Inspection on 04/07/06 for

This inspection was carried out on 4th July 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 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

03/08/07

27/03/07

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 Nichola Cahill Unannounced Inspection 4th July 2006 09:30 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.V295030.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.V295030.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 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) Manager.winglodge@fremantletrust.org The Fremantle Trust Care Home 56 Category(ies) of Dementia (16), Old age, not falling within any registration, with number other category (40) of places The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. That the Home also provides care to the following categories of Service Users under the category `Older People` 1 (One) Service User on respite care who has Dementia 6 (Six) Service Users who have learning difficulties 1 (One) Service User who may have Mental Health Issues. 7th February 2006 Date of last inspection Brief Description of the Service: The Elms is a care home providing personal care and accommodation for fiftysix 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 GP’s and community nurses. The cost of living at The elms ranges from £370 per week to £475.00 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.V295030.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This is the summary of the unannounced Key inspection visit carried out by Nicky Cahill (inspector) on 4th July 2006. The inspection took place over a period of eleven hours, this included the pre-inspection planning. The inspection consisted of the case tracking of four service users currently living in the home, service users, visitors, health care professionals and staff discussions, observations, a tour of the building, viewing of documents and meeting with the manager and service manager. The Commission received feedback from eight service users, one visitor and three heath care professionals prior to the inspection visit. An assessment was made against compliance of requirements made during the previous two inspection visits. There are two outstanding requirements with additional requirements made at this visit. For further details please see the main body of the report. What the service does well: What has improved since the last inspection? Staff have received training in the safe handling of medications. The physical design and layout of the home enables service users to live in a safe and reasonably well-maintained environment, which encourages independence. The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 6 Staff in the home are trained in mandatory areas. Staff are supervised and a quality assurance programme has recently been carried out. 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 DS0000023063.V295030.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.V295030.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 2 and 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Service users needs are fully assessed prior to admission so the individual and the home can be sure that the placement is appropriate. A contract is provided for individual service users to ensure that they are aware of the services that they are entitled to within the home. EVIDENCE: Four service users were case tracked during this inspection visit. All service users had a contract in place. All service users had received an assessment of need prior to their placement in the home. This was confirmed through discussions and documentation viewed. The Elms DS0000023063.V295030.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Care plans do not give sufficient, accurate information to ensure that care staff are able to fully meet the needs of service users. Health care intervention is supported, however, is not evidenced within care plan information. Safe systems are in place for the storage of medications, however, medication records are not accurate and the lack of adequate recording puts service users at risk. Staff are aware of the need to treat service users with privacy and dignity at all times, service users are happy with the way most staff deliver their care. EVIDENCE: Four service users were case tracked during this inspection visit. All of the four care plans viewed were poorly developed and some areas were out of date, not reflecting the current needs of service users. Examples of poor records included a ‘Waterlow’ assessment, which had been completed, but was not dated and had clearly not been reviewed at the intervals indicated, an entry into the ‘medical intervention’ record that could The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 10 not be tracked, inaccurate information regarding the current capabilities of a service user and a bath temperature record which had not been completed. It is acknowledged that some reviews had taken place, however, these records were found in the back of care plan files and were not noted on the current plan of care. It was confirmed through service users discussions, observations and discussions with a visiting health care assistant that service users receive support with their health needs from a variety of professionals. However, there was little or no evidence within care plans to support this. It is disappointing to note that a requirement has been made at the previous two inspection visits regarding the development and upkeep of care plans, however, this requirement has still not been met. The Commission are mindful that the registered manager and deputy have been on long term leave since the last inspection visit and that a new manager has recently been employed to take over the service on 10th July 2006. With this in mind a further requirement has been made, however, should this requirement not be met by the given timescale, the Commission will consider enforcement action. Medication systems are in place for the safe storage of medications. However medication records viewed were inaccurate for the four service user records viewed. Examples of inaccuracies included medications administered but not signed as such, codes put into boxes with no explanation of why administration had not been carried out and many gaps in recording with no explanation. All staff responsible for the safe handling and administration have received training. However, a requirement for improvement has been made in this area. All service users spoken to during the inspection visit reported that privacy and dignity were respected; this was confirmed through observation and discussions with staff. The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Visitors are welcomed to the home, service users maintain links with their family and friends, however, social, cultural and recreational activities do not meet service users expectations. Service users receive a varied and appealing diet, however, for some service users this does not appear to be in accordance with their assessed needs. EVIDENCE: Service users social aspirations are not indicated within care plan information. Ten service users commented that activities in the home were not sufficient and did not meet with their individual wishes. Although activities were advertised around the home, there were no records to confirm that these had taken place. The activities book had not been utilised. The staffing rota indicated that one member of staff had been employed for twelve hours per week to plan and encourage participation in activities, however, on the day of the inspection, despite being on the rota for an 11am until 3pm shift, the activities co-ordinator did not arrive until 1.30pm. A requirement has been made for improvement in this area. The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 12 The home operates open visiting. Visitors to the home on the day of the inspection appeared to be welcomed. It was pleasing to note that, due to the high temperature of the weather on the day of the inspection, care staff were spending much of the time ensuring that service users drank