Inspection on 03/08/07 for

This inspection was carried out on 3rd August 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

27/03/07

04/07/06

07/02/06

19/09/05

28/02/05

05/07/04

22/10/03

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

CARE HOMES FOR OLDER PEOPLE The Elms Verwood Road Elmhurst Aylesbury Bucks HP20 2AY Lead Inspector Chris Schwarz Unannounced Inspection 08:45 3 August 2007 rd 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 DS0000023063.V343657.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 DS0000023063.V343657.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms Address Verwood Road Elmhurst Aylesbury Bucks HP20 2AY 01296 489530 01296 337991 manager.theelms@fremantletrust.org 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) The Fremantle Trust Mrs Sue White Care Home 56 Category(ies) of Dementia (0), Old age, not falling within any registration, with number other category (0) of places The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) 2. Dementia - (DE) 12 The maximum number of service users to be accommodated is 56. Date of last inspection 27th March 2007 Brief Description of the Service: The Elms is a care home providing personal care and accommodation for up to fifty six frail older people. The home is owned by the Fremantle Trust, which is a not for profit charity. It is situated in a residential area of Aylesbury, close to the facilities that a large town can offer. It was purpose built in the early 1970s and has fifty four single bedrooms and one double bedroom. It is divided into five smaller units, each of which has a lounge and dining area. One thirteen bedded unit provides specialist care for people with dementia. There is a passenger lift. There are pleasant gardens and outdoor sitting areas. The home is well supported by local doctors and community nurses. The cost of living at The Elms ranges from £381 to £600 per week. The home caters for private clients and those supported with their funding from the local authority. Information about the service offered can be requested from the home if required. The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced key inspection was conducted over the course of a day and covered all of the key National Minimum Standards for older people. Prior to the visit, a detailed self-assessment questionnaire was sent to the manager for completion alongside comment cards for distribution to service users, relatives and visiting professionals. Any replies that were received have helped to form judgements about the service. Information received by the Commission since the last inspection was also taken into account. The inspection consisted of discussion with the manager and other staff, opportunities to meet with service users, examination of some of the home’s required records, observation of practice and a tour of the premises. A key theme of the visit was how effectively the service meets needs arising from equality and diversity. Feedback on the inspection findings and areas needing improvement was given to the manager and external line manager at the end of the inspection. The manager, staff and service users are thanked for their co-operation and hospitality during this unannounced visit. What the service does well: Prospective service users are thoroughly assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. The health and personal care needs of people living at the home are well met, promoting health and well-being. Needs arising from equality and diversity are well met, ensuring that each persons individual circumstances are taken into account. Activities are available to service users to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met. Complaints and adult protection are effectively managed to listen to views of people who live at the home and reducing the risk of harm to them. The home is being maintained whilst reprovisioning takes place, with improvement noted to general cleanliness to ensure that service users have pleasant surroundings in which to live. The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 6 The home provides staff cover to meet needs and has a training programme to ensure staff have the right skills and competencies to support the people who live there. The management and administration of the home promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. 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 DS0000023063.V343657.R01.S.doc Version 5.2 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 Outcomes Statutory Requirements Identified During the Inspection The Elms DS0000023063.V343657.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3 (6 not applicable.) Quality in this outcome area is good. Prospective service users are thoroughly assessed prior to admission and are given opportunity to visit the home beforehand to ensure it meets their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a statement of purpose and service users guide in place which outline the scope and philosophy of the service. The information would be useful in helping prospective service users or their representatives decide on a placement. A range of fees was being charged, depending on whether people were privately funded or sponsored by the local authority and the level of care required. Pre-admission documents of three people were looked at and found to contain assessments of needs undertaken by senior staff from the home plus information supplied by the local authority Social Services Department. Documentation was sufficient to understand the type of care each person needed, to ensure that the home was the best place to meet these needs. The Elms DS0000023063.V343657.