Inspection on 14/06/05 for The Elms

This inspection was carried out on 14th June 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 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 18/10/07

The Elms 16/10/06

The Elms 08/02/06

Similar services:

2 Perhaver Park

The Vicarage

St George`s

5 Seafield Road

Credence House

Radfords

Honeybourne House

32 Beaumont Way

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

CARE HOME ADULTS 18-65 The Elms 28 Elms Way Southbourne Bournemouth Dorset BH6 3HU Lead Inspector Stephanie Omosevwerha Announced 14 June 2005 th 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 D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Elms Address 28 Elms Way Southbourne Bournemouth Dorset BH6 3HU 01202 431886 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) Elms Care Limited Mrs Ana Maria Greenwood CRH (PC) - Care Home Only 3 Category(ies) of LD - Learning disability (3) registration, with number of places The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None. Date of last inspection N/A Brief Description of the Service: The Elms is a small home set in its own mature grounds and is in keeping with all the properties in its immediate vicinity. It is situated in a quiet, residential area of Southbourne and is close to local shops and amenities. Bus routes to Bournemouth and Christchurch are easily accessed. The home is registered to accommodate a maximum of three adults of both sexes with a learning disability and had no vacancies at the time of inspection. The property has limited access to service users with physical disabilities, however, the facilities are appropriate for the intended service group, i.e. adults with learning disabilities. All residents have single rooms on the first floor and share the use of a bathroom. On the ground floor there is a large lounge with a separate dining area, kitchen and cloakroom/shower room. The home is well kept and furnished. Outside there is a garden that provides a seating area for eating out and a storage shed. Service users are offered a wide range of opportunities both within and outside the home. Two service users attend day centres whilst one service user has a daily programme provided by the home. The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was an announced inspection as it was the first inspection of the service since it had been re-registered with new providers, Elms Care Limited, in April 2005. The inspection took place over approximately 6 ½ hours and the registered providers Paul Greenwood and David Lallana were present throughout the day. A tour of the premises took place and all communal areas of the home as well as the three service users’ bedrooms were viewed. Records/documentation were inspected including all of the residents care plans and individual files. Further information was available from the application to re-register the home, e.g. statement of purpose, service user guide and reports from Dorset Fire and Rescue service and Environmental Health. All the residents were out for most of the inspection, although the inspector was still present on their return from their daytime activities. During the inspection, the inspector visited two of the residents at their daytime facilities and spent an hour talking to them and their keyworkers at the day centre. Residents spoke positively about their care, “It’s OK, I’m still quite happy with the new people”. They felt there had been some changes for the better such as spending more time downstairs talking to staff and being able to participate in household tasks such as making drinks, doing the laundry and cutting the grass. What the service does well: The Elms offers a small, family-type environment, which has changed ownership since the previous inspection. The residents benefited from an extended handover period and the new providers spent time getting to know them before taking over the home. The previous provider provided detailed information, which also contributed to a smooth transition period. A keyworker at the day centre commented, “there has been no obvious emotional reaction” to the changes in the home environment. There was further evidence that the new proprietors had been sensitive to the service users needs not making too many changes initially to reassure service users and provide them with security by consistency of care, e.g. following existing care plans and maintaining weekly planned activities. The registered providers plan to make improvements to the environment and service users confirmed they had been consulted and felt able to contribute to any new ideas e.g. using the existing garage space to create a new office, The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 6 which one service user thought was “a good idea”. There is a small, competent staff team who are well qualified and have a great deal of experience working with adults with learning disabilities. Residents are able to contribute to the running of the home and enjoy flexible routines that cannot always be offered in a larger home e.g. choosing meals spontaneously in the evenings. What has improved since the last inspection? 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 D55 S63293 The Elms V230887 140605 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 D55 S63293 The Elms V230887 140605 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) 1 and 5. There have been no new admissions to the home, although existing residents have experienced a change in ownership and management of the home. Residents were kept fully informed of the changes and a detailed handover period took place ensuring service users needs were taken into account. A new contract needs to be issued to each service user to clarify the terms and conditions with the new registered providers. EVIDENCE: New registered providers, Elms Care Limited, took over the Elms in April 2005. A Statement of Purpose and Service User guide were submitted to the Commission as part of the application and these contained all the relevant information as specified in the National Minimum standards, some minor amendments were required concerning the number and sizes of bedrooms. The three service users living at the Elms have remained in the home under the new ownership, their existing contracts with the previous registered providers are in place but these are no longer valid, and therefore, each service user needs to be issued with a new contract. Service user living in the home had been kept up-dated and fully informed of the changes in the home by both the previous and the new registered providers. The new providers had visited and spent time getting to know the residents prior to taking over the service and the previous provider had provided detailed hand-over information ensuring the transition was made as smooth as possible. Service users The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 9 confirmed that they had been reassured during the transition process and keyworkers at the day centre