations Residents to be consulted with regards any personal goals they may have, and for these to feature in care plans, and to be monitored and recorded. Residents to have access to and choose from a wider range of leisure activities, and for these to be recorded. Staff to receive training on makaton. Staff training matrix to include dates of training; staff training records to be maintained more clearly. Fire procedure to be clearer. The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection 11th Floor, International House Dover Place Ashford, Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Elms H56-H05 S23560 The Elms V226238 120705 Stage 4.doc Version 1.30 Page 24 - 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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