Inspection on 20/12/06 for The Elms

This inspection was carried out on 20th December 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Excellent. 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 13/01/06

The Elms 17/10/05

The Elms 18/03/05

The Elms 21/12/04

Similar services:

Hillview Farm

Dalewood Respite Care

Orchard,The

REACH Upton Court Road

Fairways

Treloar College

Kestrel House, St Anne`s Opportunity Centre,

Pinta

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

CARE HOME ADULTS 18-65 The Elms Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ Lead Inspector Kerry Kingston Unannounced Inspection 20 December 2006 11:00 th The Elms DS0000033970.V322261.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 DS0000033970.V322261.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 DS0000033970.V322261.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms Address Ravenswood Village Nine Mile Ride Crowthorne Berkshire RG45 6BQ 01344 755575 01344 773174 theelms@norwood.org.uk www.norwood.org.uk Norwood Ravenswood Ltd T/A Norwood 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) Mr G E J Anstead Care Home 11 Category(ies) of Learning disability (11) registration, with number of places The Elms DS0000033970.V322261.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 13th January 2006 Brief Description of the Service: The Elms is part of the Norwood organisation based at Ravenswood Village. The home is registered to provide accommodation and care for up to 11 service users, aged between 18 and 65 years of age. All service users have a learning disability. The range of care needs within the home is diverse and complex. Several of the service users have needs which can challenge the service. All service users have full mobility and are able to communicate their needs and wishes. Fees are £47,053 per annum to £93,273 per annum. The Elms DS0000033970.V322261.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a routine unannounced site visit that took place between the hours of 11.00am and 6.00pm on the 20th December 2006, to collect additional information to inform the report for the key inspection. The information was collected from a pre-inspection questionnaire completed by the manager, surveys completed by five of the ten service users, discussions with three staff members and the manager, discussions with five service users and observations of service users and staff. A tour of the home and reviewing service user and other records was also used to collect information on the day of the visit. The home is registered for 11 service users - there are ten currently resident. The home has excellent outcomes for service users in several areas, is continuing to develop and has complied with all the requirements from the last inspection. What the service does well: The home makes sure that all the residents’ needs are known to staff so that they can be given the best possible care. The home makes sure that residents do as much for themselves as they can and that staff listen to what they are saying. Residents are helped to look after themselves properly and are helped to lead a happy and interesting life. The way that the home gives medicine to the residents is very safe and the staff all know what they are doing. The home is lovely and clean and comfortable and people are given a special place to live if it makes them feel better. The manager makes sure that all the things that the staff do makes life better and more enjoyable for the people who live there. The Elms DS0000033970.V322261.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 DS0000033970.V322261.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 DS0000033970.V322261.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): 2 Quality in this outcome area is good. The home would ensure that a prospective service user’s needs are properly assessed and they would be given choice about where to live prior to admission. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A full assessment of needs completed by the Community Team for People with Learning Disabilities is included in the care plan of the last service user to be admitted (in 1997). Multi-professional annual reviews are completed and reassessments made if necessary. There have been no admissions since 1997 but the admission policy would be followed if there were to be a new admission. The home has one vacancy and the manager advised that he was already beginning the admissions procedure for a prospective admission that may become resident in March 2007. The Elms DS0000033970.V322261.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 and 9 Quality in this outcome area is excellent. The home regularly assesses the needs of service users and they are helped to be as involved as possible in the decision making processes. The home has excellent risk assessments to enable service users to retain as many skills and be as independent as possible. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service users’ care plans are reviewed annually by a multi-disciplinary team and an individual plan is developed from the review. This plan includes goals and actions, which the home reviews three-monthly, updating as appropriate. Service users attend their reviews and sign review notes, if they are able. The keyworkers involve the service users in the three-monthly reviews of their individual plans. A service user meeting is held weekly and a residents’ committee meets regularly to represent service users’ views. The notes from this meeting are The Elms DS0000033970.V322261.R01.S.doc Version 5.2 Page 10 produced in a service user friendly format. The committee consists of a manager and representatives from the different houses in the care village - the Elms has a representative on the committee. There is an external self advocacy organisation (WEBCAS) who hold a three monthly meeting that individual service users can attend if they wish. Some policies and procedures have been developed into a service user friendly format. T he deputy advised that some service users had taken holidays abroad this year, in response to views expressed by them at their various forums. The home has developed excellent risk assessments covering all areas, as necessary for the individual service user. These enable individuals to have some independence, for instance freedom to access the care village independantly and live semi–independantly within the home. All staff sign to confirm that they have read and undestood the risk assessments. All risk assessments are reviewed regularly. Most reviews were completed in November and December 2006. The Elms DS0000033970.V322261.