which two of the residents attended said they had observed “no obvious emotional reaction” to the changes. The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 10 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, 8 and 9. Existing care plans were being utilised to ensure consistency of care for service users over the transition period. There was clear evidence that service users had been consulted and felt able to contribute to future plans for the service. Risks were being managed in a way that promoted service users taking responsible risks rather than being prevented from doing so. EVIDENCE: The home is currently using the existing care plans that were put in place by the previous registered provider. These were viewed at the inspection and found to be comprehensive providing a record of service users personal details, their likes and dislikes and identifying their needs with tasks specified e.g. guidance, practical help or prompting. The current registered proprietor felt it was best to utilise these plans at first to ensure consistency of care, giving themselves time to get to the know the service users before any changes were implemented. There was evidence that service users had been kept fully informed over the transition period and they were still being consulted about further plans for the service so that they could express their views about any prospective changes. The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 11 Discussion with one of the residents confirmed they knew about plans to create a new office space in the existing garage and they thought this was “a good idea”. They had also been consulted about plans to utilise the previous owners private room to apply for a variation to extend the number of residents from 3 to 4. Risk and safety issues were identified on care plans and risk assessments were in place for individual activities e.g. going fishing and accessing the community. There was evidence that risk management strategies were in place and that these enabled service users to take responsible risks rather than restricting their activities, e.g. one service user was able to go out accompanied in the community but the service user told the inspector that they carried a mobile phone in case of emergencies and was able to demonstrate how they would use it. The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 12 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) 12, 13, 14, 16 and 17. All service users had a weekly programme of suitable activities and were able to access the community on a regular basis. Individual hobbies and leisure activities were encouraged and residents were able to pursue their interests on both an individual and group basis. Service users felt their individual privacy was respected and they were clear about their own areas of responsibility in the home. A varied and healthy diet was offered and service users confirmed they enjoyed the food. EVIDENCE: Each service user had a recorded weekly plan of activities. Two service users attended statutory day centres and the third service user had a daily programme provided by the home. All service users were out on the day of the inspection but the inspector was able to visit two of the service users at their daytime facilities. The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 13 Feedback from residents confirmed they were happy with the activities provided. They were able to give examples of accessing the community such as going to the pub, local beaches and shops. There was further evidence that individual hobbies and interests were encouraged e.g. going fishing or out for drives in the car. Service users were clear about their responsibilities in the home e.g. “I do my own cleaning – hoovering my room and I do my own laundry”. One service user told the inspector they were enjoying helping in the garden and were particularly pleased that they had been able to cut the grass. The service user guide clarifies service users responsibilities and sets out that residents agree to respect each other and not go into another person’s bedroom unless invited. Service users confirmed privacy was respected and that staff knocked on doors before entering. Service users had unrestricted access to all communal areas and said, “I spend a lot of time downstairs talking to staff”. They also appreciated the fact that “I do get my personal space”. Service users told the inspector they liked the food, although one resident commented that they were not always given a choice of menu. The registered providers said that choices were often made on an informal basis, i.e. meal choices were made on a daily basis according to what was available in the home and what the service users fancied. The registered provider felt this spontaneity was more in keeping with a family run home rather than formal menus provided in larger homes. A record was kept of each meal. It was recommended that where service users had indicated a choice this be recorded to provide evidence of service user participation in the process. Service users were involved in meal preparations and shopping and gave examples of this such as making cups of tea and peeling potatoes. The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 14 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 and 19. Service users privacy was respected and their preferences were taken into account when providing personal care/support. Service users were able to access a range of healthcare services including specialist support to ensure their physical and emotional health needs were met. EVIDENCE: Service users support needs were clearly identified in the individual plans e.g. “encourage mobility by moving to different positions and seating”. Personal preferences were also recorded e.g. “X enjoys a long soak in a bubble bath.” There was further evidence that changing needs were reviewed e.g. the use of a convene at night for one resident had been stopped and their continence was now being managed with less evasive techniques. Service users confirmed that they were given the “right support”. A member of staff at the day centre that one of the residents attended also commented, “X always comes in smartly dress and appears well cared for.” The home operates a key worker system and the service user guide specifies keyworkers are responsible “for seeing that you have all the help you need to live in the way that you want”. The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 15 There was evidence on service user personal files that their medical details were recorded. Visits to doctors, dentists and opticians were noted. There was further evidence of specialist support e.g. OT, physiotherapists to provide additional assessments where necessary. The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 16 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) 22. Service users felt confident any issues/concerns would be dealt with in the home, however, the procedure needs to be up-dated to reflect