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 &10. Quality in this outcome area is adequate. The health and personal care needs of people living at the home are well met, promoting health and well-being. Needs arising from equality and diversity are well met, ensuring that each persons individual circumstances are taken into account. Some attention is needed to recording of medication to ensure that an accurate audit trail is maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Each person at the home had a care plan outlining their individual needs and how these were to be met. A sample of plans, primarily of people located in the dementia care lounge, were looked at and found to be up-to-date, generally signed and dated and comprehensive. Records of weights were being maintained, nutritional assessments were in place and each file contained a moving and handling assessment, falls assessment and a dependency level assessment. A tool to assess risk of developing pressure damage had also been used. Care had been taken to include additional information pertinent to the individual, such as a note in capitals on one care plan to alert staff that only female carers were to provide personal care to the service user. The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 10 Information on people’s history, such as occupation, was informative and important for staff to know. There was evidence of care plans being reviewed regularly and involvement of outside agencies such as the dietician. Where relevant, service users had been referred for assessment for incontinence products. Records showed access to health care professionals was arranged as and when needed, with doctors, nurses, podiatrists, opticians and dentists noted in the records examined. Vaccination against the influenza virus was also noted for some people. On arrival at the home the senior in charge was dealing with a medical emergency which necessitated a service user being admitted to hospital. Quite correctly, she put the service user’s needs before the inspection and stayed with the service user, and was heard giving detailed assessment of the situation over the telephone to the emergency services. The service user’s next of kin was informed promptly and sensitively of the admission to hospital. Medication practice in the dementia care lounge was examined. The cabinet was kept secure with the key held on the person responsible for administering medicines. A monitored dose system was being used with support provided by the pharmacy. A new medication policy was seen in the care manual in the duty office. Records of medication administration were looked at and some gaps were evident alongside prescribed dose times of a few service users’ medicines. The manager had put in place a monitoring sheet to try and overcome this issue although this was not being consistently effective in ensuring that accurate records are in place. A requirement is made to ensure that accurate records of drug administration are maintained, to make sure that a clear audit trail is in place at the home. One person who completed a comment card said “I was particularly impressed when after only a few weeks after joining The Elms the staff identified my mother’s difficulty swallowing tablets. They simply arranged to have her medication in liquid form.” At the previous inspection of the home, issues around the dignity of service users were raised as a matter of concern and a requirement made to improve practice. On this occasion, there was good regard for the appearance of service users and improvement to how mealtimes are managed (see next section of the report). An issue in the previous report relating to the management of inappropriate urination was no longer applicable at the home as the service user was no longer living there. A member of staff was overheard offering a service user assistance with reading a letter and offering a choice of venues if privacy was needed. The service user’s choice was then respected. Feedback from people who completed comment cards was positive about care provision with respondents ticking always or usually when asked if they receive the support they need. Additional comments included: The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 11 “At 95 years old and with dementia, dad’s needs are increasing and the care home is managing well…the level of care is very good and dad seems happy to be there.” “The residents are well cared for physically and mentally. Their home is always clean and tidy.” “My mother is always clean and nicely dressed. If assistance is needed they provide it quickly…if my mother is not well the staff assist with food and drinks…choice is always there along with encouragement to join in. I have seen a marked difference in my mother (for the better) since moving from her previous care home.” One of the doctors said that the home communicates clearly and works in partnership with the surgery, doctors are able to see their patients in private, staff demonstrate awareness of needs, specialist advice is incorporated into care plans and medication is appropriately managed. He indicated that he was satisfied with care provided at the home and was not aware of any complaints about practice. The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 12 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 & 15. Quality in this outcome area is good. Activities are available to service users to provide them with stimulation and contact with family, friends and the community is supported to maintain social links. Food is well prepared and presented attractively to make sure that nutritional needs are met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a part time activities co-ordinator and the home is a member of the National Association for Providers of Activities for Older People. The coordinator is undertaking National Vocational Qualification level 2 in this area of work. At the time of this visit, The Elms was having a holiday at home week with lots of different activities organised. This