Inspection on 29/11/05 for The Elms

This inspection was carried out on 29th November 2005.

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

The inspector found no outstanding requirements from the previous inspection report, but made 5 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Elms 12/11/08

The Elms 02/10/07

The Elms 04/07/06

The Elms 12/07/05

The Elms 15/11/04

The Elms 23/04/04

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

CARE HOME ADULTS 18-65 The Elms 1 Elm Gardens Hythe Kent CT21 5PY Lead Inspector Julian Graham Announced Inspection 29th November 2005 09:30 The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Adults 18-65. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service The Elms Address 1 Elm Gardens Hythe Kent CT21 5PY 01303 230131 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Lothlorien Community Ltd Care Home 4 Category(ies) of Learning disability (4) registration, with number of places The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th July 2005 Brief Description of the Service: The Elms is registered to provide accommodation and personal care for up to four people who have a learning disability. At the time of this inspection four people were in residence. The Elms is located in a quiet residential area within three quarters of a mile of the town centre and sea front. The house is a substantial property in an elevated position with the accommodation arranged on two floors. All of the Residents have their own bedrooms. There is ample garden space for use by residents. Hythe is a small town and has a selection of shops, cafes, entertainment, public amenities, and public transport links. The registered providers are Craegmoor Healthcare. The manager, Mrs Waghorne, (not registered) has recently left the home. Ms Nicola Daines is the acting manager. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was announced and started at 09.30 and lasted six and a quarter hours. A provider’s assessment form completed by the manager was received prior to the inspection. Feedback questionnaires that staff helped the residents fill in were submitted from two residents at the time of the inspection. Three of the residents were spoken with during the visit; and as on previous occasions, the fourth resident chose not to talk with the inspector. Lunch was shared with the residents. As on the last inspection, one of the residents was indicating that she would like to leave the Elms, and the manager said that she is continuing to liaise with Social Services regarding a possible move. Two staff were interviewed privately in the office. They were also observed both directly and indirectly as they were working with residents. A visiting relative was spoken with. Time was spent with the former manager who had left the home a very short while ago, and the acting manager who assumed her responsibilities two days before this inspection. Some paperwork was looked at and a tour of the premises was undertaken. Comments from residents included “I like the people working here” and “I like being up in my room”. The visiting relative expressed satisfaction with the care and service provided and said he is made to feel “at ease” when he visits. What the service does well: What has improved since the last inspection? The home has taken a much more pro-active role in assisting one of the residents in being more independent and taking more control over her life. All staff have had training on adult protection and fire safety. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 6 Procedures have been prepared as required regarding medication procurement and taking medication on leave. No staff are now working a waking night shift either followed or preceded by a day shift. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not inspected on this visit. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6,8,9, The arrangements for care planning and assessing risk remain clear and comprehensive. Residents are supported to make decisions and are offered opportunities to participate in the life of the home. EVIDENCE: Whilst examination of a sample of care plans show that all aspects of the person’s care needs are detailed, it remains a recommendation that one or two personal goals are selected with the residents. These can then be properly actioned, monitored and evaluated. Care plans and risk assessments are subject to regular review, with evidence seen on the files. Records are made of what the residents do during the day, and it was good to see that one resident is writing these notes herself. Residents are continuing to have their “house day” once a week, during which they are supported in cleaning their rooms, helping with their laundry, going into town to do their personal shopping and so on. Residents were seen assisting with clearing the table after lunch, and there are various degrees of involvement, depending on wishes and ability, on the part of most residents in the preparation and cooking of meals. One resident is largely taking sole charge of choosing, buying, preparing and cooking her meals. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12,13,14,15,16,17 Opportunities for personal development are improving. Social, educational and leisure activities need to be more varied to provide a more interesting and stimulating lifestyle for the residents. Meals in the home are good, offering a varied, healthy diet. EVIDENCE: The home has taken steps since the last inspection to provide support and assistance to enable one resident in particular to take greater control over her life and to practice, maintain and improve her independent living skills. Whilst residents are supported in going out most days, these trips tend to mainly consist of visits to the local shops and walks. Two residents go horse riding once a week and it is planned to resume going to the swimming pool for those who may be interested. The company’s vocational facility, which some of the residents attended from time to time, has recently closed, resulting in residents having even fewer interesting things to do. The recommendation made at the last inspection for the residents to have access to and choose from a wider range of social, educational and leisure activities, is now a requirement. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 11 The arrangements for transport are not ideal, and are limiting to some extent the range of opportunities open to the residents. The home has access to a car, which is leased for the benefit of one named resident through benefit allowances, and no use of this car can be made unless this person travels in it. It is recommended that this matter is reviewed and in addition to taxis and public transport, arrangements are made for residents to have access to a car that is not contingent on one named resident travelling in it. There was evidence in support of the home seeking specialist advice and guidance in safely and appropriately supporting a resident maintain an intimate personal relationship. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20 Residents’ healthcare is promoted generally, although residents need to be regularly weighed as one means of monitoring their health. Some of the home’s policies and procedures regarding medication have been tightened up. EVIDENCE: Discussion with the outgoing manager, and examination of residents’ case notes, shows that where the need arises, residents are referred to appropriate specialists, including the community nurse and speech and language therapist. There was no evidence, however, that residents are being regularly weighed. Indeed, the record in one case file showed that the person concerned was last weighed in April, with no year specified. Staff confirmed that they have received training in medication and there were records showing that their competence to administer medication has been assessed by the manager. MAR charts were in the main in order, and there are now local procedures on procuring medication and when medication leaves the premises. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,23 Whilst it would appear that complaints are taken seriously by the home, there is no documentary evidence to demonstrate that this is the case. Arrangements for protecting residents from abuse have improved. EVIDENCE: The manager said that any complaints made are dealt with straightaway, but are not always recorded. Minimal information regarding a small number of complaints was seen recorded in a bound book. These arrangements are unsatisfactory. Complaints must be recorded and made separately, and must include full details of the complaint, including any action taken by the home and the outcome. With regards to protecting residents from abuse, action has been taken since the last inspection to tighten the arrangements and ensure staff understand and follow the procedure, and embrace the rationale behind it. Further training on adult abuse has been provided, and staff understanding checked and monitored in individual supervision. Both staff who were interviewed demonstrated good understanding of the types of abuse that could be encountered in care homes, and the action to take should any allegation be made. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24,26,27,28,30 The standard of the environment is generally good within the home providing residents with an attractive, comfortable and homely place to live. The lounge, however, is now in need of upgrading. In order to minimise the risk of spread of infection, a wall mounted paper towel dispenser and pedal bin are required in the bathroom. EVIDENCE: Three of the residents’ bedrooms were viewed and these were homely and attractive. One of the rooms, whilst being acceptable, would benefit from redecorating. The lounge decoration is now looking tired and a bit shabby and this room, whilst being cosy, needs upgrading. This includes replacing the seating, which is hard and rather uncomfortable. The seating also does not have a fresh, inoffensive odour, owing to periodic incidents of incontinence over the years. The upstairs bathroom adjacent to a toilet, which does not have a wash hand basin, requires a paper towel dispenser and pedal bin to minimise the risk of cross infection. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,34,35,36 Staff morale is high resulting in an enthusiastic workforce that works positively with the residents. Staff are receiving regular training opportunities to increase their knowledge and they are being well supported and supervised. Staffing levels are generally satisfactory, but need reviewing and risk assessing for those periods when just one staff is on duty when one of the residents goes to stay with family. EVIDENCE: Two care staff were interviewed privately. Both presented very well, demonstrating a very positive approach to their work, clarity regarding their role and responsibility, and good understanding and awareness of what constitutes good practice. They both referred to a good team spirit within the home, and the friendly and open atmosphere. They confirmed they are accessing training regularly, and mentioned the benefits to their understanding and practice which some of this training is giving. Records were seen of one to one supervision sessions staff are having with the manager. Training records for the staff are being properly maintained. The file of a newly recruited staff member showed that thorough recruitment practice is being followed, which protects residents. It was noted on this file, however, that this person had signed an “individual voluntary agreement” to the effect that “the 48 hour limit on weekly working time will not apply to you. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 16 You may terminate your agreement to this opt out by giving 3 months notice.” Whether this contravenes the Working Time Directive is not clear, and it is advised that this matter is looked into and clarified. Staffing levels are generally satisfactory, with two care staff with the manager supernumerary in place during weekdays. However, there are periods during some weekends when one resident goes away, when there is just one staff on duty for the three residents, one of whom has epilepsy. The home is required to review this arrangement, including a risk assessment that demonstrates how the needs of the three residents are being met with just one staff on duty, and how any implications regarding the health and safety of residents, (and staff) are being managed. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 38,41,42 Management arrangements are in transition. An open and welcoming atmosphere is being maintained, however, which is benefiting the residents. Some aspects of record keeping need attention. Residents’ health and safety is being promoted. EVIDENCE: Discussion with staff and the relaxed manner of residents indicated that the outgoing manager, Mrs Waghorne, had established an open and inclusive management approach to which both residents and staff responded well. Mrs Waghorne returned to the home to assist with this inspection, which was also attended by the new acting manager, Ms Daines. The broad management of the home, including record keeping, has been to a good standard generally. Staff need reminding, however, that records relating to residents, need to be signed and dated. All the requirements made at the last inspection have largely been addressed. Staff are receiving training on safe working practices and with the exception of the need for a paper dispenser and pedal bin in the bathroom, no obvious health and safety hazards were noted. Fire training for staff is now up to date. The Elms DS0000023560.V257170.R01.S.doc Version 5.0 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME CONCERNS AND COMPLAINTS Standard No 1 2 3 4 5 Score x x x x x x Standard No 22 23 Score 2 3 ENVIRONMENT INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score 3 x 3 3 x Standard No 24 25 26 27 28 29 30 STAFFING Score 3 x 3 2 2 x 2 LIFESTYLES Standard No Score 11 3 12 2 13 2 14 2 15 3 16 3 17 Standard No 31 32 33 34 35 36 Score 3 x 2 3 3 3 CONDUCT AND MANAGEMENT OF THE HOME 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 The Elms Score x 2 3 x Standard No 37 38 39 40 41 42 43 Score x 3 x x 2 3 x DS0000023560.V257170.R01.S.doc Version 5.0 Page 19 no Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard YA14 Regulation 16 Requirement The home must make arrangements to enable residents to engage in a greater range of social, educational and leisure activities in line with their needs and wishes. Residents must be weighed at regular intervals. All complaints must be recorded, including any action taken and the outcome. Lounge to be redecorated and new seating provided. Staffing levels to be reviewed and risk assessment prepared regarding the level of staffing provided when one resident goes away on leave, leaving just one staff on duty. Timescale for action 29/12/05 2. 3. 4. 5. YA19 YA22 YA28 YA33 12 22 23 18 29/11/05 29/11/05 29/01/06 14/12/05 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 DS0000023560.V257170.R01.S.doc Version 5.0 Page 20 1. 2 3 YA6 YA14 YA41 Residents to be consulted with regards any personal goals they may have, and for these to feature in care plans, and to be monitored and recorded. The home’s transport arrangements to be reviewed. Records relating to residents to always be signed and dated. 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