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16 and 17. Quality in this outcome area is good. The home supports service users to have a positive and fulfilling lifestyle. This judgement has been made using available evidence including a visit to this service EVIDENCE: All individuals have an organised activity programme, which includes day activities and some evening activities such as keep fit classes, dance classes, discos and clubs. The fitness classes are run by external providers but held within the care village. Activities are mostly provided on site. They are imaginative and include carriage riding, animal care, land and stable management, tap dancing, helping in the coffee shop, helping with post and administration. Some activities are pursued off site such as football, badminton, pub visits, hairdressers and cinema. The Elms DS0000033970.V322261.R01.S.doc Version 5.2 Page 12 The manager is aware of the need for a ‘wider’ community presence and has ceased the practice of shopping on the Internet so that service users have the opportunity to go shopping for the food for the home. Service users are also encouraged to go to the community hairdressers rather than have them come to the home. One service user described her activities and told me that she ‘loves tap dancing and evening classes’. She does something everyday, usually two activities, and told me what they were. She said she ‘loves working in the coffee shop’. Another service user does a post round in the care village. Another service user said he has ‘plenty to do and he enjoys his days’. e described what he does and when. Service users choose their own activities curriculum, with the help of their keyworker, during the summer. The activities programmes follow a roughly academic year. Activity plans match, as closely as possible, the goals and action plans of the Individual Plans developed from the review process. Some service users attended college off site but have achieved as much as they can and most now attend the on-site college. Staff were observed treating service users with great respect and sensitivity, ensuring that they observed their rights and gently reminding individuals of their responsibilities, as necessary. All but one service user has contact with family, some have befrienders and one has an advocate. Staff help service users to maintain links with their families and friends. One service user has just completed, with the help of staff, the first visit to a relative’s home in 25 years. One service user was excitedly telling me about her arrangements for visiting her family over the holiday period. The home has changed its method of providing meals. Most meals are now provided in the home, rather than in the village dining hall. Service users are involved in menu planning and encouraged to go shopping with staff for their weekly supply of food for the home. Menus are written in consulation with service users and are mainly varied, although one or two teatime meals were repeated. The food was of a very good quality and one carer has been given the responsibility for looking after the catering of the home. Five service users said the food was lovely. One service user was seen having a snack prior to lunch and others were observed asking for the sweet they preferred. The Elms DS0000033970.V322261.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19 and 20. Quality in this outcome area is excellent. The home is able to offer excellent personal and healthcare support to the service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Service user care plans are comprehensive and include all the necessary information to ensure that the staff team can meet their individual needs. They are developed from the individual planning meeting and include aims and objectives. The development of service users is a priority area of the home’s work. Two service users had major behaviours that challenged the service. A positive programme has been developed and the behaviours have improved. Innovative ways of using accomodation to meet service users’ needs has assisted in the programmes. This has also improved the lifestyle of other service users as it has reduced tensions and noise levels in the home. Care plans include excellent health care records and detailed consultation sheets to inform staff of what happened at any special consultation. A consultant’s letter in a service user’s file notes that staff accompanying the service user to the appointment were well informed. The home seeks the support of other The Elms DS0000033970.V322261.R01.S.doc Version 5.2 Page 14 professionals as necessary, such as the epilepsy clinic and epilepsy nurse. Pathways to consent are organised for service users who need interventive treatment, if necessary. The home took effective and timely action when a service user’s physical health showed signs of deterioration, ie weight loss and poor colour. The home has excellent physical intervention guidelines, recording any physical interventions used. These are reviewed by a panel of senior staff to ensure that the interventions were used safely and appropriately. Positive behaviour programmes mimimise the need for physical interventions - a service user had 63 incidents of difficult behaviour in October 2005, prior to the positve care proramme and change of accomodation. These had reduced to 0 in October 2006. All health procedures take place in private bedrooms, as is appropriate. Medication records seen were accurate and the manager advised that there had been no medication administration errors for approximately two years. All staff attend a medication training course, and are assessed as competent by senior staff members three times before they can give medication. One staff member administers the medication and one staff checks that it has been given correctly. There are robust guidelines in place for the use of medication that has been prescribed by the GP to be used as necessary. The home does not use medication, currently, to help to control behaviours and has no ‘controlled’ medication. The home has a good understanding of equality, diversity and cultural issues. These are noted in the service user guide and individual care plans. The Elms DS0000033970.V322261.R01.S.doc Version 5.2 Page 15 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): 22 and 23. Quality in this outcome area is good. The home listens to and acts on the views of the service users and protects them from all forms of abuse. This judgement has been made using available evidence including a visit to this service. EVIDENCE: No complaints have been recieved by the home since the last inspection. The Commission for Social Care Inspection has received no information with regard to complaints or safeguarding adult issues. The complaints procedure has been produced in a very service user friendly format. Four service users said that they knew who to talk to if they were unhappy and three knew about the complaints procedure. Staff were clearly able to describe how they would deal with a complaint or abuse allegation in the home. They were knowledgeable about the policies and procedures. All staff have protection of vulnerable adults training, which three staff confirmed. Four service users said that they ‘felt safe’ in the home and could talk to the staff ‘anytime’. Staff described how they can tell if a service user is not happy by obsevation of their expressions and behaviours. Four of the five service user surveys said that staff usually listened and acted upon what they said. One said that this was always the case. All five surveys noted that service users knew who to talk to if they were not happy. The Elms DS0000033970.V322261.R01.S.doc Version 5.2 Page 16 The service users’ finance records held in the home are accurate and a very robust accounting system is in place. It is auditted internally on a regular basis. The provider has a person specifically appointed to be apointee for service users and he is responsible for ensuring that everyone recieves their correct benefits. The Elms DS0000033970.V322261.