included a trip to Southend earlier in the week which had been successful, a fish and chip supper which service users had enjoyed and at the weekend a Caribbean evening was planned with steel band and dance demonstration. Notices displayed around the home provided details of what activities were planned such as trips to Watermead, Quainton railway, a pub lunch, Blackberry Farm and Althorp and in-house entertainment such as belly dancers, a musical quiz, birds of prey and a clothes sale. A hairdresser is available at the home once a week and there is a monthly inter-denominational church service. An Age Concern advocate visits The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 13 to run service user meetings and posters with details and the advocate’s photograph were displayed around the building. Comments received from surveys included “Residents are encouraged to join in all activities, but if they do not wish to join in, that is respected.” One person said the home could improve by encouraging “all staff, not just the activity leader, to initiate activities to stimulate residents mentally”. Another felt that more needed to be provided for those service users with dementia to make sure that they have more mental stimulation. Visits to the home by service users’ family and friends are encouraged and there are no restrictions placed upon visitors. People completing comment cards indicated that they were kept up-to-date with important issues, one person adding “If a fall or injury is considered serious the staff telephone me. If not urgent, the staff update me at weekly visits to my mother.” One person felt that the home gave “good support to relatives/friends when it is required.” Another person commented “I have had phone calls from the home and had updates during my visits to the home. This has helped enormously.” The inspector spent time with service users in the dementia care lounge at lunchtime. Tables were attractively set with cloths and napkins and cloth clothes protectors were used where service users were assisted to eat. A choice of meal and soft drinks was offered and a couple of service users opted to have lager with the meal. Assistance in eating was given at a gentle pace and staff engaged with service users; a straw was offered to help one person better manage her drink. Some service users who were able to give a verbal response said that they had enjoyed lunch. Input from a dietician was being sought as necessary; care plans contained nutritional assessments. The manager was advised to check seating arrangements in the dining room after the inspector found the table to be a bit too high for comfortable eating. The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 14 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 & 18. Quality in this outcome area is adequate. Complaints and adult protection are effectively managed to listen to views of people who live at the home and reducing the risk of harm to them. However, the home’s recruitment procedures could place people at risk through lack of robustness. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home had a complaints procedure plus revised Protection of Vulnerable Adults and whistle blowing policies. A small number of complaints had been received at the home during the past year although the complaints and compliments log contained mostly letters and cards of thanks and appreciation for care given to people’s relatives. The Commission has not received any complaints about the service directly from service users or their representatives. People who completed comment cards were aware of how to make a complaint, one person who had needed to raise some issues said the matter had been dealt with promptly. There had been one adult protection referral in the past year. Senior staff at the home are good at notifying outside agencies of incidents in general, such as informing the Commission of injuries to service users and hospital admissions. Records of accidents are maintained to provide an audit trail of injuries or marks to service users. As well as the provider’s policies and procedures, the home had obtained a copy of the inter-agency adult protection The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 15 procedures from Social Services. Training records showed that staff had attended Protection of Vulnerable Adults courses in spring of last year and the manager has been undertaking a train the trainers course. It is suggested that staff training on adult protection is updated over the coming year as part of the home’s overall development plan, to make sure that skills are refreshed and opportunities are given to discuss issues relating to current care practice. The home’s policies, procedures and training in this area of practice are being undermined by less than rigorous recruitment practice with some staff starting to work at the home before the full range of required checks are in place (see staffing section). The Elms DS0000023063.V343657.