Inspection on 02/10/07 for The Elms

This inspection was carried out on 2nd October 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 12/11/08

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

Similar services:

Thorndene

Insight - Eastchurch

Southfields

Magenta

Seabourne House

33 St John`s Church Road

Dovedale Court

Lyncol House

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 Wendy Gabriel Key Unannounced Inspection 2nd October 2007 09:45 The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms Address 1 Elm Gardens Hythe Kent CT21 5PY 01303 230131 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Lothlorien Community Ltd Post Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 4th July 2006 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. The registered providers are Craegmoor Healthcare. Ms Nicola Daines is the acting manager. 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 £564.85 - £1169.15 per week. For further information please contact the provider. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. During the unannounced inspection the Inspector met and spoke with two members of staff, a work experience person and a relative of a resident who had just returned from a holiday. There was some limited conversation with two residents. Some records were seen and an accompanied tour of the premises was undertaken. The manager was not on duty at the time but was due into the home later to work during the night. The report reflects that some information was not available to the staff and that some findings could not be clarified with the acting manager. A telephone conversation with the acting manager took place some days after the inspection when further information was given to the Inspector. The home has undertaken considerable outside repair and redecoration since the previous inspection. A member of staff stated that near neighbours in the road had commented favourably about the changes made to the appearance of the house and that it now fitted in with the remaining properties. A member of staff confirmed a new staff appointment and that there is now a full staff compliment. A member of staff had left during the previous week and residents and staff took her out to dinner as a farewell gesture. The relative said that the home has improved a great deal in the past few years and that she had no problems with the manager or staff and that they were very friendly and caring. The staff were heard and observed talking with the residents in a warm, caring and appropriate manner. The home was comfortable and homely and was clean, tidy and hygienic. What the service does well: The atmosphere is that of a warm, friendly, family home. The décor and furnishings around the home is pleasant and individual. There is an activities organiser and a relative said that the home had arranged for an occupational therapist to organise certain activities including computer skills both in and out of the home. Staff communication with residents was appropriate and kind. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 6 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 summary of this inspection report can be made available in other formats on request. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Elms DS0000023560.V352031.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents are given information to enable an informed choice about where to live. Pre-placement and care plan guidance assist staff to support the needs and aspirations of people who live in the home. Service user agreements are in place but have yet to be completed with full information. EVIDENCE: A member of staff stated that there had been no new residents in the home for several years. Although she had not been involved with any new admittance, the member of staff was very clear about the need for prospective residents to have their needs properly assessed to enable the home chosen to be right for them. Staff discussions indicated that there was a good understanding of residents’ needs being identified, recorded and acted on. The company has an admission procedure and allows for a period of introduction including visits and over night stays. The procedures include assessments being undertaken. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 9 A service user agreement seen had not been fully completed. This had been mentioned in the previous report. The acting manager was not available to comment. A recommendation is made for the service user agreements to be reviewed to fully meet standard 5 of the National Minimum Standards. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know their personal needs and goals are assessed and they are consulted and enabled to make their own decisions about their lives. Residents are supported to take risks to enable their participation in their chosen lifestyle. Confidential information is maintained securely. EVIDENCE: Person centred plans seen included details of physical and social care needs. Risk assessments are comprehensive. The company has recently undertaken a change of format for the personal centred plans and these include a variety of information detailing physical and emotional needs and preferences. Residents have meetings and these are documented. A member of staff said that residents can be forthright in their views. Staff complete a daily record for each person who lives in the home. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 11 Each person has a house day where they assist in cleaning and with the laundry. One person takes responsibility, with some staff input, for planning, shopping and cooking her own meals. Confidential information is locked in cabinets within a secure office. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents have opportunities for age, peer and culturally appropriate activities. Family and friends are welcomed by the home. Residents’ rights are respected. Meals are varied and include dietary needs and choices. EVIDENCE: Activities include a variety of options to meet the interests of the residents. One resident showed the Inspector her knitting she was absorbed in and indicated the different interests she had in her room including puzzles. One resident works at the library and undertakes computer training. Different activities are available each day and this is indicated in care plans and on display in the office. The home has the use of a company vehicle. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 13 Activities in the community include hairdressers, shopping and pub lunches. Music and movement, including singing, is enjoyed weekly and there are opportunities to attend a disco; although the member of staff said that often residents have had a full day and are too tired to all attend. Once a week residents go to a snoozelan at a local KCC centre. Line dancing, swimming, bingo, bowling and visits to local leisure attractions are also enjoyed. During the day one resident spoke several times about an event she is looking forward to and the staff kindly and positively reaffirmed this for her. Cookery classes are undertaken in house with support from staff. Rehearsals for the company’s annual carol concert are underway and these are currently taking precedence over some other activities. Families are welcomed to the home and a relative said that the staff were friendly and caring. Residents have the opportunity to help choose the menu. A relative said the food is good. The menu was varied and included fresh vegetables and fruit. There was evidence of dietary needs and choices being recorded and cupboards in the kitchen had special foods and residents preferred choices stored and labelled. