Inspection on 27/10/06 for The Elms

This inspection was carried out on 27th October 2006.

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 11/10/05

The Elms 25/05/05

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 Key Unannounced Inspection 27th October 2006 11:00 X10015.doc Version 1.40 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 DS0000024301.V323079.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 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 DS0000024301.V323079.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms Address 2 Arnolds Lane Whittlesey Cambridgeshire PE7 1QD 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) 01733 202421 01733 205584 www.bupa.co.uk BUPA Care Homes (CFCHomes) Limited Tracey Lynne Colley Care Home 37 Category(ies) of Dementia - over 65 years of age (12), Old age, registration, with number not falling within any other category (35), of places Physical disability (2), Physical disability over 65 years of age (33) The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Two named male persons under 65 years of age with physical disabilities (PD) for the duration of their residency only Thirty three persons over the age of 65 years with physical disabilities (PD(E)) for the duration of Condition 1 11th October 2005 Date of last inspection 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 main floors, with two further split levels from the upper floor. The upper floor is accessible by stairs or lift, the split levels are accessible by stairs with chair lifts. 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. 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 town centre of Whittlesey is a 5 to 10 minute walk from the home. Fees for the home range from £330 to £780 per week. The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 6½ hours and was carried out as an unannounced inspection on 27th October 2006. It was the key inspection for this home for the 2006-2007. 4 hours were spent with staff members, service users and undertaking a tour of the home. The inspection was conducted with the manager present. The home was asked to complete and return a pre-inspection questionnaire to the Commission before the inspection took place. Ten comment cards from relatives and visitors, and ten comment cards from service users were returned. Information given in these questionnaires has been used in the inspection report. 5 requirements and 6 recommendations have been made as a result of this inspection. One of these requirements have been carried over from the last inspection. What the service does well: The home provides personal and nursing care and accommodation for up to 37 older people, of which 12 people may also have dementia care needs. Medication administration, storage and safe keeping is completed correctly, making sure people who live at the home obtain their medication as they should do for optimum health. Visitors are welcome at the home at any time during the day, with everyone answering a questionnaire before the inspection saying they were always made welcome and were able to visit in private if they wished. People who live at the home are able to choose how they spend their days, when they get up and go to bed, and what they want to eat and when they eat it. A two course hot meal is served every day and people who live at the home said they have a choice most days. The meal seen during the inspection looked appetising and well balanced. The home has policies and procedures that guide staff members in what they must do if they receive a complaint or suspect someone living at the home has suffered abuse of any kind. Complaints are responded to in the correct amount of time and staff members have a good understanding of their role in these situations. Mandatory health and safety training is given to staff when they start working at the home and as regular updates when this is needed. Additional training is also given to make sure staff have the skills and knowledge they need to properly look after everyone who lives at the home. Everyone answering the The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 6 questionnaire before the inspection said they are treated well. Recruitment and vetting checks are completed correctly before new staff members work at the home. Information shows 31 of staff have a NVQ qualification. The views and opinions of people who live at the home is obtained in a quality assurance survey. The results are published and available in the home. An action plan is developed from these results to show what the home is doing to improve, and this has been sent to the provider organisation for approval. People who live at the home also attend residents meetings where they discuss issues that affect them and what they would like to have happen. For example, in the last meeting minutes residents said they only wanted Halloween decorations in the foyer of the home, which is what was seen during the inspection. The home looks after service users money if they are not able to or do not wish to do this themselves. There is a computer system that shows each person’s money separately and keeps records of debits and credits made. What has improved since the last inspection? What they could do better: The home completes pre-admission assessments, or obtains these from health and social care professionals before residents start living at the home. This information should be more detailed to make sure staff have as much information about that person as possible before they live at the home. Care plans must show staff members everything they must do to make sure the person is cared for properly. In some care plans, obvious information is missing, such as that a person must be weighed in order to show if they are losing weight or not. Referrals to healthcare professionals are also not always made, and this must change to make sure everyone at the home is given the healthcare advice they are entitled to and the proper care for their health needs. Although there were some very positive comments about the care staff and how they treat people who live at the home during