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 & 26. Quality in this outcome area is adequate. The home is being maintained whilst reprovisioning takes place, with improvement noted to general cleanliness to ensure that service users have pleasant surroundings in which to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Elms is a large building divided into lounge groups with small group dining and kitchen areas. Limitations of the building are known to the provider and the home is being completely redeveloped as part of wider reprovisioning plans by the Fremantle Trust. Comment cards gave indication that relatives are being kept informed of what is happening and staff spoken with as part of the inspection said they are regularly updated. Matters regarding the environment that were raised at the last inspection have mostly been met or there are plans to meet them. A strong smell of urine The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 17 evident on the first floor was said to come from the flooring of a bedroom – agreement has been given to replace the flooring. Bedrooms varied in size and degree of personalisation. Bedrooms in the dementia care part of the building looked the most sparse due to lino floorings and some attention was needed to décor where paint had become chipped or worn. The manager was able to produce a maintenance plan agreed by the provider for works to take place at the home from the central budget. The manager is also able to utilise the home’s own budget. There was therefore scope for redecoration to take place for the most worn rooms and for a number of areas to receive new flooring. Advice was given to limit lino flooring to rooms where the service user’s care plan identifies a need and for carpets to be in place for others. The day of the inspection was hot and sunny and staff were vigilant in ensuring that fans were switched on to help cool people down and blinds adjusted to keep the sun off them. Windows were open throughout the building to ventilate the premises, as were doors leading to the enclosed garden. All bathrooms and toilets seen or used had working locks and were clean and supplied with toilet roll, soap and towels. Yellow “wet floor” signs were used as necessary. Sluice rooms were kept locked when not in use and the laundry, although busy, was under control. The kitchen and store areas were clean. The home has an enclosed garden with benches and tables and was well maintained and provided a pleasant area for service users to use. Comments from people who completed survey cards included “The building is old, but the everyday maintenance is good i.e. furnishings clean, rooms disinfected at least once a week. New build is in progress” and “The home is always clean and tidy.” The Elms DS0000023063.V343657.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 & 30. Quality in this outcome area is poor. The home provides staff cover to meet needs and has a training programme to ensure staff have the right skills and competencies to support the people who live there. Attention is needed to recruitment practice, to make sure that all necessary checks have been completed, to reduce risk of harm to service users. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Elms is staffed with a mix of senior carers and carers, catering and domestic staff. The manager’s hours are in addition to the care rota and there is a part time, 30 hours a week, administrator and an activities co-ordinator who works three days a week. A duty senior is identified for each shift with responsibility for co-ordinating and running the shift and handovers take place to relay important information. A staff rota is maintained, showing that appropriate numbers of staff are being deployed to meet service users’ needs. No agency staff were being used at the time of the inspection to cover care hours; agency cook hours were being used to cover sickness. The home had a mix of male and female staff, mainly female, and just two people had left in the past year. There was a good bank of relief staff to help cover the rota. The manager had achieved the Registered Managers Award and was completing National Vocational Qualification level 4 to supplement this. Eighteen of fifty three staff had achieved National Vocational Qualification level The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 19 2 or above, according to information submitted before the inspection, and a further sixteen were undertaking National Vocational Qualification. All catering staff had undergone the relevant food handling and hygiene training. Comments on survey cards were positive about staffing and the quality of care provided to service users: “Staff are confident in their care and can ask a manager for assistance (managers always have an overview of each person’s care).” “They care. They notice. They act. They always seem to do the best they can. The staff are happy and this reflects the care they give, so making happy residents.” “Have noticed that there are more permanent staff now instead of agency. This helps with the continuity of looking after my relative.” “Very caring staff for residents’ physical and mental welfare.” “The staff are very kind and helpful.” Observation of staff practice showed positive elements such as asking a service user if he would like help with cutting his food up and waiting for a reply, showing service users the choice of soft drinks to help them make a decision, speaking with service users whilst assisting them to eat, using appropriate touch and making eye contact with service users and asking people if they enjoyed their meal at the end of it. Interventions that could have been handled better included speaking to service users in an irritated manner with a raised voice, speaking derogatorily to a service user who put a foreign object in her mouth, moving a service user’s chair without asking if the person needed to change their sitting position and banging a metal serving spoon noisily on a metal container in the food trolley whilst clearing up. In feedback to the manager, it was suggested that service users could feel threatened by such actions and the member of staff needs to be made aware of how actions can be perceived by others, especially vulnerable adults. It is acknowledged that the negative interventions are attributed to one member of staff and not a range of staff. Notes of staff meetings showed that staff had been made aware of the findings of the last inspection report and issues relating to dignity and respect had been raised. Training records showed an on-going programme of courses is available to the staff team. Nine people had current first aid certificates, all staff had undertaken training on dementia, moving and handling