Inspection on 12/11/08 for The Elms

This inspection was carried out on 12th November 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

The Elms 02/10/07

The Elms 04/07/06

The Elms 29/11/05

The Elms 12/07/05

The Elms 15/11/04

The Elms 23/04/04

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Extracts from inspection reports are licensed from CQC, this page was updated on 17/02/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: The Elms 1 Elm Gardens Hythe Kent CT21 5PY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Kim Rogers     Date: 1 2 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 26 Information about the care home Name of care home: Address: The Elms 1 Elm Gardens Hythe Kent CT21 5PY 01303267212 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Lothlorien Community Ltd care home 4 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability Additional conditions: The maximum number of service users who can be accommodated is: 4 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Learning disability - LD Date of last inspection Brief description of the care home The Elms is registered to provide accommodation and personal care for up to four people who have a learning disability. The registered providers are Craegmoor Healthcare. The Elms is located in a quiet residential area of the small seaside town of Hythe where there is a selection of shops, cafes, entertainment, public amenities, and public transport links. All of the residents have their own bedrooms. The rear garden is on a slope but with walkways and steps down to a level lawn. There is parking in the road outside of the premises. The reported fees are between about 564.85 - 1169.15 pounds per week. For further information please contact the provider. 4 Over 65 0 Care Homes for Adults (18-65 years) Page 4 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: This was a key inspection which means that all of the Key Minimum Standards were assessed. The last key inspection was 2.10.07 and we carried out an Annual Service Review on 20.06.08. Reports can be obtained from the provider. We spoke to the manager staff and service users, sampled records and had a look around the home. We also looked at the information in the Annual Quality Assurance Assessment completed by the manager. This gives information about what the home does well, what could be better and how they intend to improve. Care Homes for Adults (18-65 years) Page 5 of 26 Care Homes for Adults (18-65 years) Page 6 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get Care Homes for Adults (18-65 years) Page 7 of 26 printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Assessments of peoples needs are completed before a person moves in. Information about the home must be right and meaningful so people have the most up to date information about the service. Evidence: We found that an assessment tool is used by the company to assess a persons needs. This is done to ensure the home can meet the persons needs. We found that this does not include the persons aspirations so staff may not be aware of personal aspirations at an early stage. The manager said there are plans to update and improve the assessment tool. No one has moved in to the home since the last inspection and there are no current vacancies. There is some information about the home, which is written. Some information has symbols with text. We found that the Statement of Purpose on display dated 26.06.07 has some incorrect information like an ex managers name and may not be meaningful to everyone. The AQAA says they plan to update this so prospective and current Care Homes for Adults (18-65 years) Page 10 of 26 Evidence: residents have the most up to date information about the service. The Statement of Purpose is displayed across the hallway wall with other written information. You see this as you enter the home and it does not make it feel homely but like an obvious care home. The manager agreed and said they would talk to service users about this. The manager has improved service users agreements by increasing the font size and adding pictures. These detail the terms and conditions of a persons stay at The Elms. This means that service users have a better understanding of their responsibilities. Care Homes for Adults (18-65 years) Page 11 of 26 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Plans of support are needed to ensure that people achieve their personal goals. Risk taking and communication are supported to people can lead more independent lives and have some control. Evidence: One service user plan was sampled in detail and we spoke to the manager. Service user plans should detail the persons needs and goals as well as show what staff support is needed to support the person. All plans look the same so are not individual to each person. We found that some personal goals are recorded but there are no plans in place to say how staff should support goals, what they should do and by when. Without detailed plans of support people will not achieve their goals and learn new skills. The manager has recognised this shortfall in the care planning system and has developed her own plans. She plans to implement these so staff can see what they need to do to support people. This will also show achievement towards personal goals and will show if the support is right or needs to be changed. We found that service Care Homes for Adults (18-65 years) Page 12 of 26 Evidence: users and their families are involved in developing plans. Detailed life history information gives staff a complete picture of the person and any significant life events. The manager has introduced a tool for key workers to use each month called a chit chat sheet. Key workers meet with service users and review their plans and talk about any issues and record this with any action on the chit chat sheet. This means that service users are involved in the regular review of their plans and can air their views about things. We found that where people are at potential risk of harm assessments have been carried out. This means that the risk has been considered and steps taken to reduce risks to people. We found that there is basic information about communication needs recorded in care plans. The manager has written further more detailed guidance for staff about how people