the inspection and in the The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 7 questionnaires completed before the inspection. There was an incident during the inspection where one person’s privacy was not protected, and a comment in the questionnaire stated that some staff members could be off hand. Activities are more available than at the last inspection and most people are happy with the amount and type of activities that are provided. This needs further improvement to make sure there is something for everyone living at the home that they are able to and wish to join in with. There has been a little improvement in the décor of the home, with some walls, skirting and doorframes now painted, and a plan in place for replacement of window frames. However, there needs to be a programme of maintenance and a regular check of work that needs to be done as issues identified in previous inspections has still not been repaired or replaced. There was an unpleasant smell on entering the home, and although this had dissipated from the foyer later in the day, it could still be smelt in other areas throughout the home. The home must improve this. Staffing levels at the home are adequate, with staff members saying there are only a few dips due to unexpected leave. This is generally supported by the visitors’ questionnaire and signs like how people who live at the home are treated, whether they feel well cared for and whether their privacy is respected are all acceptable and also show that staff members are not rushed. However, one person answering the questionnaire said there wasn’t enough staff available, especially at weekends. The home provided information that shows there are lower staffing levels at weekends and occasions when there is no registered nurse on the staff rota. 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 DS0000024301.V323079.R01.S.doc Version 5.2 Page 8 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 Outcomes Statutory Requirements Identified During the Inspection The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has systems in place to ensure that there is an assessment prior to people moving into the service. This needs to be more detailed to ensure all of the service users needs can be met. EVIDENCE: Care records of one person who has gone to live at the home since the last inspection contain pre-admission assessments undertaken by the home. The assessment consists of a scoring system and provides areas for comments and details. However, there was only a little information about that person, their abilities or disabilities, which means initial care plans cannot be detailed enough to ensure staff have all the information they may need to care for that person. The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 10 The home does not provide accommodation specifically for intermediate care or for rehabilitation purposes. The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The care planning system does not adequately provide staff with the information they need to satisfactorily meet service users needs. EVIDENCE: The home has individual care plans for each person living there. Most plans were written in sufficient detail to enable staff to adequately care for service users. However, plans are not written with enough descriptive information about the need or how it presents, or the action required to meet an identified need. For example, a plan for confusion did not describe how that person was confused and another plan for nutrition did not identify in its actions that the person should be weighed, although the aim of that plan was to identify weight loss. This means appropriate actions cannot be identified for needs, and whether care plans are effective at meeting needs may not be able to be determined. Incidents in one person’s care records suggesting that person The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 12 presented with challenging behaviour and inappropriate actions towards staff members did not have an associated care plan. There was nothing in the care records to show service users were involved in their care plans, although this was not confirmed with people living at the home. Not all plans were reviewed on a monthly basis, although one plan that had been reviewed every month did not show that person had suffered two falls since the plan had been developed. This means that reviews are not effective in assessing whether the care plan is relevant to that person’s needs. Although care records show service users have access to health care professionals, such as chiropodist and GPs, one plan does not indicate referral to a falls coordinator when that would be an appropriate referral to make. Risk assessment for this person showed a very high risk of falls, the person has a history of falling and has been severely injured as a result, and has had two falls since being admitted to the home. Referral to appropriate healthcare professionals must be made to ensure everything is done for the health and safety of service users. Medication is administered via blister packs supplied on a 4 weekly basis and medication administration record (MAR) sheets. There were some minor recording errors on the MAR sheets of which there was only one of note; when a key is used to show why medication is not given, there must be a definition for every letter, number or symbol used in the key. Most medication checked against MAR sheets appeared to have the correct number of doses given and number of medication left. Clarification has been obtained from the dispensing pharmacist about one prescription where there appeared to be over-dosage. The controlled drug (CD) register and CD medication for one service user was examined and correct. There was no entry of the name and address of each pharmacist/pharmacy used to supply the drugs to the home. The home only uses one pharmacist/pharmacy and these details were added to the CD register at the time of inspection. Medication training was discussed with a registered nurse who said she had received training from community nurses, from the deputy manager, and is aware of the home’s