training looked up-todate and the manager has undertaken train the trainers courses on Protection The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 20 of Vulnerable Adults, infection control and food handling for care staff. Some staff had updated fire safety training in December last year, a few had attended a course on nutrition and older people last year and Protection of Vulnerable Adults had been attended in the spring. As well as suggesting an update in Protection of Vulnerable Adults for all staff over the coming year, the inspector also advised making use of local health care professionals to boost the home’s development plan, such as the community psychiatric nurse and dietician. A sample of recruitment files was looked at. Four files of recently appointed staff were examined. There was only one reference of two required in place in one file. Another person had been allowed to start work on 1st April this year but their preliminary clearance, POVAfirst, had not been received until 12th April. There was no evidence to prove that the person had not been involved with personal care until the clearance was received and then no proof of being supervised until full Criminal Records Bureau clearance had come in. For a third person, they too had commenced on 1st April but POVAfirst clearance had not been received until 12th April. For the fourth person there was one reference missing and they had started shifts on the day the POVAfirst clearance was received although there was no record to show that other staff had been made aware that she needed to be supervised until full Criminal Records Bureau clearance had been received. Overall, the files examined showed flaws in the recruitment practices at The Elms which could have repercussions for service users and how they are protected from the risk of abuse. A requirement is made to ensure that staff are recruited in line with required checks and the manager is advised to ensure that any risks in starting staff prior to full Criminal Records Bureau clearance are recorded and shared with senior staff who take responsibility for running shifts. The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 21 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 & 38. Quality in this outcome area is good. The management and administration of the home promote continuity and quality of care for the people who live there and ensure that risk is safely managed to reduce the likelihood of injury or harm. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home’s manager is registered with the Commission and has the necessary management experience to ensure effective day to day operation of The Elms. She has attended periodic training such as fire risk assessment, finance procedures, health and safety and disciplinary procedures. Areas highlighted at the last inspection for improvement have been attended to. Regular monitoring visits are carried out by the provider and reports are kept in the duty office and accessible to the staff team. A quality audit of care provision had taken place last May with a further audit due in September this year. The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 22 Service users’ money that is handled by the home is managed in the provider’s residents’ savings scheme. Only the administrator and manager at the home have password access to the computerised records. Manual records of expenditure are kept and receipts are obtained to verify spending then forwarded each month to the provider’s headquarters with the imprest claim. Statements of accounts are given to those service users or relatives who want a printed record. An inventory was in place for items held for safekeeping and receipts issued to the person depositing the item. A range of health and safety checks was taking place at the home. The fire officer visited in July this year and was satisfied with measures in place. The home’s emergency evacuation procedures were used in June this year following a fire in the laundry – no harm to staff or service users resulted. Water temperatures were being monitored and the home’s boiler and hot water system had been attended to, to improve supply of hot water around the building. First aid boxes were being checked regularly to make sure the necessary contents were in place. Portable electrical appliances had been checked in April this year and the home had a current electrical hard wiring certificate. Hoists had been serviced in July this year. It was not clear whether the home had a current landlord’s gas safety certificate and the manager is advised to look into this – evidence of just the kitchen gas appliances being satisfactory was seen in a report from earlier this year. The Elms DS0000023063.V343657.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for 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 3 x 3 x x N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 2 x x x x x x 2 STAFFING Standard No Score 27 3 28 3 29 1 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 DS0000023063.V343657.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation 13(2) Timescale for action Accurate records are to be kept 01/09/07 of medicines given to service users, to ensure that a clear audit trail is in place. Staff are to be recruited in line 01/09/07 with the required checks and clearances outlined in schedule 2, to protect service users from the risk of harm. Any risks in starting staff prior to full Criminal Records Bureau clearance are to be recorded and shared with senior staff who take responsibility for running shifts. Requirement 2 OP29 19(1) 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 DS0000023063.V343657.R01.S.doc Version 5.2 Page 25 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 DS0000023063.V343657.R01.S.doc Version 5.2 Page 26 - 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!