Inspection on 25/05/05 for The Elms

This inspection was carried out on 25th May 2005.

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

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

Other inspections for this house

The Elms 11/09/07

The Elms 27/10/06

The Elms 11/10/05

The Elms 19/10/04

The Elms 18/07/04

Similar services:

Claremont House

Oak Ridge

Sun Court Nursing Home

Ashville House

Bramley Avenue (73)

Bilney Hall

Hill Barn

Mabbs Hall Nursing Home

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

CARE HOMES FOR OLDER PEOPLE The Elms 2 Arnolds Lane Whittlesey Cambridgeshire PE7 1QD Lead Inspector Lesley Richardson Unannounced 25 May 2005 @ 10:00 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 Older People. 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 I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service The Elms Address 2 Arnolds Lane Whittlesey Cambs PE7 1QD 01733 202421 01733 205584 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) BUPA Care Homes (CFC Homes) Ltd Care Home with Nursing 37 Category(ies) of Old age, not falling within any other category registration, with number (OP), 37 of places Terminally ill over 65 years of age (TI(E)), 37 Physical disability over 65 years of age (PD(E)), 35 Dementia - over 65 years of age (DE(E)), 37 Physical disability (PD), 2 The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: 1. Two named male persons under 65 years of age with physical disabilities (PD) for the duration of their residency only. 2. Thirty five persons over age of 65 years with physical disabilities (PD(E)) for the duration of Condition 1. Date of last inspection 19th October 2004 Brief Description of the Service: The Elms is a large converted and extended house, situated in a residential area close to the centre of the market town of Whittlesey. It provides care and support, including nursing care, for up to 37 older people. There are 29 single and 4 double rooms; 17 of the single rooms and 2 of the double rooms have en suite facilities. Resident accommodation is on two floors, the upper floor being accessed by stairs or lift. There are a variety of communal areas available to service users, the smaller areas being on the upper floor. In additional to the en suite facilities there are 12 toilets and 5 bathrooms. Not all of the areas for communal use are accessible to service users with limited mobility. An enclosed garden surrounds the home and provides a safe environment for service users to enjoy the mature garden. The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 6 hours and was carried out as an unannounced inspection on 25th May, 13th and 14th June 2005. The last two visits were spent checking on some of the issues from the last inspection and obtaining further information that was not available on the first visit. Three hours was spent examining records and documents and three hours was spent looking around the building and spending time with service users and staff. Six people who live at the home and four of the staff on duty were spoken to during the inspection. A second inspector accompanied the lead inspector for 2 hours of the first visit. The home has been without a manager since 29th April 2005. What the service does well: What has improved since the last inspection? What they could do better: The home has a lot of work to do to bring it up to an acceptable standard. The relationship between staff, management and service users needs to improve to stop service users feelings of not wanting to complain or mention things they are not happy with. Reporting of issues around adult protection also has to follow local authority guidance to make sure service users are not at risk of abuse. Assessment of service users before they come to the home has to improve so that the home and the service users both know the home can look after them properly. Recording of medication that has been given or missed needs to be accurate to make sure service users receive the prescribed dosage. Please contact the provider for advice of actions taken in response to this The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 6 inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2 and 3 The home does not fully assess potential service users needs prior to admission or review the assessment, so cannot give assurances that their care needs can be met. EVIDENCE: Admission assessments were seen on the three service users files looked at but there was no indication that assessments had been undertaken by the home prior to these service users being admitted. Nor was there evidence of assessments from social services departments or from hospitals in any of the files, although two service users had been admitted to hospital since moving to the home, and are now back at The Elms. Service users are issued with a copy of the terms and conditions, which include details of the contribution for nursing care. The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8, 9 and 10 Systems are in place for referring service users to health care professionals and for care planning to ensure personal and health care needs are met. EVIDENCE: Service users files contain care plans and risk assessments that enable staff members to meet care needs. Care plans are rewritten regularly and reviewed on a monthly basis to reflect changes in service user needs. However, one service user’s file did not show how care needs had changed and the further care needed to meet those needs, although a change in the level of need had been documented. This service user’s file also included a risk assessment for pressure sore development, although no care plan or action had been documented for the risk that had been identified. Records indicate service users have access to healthcare professionals including district nurses, dieticians and CPN (community