recent changes within the home. EVIDENCE: The home is currently using the leaflet devised by the previous registered provider. This needs to be updated to include the changes in ownership to the home and ensure the procedure accurately reflects the current practice in the home. One service user was able to describe the current procedure and said they were able to discuss any issues or concerns with a member of staff, the registered providers or the manager. The service users felt confident any issues would be “sorted out and make me happy”. The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 17 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 and 30. The Elms provides service users with a comfortable and homely environment and the new providers have plans to make further improvements to the facilities. The home was observed to be clean and hygienic with policy and procedures in place for the control of infection. EVIDENCE: A tour of the premises was carried out as part of the inspection. All communal areas of the home were viewed and all three residents bedrooms were also seen. A few minor improvements were noted e.g. a new vinyl floor had been laid in the upstairs bathroom, a handrail had been fitted up the stairs to facilitate mobility and a hand basin had been fitted in the laundry room. The registered provider discussed changes that they wanted to make to the home including creating an office space in the garage area, re-decorating the lounge and replacing some of the furniture, utilising the previous registered providers accommodation to create a fourth bedroom and replacing the furniture in one of the service users bedrooms whose chest of drawers had broken. Discussion with service users confirmed they were aware of these plans and felt they had been able to contribute to them. The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 18 Service users were happy with the accommodation provided and told the inspector they were relieved the Elms had been able to continue as a care home ensuring they did not have to move to an alternative placement. Observation on the day found the home to be clean, tidy and hygienic. The laundry facilities are sited in the garage area and procedures are in place to deal with soiled washing. A new hand basin has been installed in this area as required by the Environment Health department. The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 19 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) 32 and 33. Service users benefit from a small, experienced staff team who are well qualified and have an excellent understanding of working with people with learning disabilities including those with more complex needs. EVIDENCE: There were no care staff on duty during the inspection as all the service users were out of the home. The staff rota was observed and showed that the home was staffed 24 hours a day, usually with one member of staff on duty, however, there had been 2 members of staff on some occasions when extra support had been needed, e.g. prior to the handrail being fitted it had been necessary to have 2 members of staff to support one of the residents going up and down the stairs. There was a small, experienced staff team as the registered provider stated it was important to have competent staff, particular when they were working in the home alone. The team included the registered providers whom are all qualified Registered Nurses (Learning Disabilities) and have a great deal of experience working with people with learning disability including those who have complex needs. The registered provider said that all members of staff had received induction training specific to working in the Elms. There had been an extended handover The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 20 period prior to the new providers taking over and this had given them the opportunity to meet and spend time with the service users and benefit from detailed information from the previous provider to ensure the transition was as smooth as possible. Residents stated that “the staff are OK” and that they were “still quite happy with the new people”. When 2 service users came home from the day centre, the inspector observed them interacting with the registered providers and it was clear that they had begun to form positive relationships. The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 21 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) 42. Reports from other agencies, regular servicing and maintenance of equipment and working practices in the home ensure that the health, safety and welfare of service users are promoted in the home. EVIDENCE: Reports from the Dorset Fire and Rescue Service and the Environmental Health Department confirming the home meets their requirements had been obtained prior to registering the new providers. Records showed that services and equipment were being inspected at the required intervals. Records of fire drills and safety checks were up-to-date. The registered providers are aware of the relevant legislation regarding health and safety and policies and procedures are in place. The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 22 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 2 x x x 1 Standard No 22 23 ENVIRONMENT Score 1 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 LIFESTYLES Score 3 x 3 3 x Score Standard No 24 25 26 27 28 29 30 STAFFING Score 2 x x x x x 3 Standard No 11 12 13 14 15 16 17 x 3 3 3 x 3 3 Standard No 31 32 33 34 35 36 Score x 3 3 x x x CONDUCT AND MANAGEMENT OF THE HOME PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Elms Score 3 3 x x Standard No 37 38 39 40 41 42 43 Score x x x x x 3 x D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 23 No 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 1 Regulation 4 Requirement The registered provider needs to make minor amendments to the Statement of Purpose to ensure information about bedroom facilities are accurate. The registered provider needs to make minor amendments to the Service User Guide to ensure information about bedroom facilities are accurate. The registered provider must provide all service users with a written contract specifying the terms and conditions of occupancy and the facilities and services provided. The registered provider must ensure there is a clear and effective written complaints procedure that is given and/or explained to service users in an appropriate language/format. The registered provider must repair/replace the broken chest of drawer in one service users bedroom. Timescale for action 1 September 2005 1 September 2005 1 October 2005 2. 1 5 3. 5 5 4. 22 22 1 August 2005 5. 24 16 1 September 2005 The Elms D55 S63293 The Elms V230887 140605 Stage 4.doc Version 1.30 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard 17 Good Practice Recommendations It is recommended that when service users choose meals this is recorded to evidence their participation in menu selection. 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