communicate and added this to plans. This shows clearly when I do this, it means this. These plans of support mean that people have better support to make choices and decisions about their lives. Referrals have been made for extra support with communication. We found that not all information is presented in a way that is meaningful to all service users. For example people currently only know who is on duty or what is happening that day if they ask staff. This means that they are not in control of finding out for themselves. The manager has recognised this and has started to take photographs of staff and activities, which she plans to laminate and display. We found that people are supported to make choices about their lives like holidays, menu and activity choices. One person is having support to develop their computer skills and another person has chosen to move more independent living. Advocacy services support one service user. Care Homes for Adults (18-65 years) Page 13 of 26 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have access to a range of activities. There are opportunities for personal and skills development. Relationships are supported. Evidence: We found that there is a range of activities on offer that people have the opportunity to take part in. Some of the activities are group activities provided by the company and held at a local community centre. Evening activities like discos are also offered. Some people access community based activities. On the day of the visit two people went to a local spa with two staff and one person went out with a friend. There are some opportunities for one to one support. The home has an activity person who has had training related to service users needs so has a good understanding and experience of supporting people to achieve. There are opportunities and support for continued learning, for example one person has accessed a computer course. Each Care Homes for Adults (18-65 years) Page 14 of 26 Evidence: person has an activity planner covering seven days and evenings. The manager has reviewed the activities on offer recently with service users and staff to ensure that there is a variety and range to suit everyone. The manager plans to present this information in a meaningful way and hopes it will give people more choice. We found that relationships are supported and people have opportunities to make friends. People have the support they need keep in touch with family and friends. Families are involved in reviewing and developing service user plans. We found that although staff do most of the cooking and cleaning service users have house days when they have support to clean their room. People make their own breakfast and get involved in planning and preparing meals. Staff order food on line and have it delivered. This means that service users do not get the opportunity to experience supermarkets. Some go to the local shops to buy small household and personal items. The manager has developed clear guidelines for staff about how to support people to develop their skills. She plans to introduce this at the next team meeting. People have support to access the community like local pubs, shops, churches and cafes. Some people are going away for a long weekend soon and others have chosen to have days out. People hobbies are supported and encouraged. Care Homes for Adults (18-65 years) Page 15 of 26 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People know that their personal and health needs will be supported. Medication practice is safe. Evidence: We found that personal care needs are recorded in service user plans although there is not much detail about how people want to be supported. Without detail people may not get the support they need in the way they prefer. The manager agreed to add more detail. We found no plans in place to develop or increase peoples skills with personal care. This means that skills may not be developed so people have to continue to rely on staff. The manager has recognised this and is developing individual action plans to help increase peoples skills. We found that health needs are recorded with clear guidance on how to support people to stay healthy. Everyone has a GP and staff make referrals for extra health support when necessary. Everyone has a health checklist and the manager has developed health action plans with people to show what support they need to remain healthy. The manager has tried to make these as meaningful to service users. The manager Care Homes for Adults (18-65 years) Page 16 of 26 Evidence: said she plans to improve this by showing they are reviewed more regularly. We found that medication storage is safe and there are good records of receipt and administration of medication. Although storage is safe it is cramped with no room to divide internal and external medicines. The manager said she plans to improve storage. We found that staff have training before they administer medicines. Systems have been improved following some medication errors to make sure people remain safe. The issue of people needing to take tablets out of the house was discussed. People should not miss out on opportunities because they need to take medication. The manager should refer to the Royal Pharmaceutical Society Guidelines for medication practice in care homes to ensure they follow best practice guidance. We found that some people are subject to quite sensitive medication regime, however no consent has been sought to this from the person. The manager must seek advice about this following the implementation of the Mental Capacity Act 2005. Care Homes for Adults (18-65 years) Page 17 of 26 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service know who to complain to. Staff know about safeguarding procedures to keep people safe and protect them from harm and abuse. Evidence: We found that there is a written complaints procedure displayed in the home. The manager said this is also produced with text and symbols. The manager agreed that this is not meaningful to everyone so people who use the service may not know about the complaints procedure. Records show that they take complaints seriously, investigate and take any necessary action. We have received one complaint about the home since the last inspection. This was about the managers qualification and the opportunity