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents know that their emotional and health care needs will be met and that support will be given in a manner that maintains their dignity. Residents are safeguarded by medication administration procedures. EVIDENCE: Person centred plans record assessed needs for staff to be aware of preferred support for physical and emotional needs. Staff were able to talk about the residents different lifestyles. Through observing and listening to staff communicate with residents during the inspection; it was clear that they promoted residents’ rights to enjoy their chosen lifestyle. There was recorded evidence of healthcare needs being supported. A resident was escorted to a surgery during the inspection. Staff ensured the resident was aware of the procedure and the resident was able to confirm to the Inspector why she was attending. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 15 Medication administration is a monitored dosage system and there are company policies and guidelines for the staff. Staff receive training before being allowed to administer medication. Two people have to sign a release form before medication is allowed to leave the premises, for example to be taken with the resident on holiday. This is good practice. A member of staff said that an administration practice has altered recently to improve safety. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are encouraged to express their views and concerns. Staff training is relevant to protecting the vulnerable. EVIDENCE: Records are maintained of concerns raised and of action taken. A member of staff was able to speak with clarity about the procedure for raising concerns or complaints and stated that the acting manager was approachable. A complaints procedure is on display in the home. Staff training includes adult protection and POVA. Regular supervision monitors staff understanding of adult protection needs. A relative said that she knew the procedure for making complaints and was able to raise concerns with the acting manager. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The environment is homely, comfortable, clean and hygienic. There is ample communal space to compliment residents’ individual rooms. EVIDENCE: Since the previous inspection, the exterior of the home has been greatly improved by being repainted and by several windows being replaced. A member of staff said that some near neighbours of the home had commented favourably of the improvement and that they had said it now fitted in with the rest of the properties in the road. The interior of the home was clean and tidy and well presented. Some bedroom carpets were looking dingy in places, although were clean. Bedrooms seen were very individual and contained personal possessions that made them homely and comfortable. A relative commented on the fact that a bedroom door closed very quickly because of the fire safety precautions and was concerned the resident might The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 18 be accidentally knocked over if not able to get out of the way in time. A recommendation is made for the home to review the risk regarding the safety closure on the door. Bathrooms and toilets were clean and hygienic. The laundry is domestic in scale but adequate for the homes use. The kitchen is clean and tidy but some cupboard doors are showing signs of wear. Coshhe is secured in a locked cupboard. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 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 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported by a full staff compliment and by robust recruitment procedures. Staff receives training and regular individual supervision. EVIDENCE: Staff files could not be reviewed at this time as the acting manager was not available. However, staff were able to comment on the amount of training they had received from the company. Training certificates and a training matrix seen, indicated that induction is undertaken by all staff. A ‘staff induction and workbook folder’ is provided by the company and is linked to ‘Skills for Care’. There were three residents in the home and one due to return from holiday at the time of the inspection and there was a member of staff and a work experience person in the home followed by another member of staff later in the morning. Formal supervision and annual appraisals are undertaken. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 20 Staff confirmed that they had had CRB checks. A key worker system is in place and a member of staff was able to describe this process and how it benefits residents. Staff understood the whistle blowing procedure that is provided by the home. The acting manager confirmed during a telephone conversation, that 5 members of staff had or were currently undertaking NVQ3 that 2 members of staff were taking NVQ2 and that a member of staff from a European economic area had a certificate similar to NVQ. It was clear by observing and hearing communication between staff and residents that the ethos of the home is caring and positive and that residents are enabled to enjoy their preferred lifestyle. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 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 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ benefit from a well run home. Quality assurance in the home underpins the health and safety of the residents. Residents’ views are listened to when planning their best interests. EVIDENCE: The acting manager was not available at the time to comment on her own responsibilities or to discuss any of the standards. During a telephone conversation later, the acting manager confirmed that she is to apply to be registered at the end of the month. Members of staff were able to discuss various policies regarding the welfare of residents in the home and a robust quality assurance file was seen regarding policies and regular auditing of finances, clinical governance and evidence of residents involvement. Staff meetings are recorded. Monthly monitoring visits The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 22 are carried out to ensure the standard of care and documentation is carried out. Accident and incident records are kept. The home maintains an up to date fire safety record book. Water checks are undertaken for safety and regular maintenance checks are undertaken. Other maintenance records were not seen at this time. Staff confirmed the relaxed and approachable management of the home. The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 23 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 Standard No Score 1 3 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 3 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF 3THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 X 3 3 LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X The Elms DS0000023560.V352031.R01.S.doc Version 5.2 Page 24 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. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA5 YA42 Good Practice Recommendations Service user agreements are to be completed. Bedroom door to be risk assessed for safety of the occupier of room. 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