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): 24 and 30. Quality in this outcome area is excellent. The home is comfortable and safe and the staff use the available accommodation innovatively to improve the lifestyle of service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is extremely clean and tidy. There are very high standards of hygiene throughout. The manager has developed parts of the home to provide indiviual acommodation to meet the special needs of two service users. All service users’ bedrooms are well kept and reflect service users’ individuality, taste and personality. There are ample bathing and toilet facilities that are extremely well designed so that all service users are able to access them comfortably. The Elms DS0000033970.V322261.R01.S.doc Version 5.2 Page 18 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): 32, 34, 35 and 36. Quality in this outcome area is good. Service users benefit from an experienced, well trained staff team who are safely recruited. This judgement has been made using available evidence including a visit to this service EVIDENCE: The home has 17 staff – 13 work day shifts and 13 have NVQ 2 or above. There is a minimum of four staff on duty during daytime hours. There are usually five staff and a manager in the mornings and four in the afternoons/evenings. Sevice users with additional needs have a specific allocation of staff, for example one service user has an allocation of 15 hours a day and staff work one-to-one with them. Three staff were spoken to - the deputy and two support workers. They were very knowledgable about the service users’ needs and the policies and procedures in the home. They advised that there are enough staff on duty to complete all the necessary tasks within the home. They described an excellent team spirit and high staff morale. One staff member had worked in the home for 15 years. Staff are supervised monthly and said that supervision was very The Elms DS0000033970.V322261.R01.S.doc Version 5.2 Page 19 helpful for their development and to improve practice. Supervision records are well kept. The majoriy of the staff team are very experienced, with three new staff on night duties. The staff team appeared to be committed and enthusiastic. They were observed to be interacting extremely well and positively with service users. Staff confirmed that they were provided with good trainig opportunities. The three staff spoken to had NVQ qualifications, said that training was updated regularly and that they were supported to pursue any training seen necessary for thier further development. Five service users said that staff are always there to help them – ‘They are nice and they treat us well’. Four staff files were seen and recruitment records contained all the necessary information. The Elms DS0000033970.V322261.R01.S.doc Version 5.2 Page 20 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): 37, 39 and 42. Quality in this outcome area is excellent. The home is extremely well managed, with the staff team continually involved in development work to enhance the lifestyle of the service users. Health and safety is a priority in the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager was registered in March 2006. He has achieved the Registered Managers’ Award and the NVQ 4 in Care. He has been in post for approximately 18 months. Staff said that this had been a positive time for them and for the service users. The home is extremely well organised and good quality staff are supported to participate in training and to develop individual skills for the benefit of service users. The Elms DS0000033970.V322261.R01.S.doc Version 5.2 Page 21 Staff spoken to said that the management is very good, with lots of development work being undertaken. They felt that the management team was very approachable and inclusive. The Quality Assurance System consists of regular Regulation 26 visits, lay mentor visits (approximately twice per year) residents’ committee meetings and resident’ meetings. Development plans for the home are in the form of an annual capital budget (for physical developments/improvements to the environment), a home and individual training analysis and development plan and individual development plans for service users. It was discussed with the manager that there may be some advantage in combining the different plans into one simple document. There was evidence of development work being progressed, eg making the accommodation at the end of the building into a proper self-contained flat and the identification of areas of further training needed by staff. All health and safety training is provided on a cyclical basis and was generally up-to-date. All maintenance checks are carried out regularly and recorded accurately - these too were up-to-date. The organisation has a health and safety advisor on site to whom the home can go for any specialist advice. Comprehensive safe working practice risk assessments are in place and include robust risk assessments for pregnant staff. Five accident and emergency admissions were recorded in the last year, and these were reviewed and properly dealt with. Accidents and incidents are accurately recorded and there is a ‘near miss’ log so that the home is able to use this information to minimise risk, wherever possible. The Elms DS0000033970.V322261.R01.S.doc Version 5.2 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 Standard No Score 1 X 2 3 3 X 4 X 5 X 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 4 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 3 33 X 34 3 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 X 4 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 4 3 4 X 4 X 3 X X 3 X The Elms DS0000033970.V322261.R01.S.doc Version 5.2 Page 23 NONE 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. Refer to Standard Good Practice Recommendations The Elms DS0000033970.V322261.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Oxford Office Burgner House 4630 Kingsgate Oxford Business Park South Cowley, Oxford OX4 2SU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © 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 DS0000033970.V322261.R01.S.doc Version 5.2 Page 25 - 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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