medication policy. There were a number of positive comments about the staff from service users during the inspection and from people who had responded to a survey by CSCI before the inspection. These include comments about how staff present themselves to service users and visitors to the home, that they are friendly, caring and polite. Staff members were friendly during the inspection, and they spoke to service users politely. However, one person responding to the survey said although most of the staff are very caring and helpful, there are a few who seem very “off hand”. During a tour of the building, a staff member opened a service user’s door, showing him lying on the bed covered only with a towel. The door remained open while the staff member waited for another member of staff to assist her with personal care, thereby exposing the service user to anyone else passing the room. The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 13 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Social activities provide stimulation and interest for people living in the home, and visits from relatives and friends ensure continued social contact. EVIDENCE: The home has an activities co-ordinator and information provided prior to the inspection shows there is a number of activities available to service users. Short trips out of the home are available upon request or if an interest has been expressed in a daytime activity. 60 of people responding to a questionnaire before the inspection said there are suitable activities at the home, although 20 said they felt there were not. Staff members gave details of activities available, and evidence that these are discussed with service users was seen in minutes from a residents meeting. Magazines and interests pertinent to two people who spoke with the inspectors were evident in those service users rooms. However, there was little information in the care records seen, that shows individual interests have been explored with every The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 14 person that lives at the home. One person living at the home said there are no activities available for him. Service users’ families and visitors to the home are welcome at any time, and everyone who responded to a questionnaire sent out before the inspection said they are welcome at any time and can visit in private if they wish. People who live at the home confirmed they are able to choose when they get up and go to bed, what they have to eat and when they eat. Staff members gave appropriate responses when asked how they enable service users to choose how they would like to live. A main meal was served during the inspection, which appeared appetising and contained a variety of food groups. Service users said in the questionnaire sent out before the inspection and during the inspection that meals served at the home were good and they like the food. During the inspection one person confirmed meals are available at any time to suit individual people. The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has protection from abuse and complaints systems in place that enable service users to raise concerns and ensure staff have adequate knowledge to ensure service users are safe. EVIDENCE: The home has received 5 complaints since the last inspection; 4 of which are regarding the same issue. These were responded to appropriately, with the manager arranging to meet with the complainants of one complaint, in order to resolve the issue. 80 of service users said they know who to speak to if they are not happy with something at the home, and 90 said they feel safe living at the home. 70 of visitors to the home said they are aware of the complaints procedure, and had not had to make a complaint. Staff members have received protection from abuse training and those spoken to gave appropriate answers to questions about how they would respond if they suspected abuse had occurred. There was also an awareness of the home’s own policies and procedures, including the whistle blowing procedure. The home has not made any referrals to the local Protection of Vulnerable Adults team since the last inspection and no concerns have been identified. The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Minor improvements have been made to the home, although there were a number of matters that put service users at risk of harm and do not provide safe or pleasant surroundings in which to live. EVIDENCE: There has been some improvement in the general décor and appearance of the home since the last inspection visit. The car park has been covered with tarmac, the front door has been repainted, and gouges and scuffmarks in some of the areas identified in the last inspection have been repaired and repainted. However, not all marks had been repaired and there was an offensive smell in the foyer of the home and at other areas throughout individual and communal areas of the home. Although, the smell in the foyer dispersed during the day, The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 17 these smells need to be addressed to ensure service users live in a pleasant environment. There remain stains on a number of individual room ceilings, and some corridor and communal area ceilings. There have been a number of requirements made at inspections in the last two years regarding the décor and general environment that have been only partially complied with. The home has a new manager and a maintenance person who works part time. This would therefore be an ideal opportunity for a programme of maintenance to be developed to ensure issues are identified and resolved promptly. Work has been carried out to cover exposed radiator piping in one corridor, but there remain radiators and pipes in some parts of the home that are exposed and hot to touch, and one radiator temperature gauge that had broken away from the radiator and pipes leading to this radiator were very hot to touch. This places service users at enormous risk, but shows the home makes changes when these are identified and required but does not conduct its own assessment. The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 