psychiatric nurse). Additional information is obtained from relevant sources such as the NHS Clinical Guidelines and the National Osteoporosis Society for falls prevention. Service user and/or family involvement in care planning was seen in two service user files. The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 10 There was mixed reaction from service users regarding whether they are treated with respect and dignity, with one service user saying care staff were “rough and ready” when getting him up but two service users said carers looked after them “alright”. Care staff were polite and talked to service users with respect during the inspection. Some service users were reluctant to allow inspectors to discuss their comments with the acting manager and this contributed to a feeling of oppression within the home. Inspection of the medication (MAR) sheets for 7 service users shows correctly signed sheets for 3 service users for the two week period prior to the inspection visit. Of the other four service users medication had not been signed for on a number of different days, but consistently in the evening or night doses, with only one service users sheet indicating previous refusal of one medication. A requirement had been made at the previous inspection regarding the need for accurate recording of the administration of medication. Failure to comply with requirements may result in legal action being taken against the home. The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12, 13, 14 and 15 Social activities are not well organised and only provide limited stimulation and interest for people living in the home. Meals offer a healthy, varied diet for service users, although the home should seek service users views so that all tastes can be accommodated. EVIDENCE: Service users said there were not many activities, but they were usually told about things that had been arranged before they were due to start. One service user said she would like to get out more, other than just around the shops and was quite enthusiastic about suggestions made. An admission assessment on one service user’s file and a newly developed ‘Map of Life’ on another service user’s file gave basic information about service users likes and interests, although this information had not been transcribed into care plans and was not detailed enough to enable individualised activities. Visitors are able to visit the home at any time during the day and service users said they had relatives visit. The acting manager said the home did not have an activities co-ordinator but care staff had dedicated hours during their working week to organise and assist with activities. Although this had begun well, the level of activities available to service users had diminished in recent months. The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 12 Service users said they felt there was not much choice in the meals offered at the home, and if they did not like something they would just not eat the meal, rather than say something. However, generally they liked the food. The main meal on the day of inspection was acceptable, containing a variety of food groups, and a choice was available. Meals are served in the dining room from a heated trolley by the cook or chef on duty and care staff give out drinks. Service users were served without consultation about what they would like on their plates or which drink they would prefer, although the acting manager said this is because staff are aware of preferences and alternatives were always available. The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The home has systems that enable service users to raise concerns and for their protection but there is little evidence that these are effective, therefore leaving service users at risk of abuse. EVIDENCE: Although the home has a complaints policy and procedure, two service users said they would not raise concerns if they did not like something and were reluctant for the inspector to raise issues with the acting manager that had arisen from the inspection. One other service user said he felt he would be able to make a complaint if he needed to. There have been some Adult Protection issues recently at the home and these have mostly been addressed under the local authority Adult Protection procedures. However, some incidents were not reported in accordance within the policy and it is a matter of concern that the manager at the time of the incidents had not acted appropriately to ensure the protection on service users. There is an ongoing problem with theft at the home, incidents have been reported to the police but this issue had not been resolved at the time of inspection. The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 25 and 26 The standard of décor within this home is poor with little evidence of improvement through maintenance or future planning. The home does not, therefore, present as a homely and comfortable environment for service users. This compromises service users dignity and indicates a lack of respect. EVIDENCE: The home has an annual budget for maintenance and redecoration. However the general décor of the home has not changed from the last inspection visit, areas identified then as previously needing attention still require attention, and the fabric in some parts of the home looks worn. Specific areas of concern are: • Scuff and gouge marks on wall corners and doorframes throughout the home. • Gouge marks on wall behind recliner chair in room 18. • Holes in en suite or wardrobe doors in rooms 16 and 18. • Stain on the ceiling in room 29. • Cracked and flaking paintwork on window frames in room 22. Sash window broken and kept open with a biscuit tin. The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 15 The requirement made at the last inspection has not been complied with. If these issues are not