for one to one support. This was passed to the Provider to investigate and take action, which they did. For more information about this please contact the Provider. There is a safeguarding vulnerable adults and whistle blowing policy and procedure. Staff attend training in safeguarding vulnerable adults. The manager was clear about the safeguarding protocols when we asked and knew what action to take of a disclosure is made or concern reported to her. This means that service users are protected. Care Homes for Adults (18-65 years) Page 18 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well maintained and a pleasant safe place to live. Evidence: The home is well maintained with adequate furniture and fittings. There are spacious communal areas and each bedroom is single with a wash hand basin. There are enough bathrooms and toilets. There is unrestricted access to the gardens so people can get fresh air when they want. People have a key to their bedroom and the front door if they want one. There are plans to improve the kitchen. We found the home is clean and smells fresh. On entering the house from the front doors we found lots of company information displayed on the walls. This does not make the home feel homely and ordinary but like a care home. The manager said she would discuss with service users about putting this information in a file so it looks more homely. Care Homes for Adults (18-65 years) Page 19 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There are enough trained staff to meet service users needs. Recruitment checks are robust protecting service users. Evidence: We found that access to mandatory training is good and the induction is adequate. Some staff have attended training relating to service users needs like epilepsy and autism although training is person centred planning is very limited. This means that staff are not competent in developing person centred plans with individuals to support them achieve their goals and live the lives they want. About half of the staff have a National Vocational Qualification in care. We found that recruitment checks are carried out before a person starts work at the home. The home employs some overseas staff and commissions a company to carry out the required checks on these staff. This protects service users. The manager said that the home is fully staff with some long standing staff who know service users well. We found that there is usually two staff on duty during the day and one waking staff at night. Extra staff can be called in for activities planned in advance. The manager said that there is frequent opportunity for one to one support. Care Homes for Adults (18-65 years) Page 20 of 26 Evidence: We found that staff have the opportunity to attend regular staff meetings and supervision meetings. This means they have the opportunity to discuss training, service issues and have the support and coaching they need. Staff currently work up to 14 hour long shifts. This means they may get tired and impact on outcomes for service users. We recommend that staff working long shifts be reviewed. Care Homes for Adults (18-65 years) Page 21 of 26 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is well managed and peoples health and safety is protected. Service users views underpin the review and development of the service. Evidence: Since the last inspection there has been a change of manager. The manager has been working at the home for about two years and is applying to the Commission to be the Registered manager. This means that she will go through the fit person process so people know that she is a fit person to manage the home. The manager has support from an area manager. The manager has a National Vocational Qualification, NVQ, at level 3 in care and plans to complete the required NVQ in care and management at level 4. The manager has no qualification in learning disabilities. The manager spoke with knowledge and understanding of service users needs and has creative and innovative ideas about improving the service and outcomes for service users. We carried out an Annual Service Review, ASR, of the home on 20.06.08. Due to the lack of information in the Annual Quality Assurance Assessment, AQAA, the date of this key inspection was brought forward. A copy of the ASR can be obtained from the provider. Care Homes for Adults (18-65 years) Page 22 of 26 Evidence: We found that there are some quality assurance systems in place. The manager completes weekly and monthly returns for head office. The manager said that surveys are sent out to stakeholders by head office but the manager was not aware of any responses or action plan form these surveys. We found that service users meetings are held so people get to air their views. The AQAA gives examples of changes that have been made based on service users views including an improved range of activities and menu choices. We found that real issues are discussed, for example a recent application for planning permission by a neighbour. An area manager or other senior manger makes monthly monitoring visits to the home. We found that reports are completed and show that service users and staff are spoken to. The company carried out a yearly audit of the service and this was completed on 16.09.08. Some recommendations to improve practice were made. The AQAA shows that health and safety checks are carried out. We found that staff attend training related to health and safety including food safety and first aid. We found that fire equipment is checked regularly but there has not been a fire drill this tear. The manager said she would organise a drill by the end of this year. Care Homes for Adults (18-65 years) Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 20 34 Advice should be sought following the Mental Capacity Act 2005 so people consent to intrusive medication. Staff working 14 hour long shifts should be reviewed to ensure there is no negative impact on outcomes for service users. Staff should have training in person centred planning so they know how to develop plans with individuals to support them achieve and live the lives they want. 3 35 Care Homes for Adults (18-65 years) Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 26 of 26 - 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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