18 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing numbers and staff training opportunities were sufficient to meet the needs of service users. EVIDENCE: Information obtained before the inspection shows 31 of care staff members without a nursing qualification have a NVQ qualification in care at level 2 or above. Mandatory health and safety training is given to most staff as required, although one staff member said she had not received infection control training. However, all staff members spoken to gave appropriate answers to questions about health and safety issues. Additional training is also given to staff so they have the skills to meet all service users needs. Staff members felt there are usually adequate staffing levels at the home, and this provides a supportive environment where there is little use of agency staff and service users are not kept waiting too long for assistance. Service users and visitors to the home who responded to a questionnaire before the inspection echoed this; 80-100 of people thought staffing levels are satisfactory, they are well cared for, treated well and their privacy is respected. These are all things that would deteriorate if staffing levels were reduced and The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 19 staff were placed under pressure. However, one person said there are not always enough staff during the weekend to ensure service users are able to go to the toilet when they want to, and sometimes have to wait for this. The staff rota was provided before the inspection and this shows there are lower staffing levels at weekends, with two occasions over a 4 week period when there is no registered nurse on the rota for a 2 hour period. The records of two staff members employed since the last inspection were examined and show the home obtains all the required checks and documents to ensure new staff are safe to work with vulnerable people. The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 20 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 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The systems for service user consultation are good with evidence that service user views are both sought and acted upon. Records are kept to show service users health and safety is not compromised. EVIDENCE: The home has a new manager, who is now registered with the Commission for Social Care Inspection. She is a registered nurse and has previous experience as a manager in care homes for older people. The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 21 A quality assurance survey has been completed by the home and an action plan sent to the provider organisation to show how the results will develop and improve the home. Residents meetings are held and this enables service users to discuss and make decisions about what is happening in the home. A copy of the minutes of the residents meeting held before the inspection was made available following the inspection and this shows discussions were held about events in the future. However, the date of this meeting was August 2006 and another meeting had not been held since then. Service users entering the home are given written information about how the home takes care of their money and the procedures for debiting an account. Statements are sent on a monthly basis, detailing incoming and outgoing transactions, and any interest earned. Although all service users funds are placed into the same account, each service user using the system has a separate written account and record on the computer. Information provided prior to the inspection shows maintenance checks and service visits have been completed at required intervals. Fire safety records seen at the inspection have been completed and are satisfactory. The Elms DS0000024301.V323079.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 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 Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 2 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 1 X X X X X X 1 STAFFING Standard No Score 27 2 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? YES 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 OP7 Regulation 15(2)(c) Requirement The registered person must revise the service user’s plan. The plan must be revised when there are changes to the identified need. The registered person must make arrangements for service users to receive where necessary, treatment, advice and other services from any health care professional. (Timescale of 15/10/05 not met.) The registered person must make suitable arrangements to ensure that the care home is conducted in a manner, which respects the privacy and dignity of service users. The registered person must ensure that the premises to be used as the care home are kept in a good state of repair internally, and all parts of the care home are kept clean and reasonably decorated. The registered person must keep the care home free from offensive odours. Timescale for action 31/12/06 2. OP8 13(1)(b) 15/12/06 3. OP10 12(4)(a) 15/12/06 4. OP19 23(2)(b), (d) 30/04/07 5. OP26 16(2)(k) 31/12/06 The Elms DS0000024301.V323079.R01.S.doc Version 5.2 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. 2. 3. 4. 5. 6. Refer to Standard OP3 OP7 OP12 OP19 OP27 OP28 Good Practice Recommendations Pre-admission assessments should be more detailed to ensure staff have adequate information from which to form care plans. Care plans should be reviewed at least monthly to ensure changes in care needs are met. Activities organised should be based on service users social interests as much as possible. A programme of maintenance checks should be developed to ensure repairs are identified and resolved quickly. The staff rota must show a registered nurse is on duty at all times. 50 of care staff working at the home should obtain a NVQ level 2 in care. The Elms DS0000024301.V323079.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Cambridgeshire & Peterborough Area Office CPC1 Capital Park Fulbourn Cambridge CB21 5XE 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. 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