addressed within the stated time scale, the Commission will take legal action against the home. Exposed radiator piping in one corridor (rooms 16-19) was too hot to hold when the heating was turned full on and as such poses a risk to service users should they fall. There was an offensive smell in the foyer of the home and again at the top of one set of stairs leading to the first floor, which dissipated later in the day but was still present. The laundry is situated close to the kitchen and along the same corridor as 2 upright freezers and the staff change area. The acting manager said an environmental health inspection had been undertaken and the report seen during the inspection showed no adverse comments regarding the proximity of the freezers to the laundry. The home has had renovation work to the laundry area, which has allowed space for another washing machine and dryer and this should better cater for the laundry demands of 37 service users. The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 29 Vetting and recruitment procedures ensure that all appropriate checks are carried out, thereby reducing risk to service users. EVIDENCE: On the day of inspection there were adequate numbers of staff on duty to meet the needs of service users. The home employs registered nursing staff and there is a qualified member of staff on every shift. Staff files contained all the information needed but evidence that Criminal Records Bureau or Protection of Vulnerable Adults checks had been completed is held in another part of the home. The acting manager said these were kept in another part of the home to ensure data protection procedures were maintained. Copies of these records were supplied later and confirmed CRB and PoVA checks had been requested before staff started working at the home. The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. 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 and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31 and 38 Not all precautions are taken to ensure the health and safety of service users. EVIDENCE: The home is without a permanent or registered manager and is being managed by the deputy manager, who has support from other home managers within the same organisation. The health and safety of service users is generally protected throughout the home and exposure to hazardous substances is controlled and kept to a minimum. However, open boxes of washing powder and pre-wash stain spray had been left on top of one of the washing machines. This poses a health and safety risk to service users as there is no locking device on the laundry door. The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 2 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION 1 x x x x x 1 2 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 1 2 x x x x x x 2 The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 19 YES Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 3 Regulation 14(1)(a), (b) Requirement The home must not provide accommodation to a service user unless the needs of the service user have been assessed by a suitably qualified or trained person, and a copy of the assessment has been obtained by the home. The home must keep service users assessments under review and revise at any time when it is necessary to do so having regard to any change of circumstances. The home must made arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received. All medication prescribed on a regular basis must be recorded as given or the reason not given in the MAR sheets. (Timeframe of 19th October 2004 from previous inspection not met.) Failure to comply with requirements may lead to legal action being taken against the home. The home must maintain good personal and professional relationships with service users, Timescale for action 25th May 2005 2. 3 and 7 14(2)(a), (b) 25th May 2005 3. 9 13(2) 13th June 2005 4. 10 12(5)(a), (b) 25th May 2005 Page 20 The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 5. 12 16(2)(n) 6. 18 13(6) 7. 19 23(2)(b), (d) 8. 25 and 38 13(4)(a), (c) 9. 10. 26 31 16(2)(k) Section 11(1), Care Standards Act 2000 and encourage and assist staff to maintain good personal and professional relationships with service users. Service users must be offered a programme of activities and be consulted about this. The home must provide facilities for recreation including, having regard to the needs of service users, activities in relation to recreation and fitness. The registered person must make arrangements to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. The premises must be kept in a good state of repair externally and internally, and all parts of the home must be kept clean and reasonably decorated. All windows identified as being in a poor state of repair must be repaired or replaced. (Timeframe of 28th February 2005 not met from previous inspection.) Failure to comply with requirements may lead to legal action being taken against the home. All parts of the home to which service users have access must be kept free from hazards to their safety. Unnecessary risks to the health and safety of service users are identified and so far as possible eliminated. The home must be kept free from offensive odours. An application to register a manager must be submitted to the Commission. 30th August 2005 25th May 2005 31st August 2005 25th May 2005 25th May 2005 31st August 2005 The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 21 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 Good Practice Recommendations The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 22 Commission for Social Care Inspection CPC1, Capital Park Fulbourn Cambridge CB1 5XE National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Elms I53 I03 S24301 THE ELMS V227921 250505 STAGE 4.doc Version 1.30 Page 23 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!