plenty and were kept cool. The lunchtime meal was served in comfortable surroundings in the individual smaller dining areas around the home. Service users were offered a choice of cheese and potato pie, or chicken casserole, with a variety of fresh vegetables. Service users needing assistance were catered for with dignity and respect. One concern noted with regard to the provision of a healthy diet was that two of the service users who were case tracked during the inspection were identified as having specialist dietary needs. However, these were clearly not being met. Through discussions with staff it was apparent that there was insufficient knowledge regarding how such specialist dietary needs should be met. A requirement has been made for improvement in this area. The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for 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 the service. Service users have access to a robust, effective complaints procedure and are protected from abuse. EVIDENCE: The home has a complaints policy called the listening ear. This is available to all service users, staff and visitors to the home. The complaints log showed that any concerns or complaints aired were dealt with in an appropriate manner and in accordance with policies and procedures. Service users and visitors reported that they were able to air any concerns or complaints to staff should the need arise. The home had many recorded compliments regarding the care given to service users both past and present. Most staff have received training in the awareness and protection of adults from abuse. A policy and procedure is in place. The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The physical design and layout of the home enables service users to live in a safe and reasonably well-maintained environment, which encourages independence. EVIDENCE: The maintenance programme has been continued and most resident’s rooms have now been refurbished. However, it was noted that some areas of the home are still in need of repainting and attention to décor. Door locks, which can be opened from the outside in an emergency, have been fitted. Security locks have been fitted to both units on the ground floor. A number of new beds have been purchased as have a number of new commodes, (the rooms are not ensuite). It was noted at the previous inspection visit that not all divan beds had headboards and some of these appeared not to fit the bed. The provider’s The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 15 information supplied does not indicate that these have yet been replaced, this was confirmed through observation. A requirement has been made for further improvements in this area. There is an infection control policy and procedure. The laundry is situated away from the kitchens and has impermeable floors. The washing machines have the capacity to wash at a minimum of 65°C. Hand washing facilities are available although not all resident’s rooms had wall mounted liquid soap and paper hand towels for staff. Liquid soap dispensers were empty, however, all wash room areas visited had medicated hand wash available. The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. 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 the service. Recruitment practices are robust. Staff in the home are trained in mandatory areas, however, shortfalls in specialist areas of training do not ensure that service users needs are fully met or that their safety is maintained. Staffing numbers appear to be sufficient, however, this cannot be evidenced from the documentation in place, this does not ensure an adequate number of staffing on duty at all times. EVIDENCE: Five personnel files were viewed. All documentation was in order. Staff training has improved since the previous inspection visits with most staff having completed mandatory training. The new manager must be mindful that some areas of mandatory training are, now or in the near future, due for renewal. During the inspection it was apparent from discussions and documentation viewed that not all staff were aware of how specialist needs should be met for individual service users. Examples of shortfalls were in the care of a service user with diabetes and a service user with learning disabilities. It was also noted that the knowledge around use of COSHH items was not adequate and did not ensure safety at all times. A requirement has been made for improvement in this area. The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 17 NVQ training has not moved forward since the previous inspection visit. However, it is hoped, with the appointment of the new manager, who is an NVQ assessor, this area will have improved at the next inspection visit. This is an unmet requirement from the previous inspection visit. A further requirement has been made for improvement in this area. At the time of the inspection visit the home appeared to have an appropriate number of staff on duty to meet the needs of the service users group. However, staffing rotas were poor and did not accurately reflect the staffing numbers on duty at any one time. Some rotas viewed would indicate drastic understaffing, especially on the night shift. However, after much searching through records other documentary evidence was produced to confirm staffing numbers had been adequate. Rotas also indicated staff to be in duty who had clearly ‘swapped’ shifts. This was confusing and difficult to monitor. A requirement has been made for further improvement in this area. The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 18 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Service users presently live in a home that is reasonably well managed by a manager from another home within the organisation; Staff are supervised and a quality assurance programme has recently been carried out. However, the results of any shortfalls in quality have not yet been addressed and such shortfalls do not ensure effective and efficient systems in place to improve outcomes for service users. EVIDENCE: A manager seconded from another home within the organisation is presently managing The Elms. A new manager has been appointed to start on 10th July 2006. Some shortfalls have been addressed in the interim; however, work The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 19 must be completed in areas previously noted to ensure that outcomes for service users are appropriately met. Staff supervision has improved since the previous inspection visit with all team leaders carrying out supervision sessions with allocated staff. It is anticipated that all supervision sessions will be up to date at the next inspection visit. The service manager has recently carried out a quality audit. Many areas identified as having shortfalls were reflected in the inspection findings. It was confirmed that a copy of the quality audit and an appropriate action plan will be forwarded to The Commission at the organisations earliest convenience. Health and safety systems viewed appeared to be in order, with the exception of weekly fire testing. The service manager identified this during the quality audit. A requirement has been made for improvement in this area. The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 20 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 3 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 3 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X X 2 X 2 The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 21 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 OP7 Regulation 15 Requirement All residents must have their care plans reviewed by the unit care co-ordinator on a monthly basis, to ensure that they contain the correct documentation, are complete and have been updated to describe the residents current care needs. This is an unmet requirement of previous reports and a new timescale has been set. The manager must ensure that all medication administration records are completed accordingly. The manager must ensure that the social, cultural and recreational needs of service users are met and that appropriate recording systems are in place. The manager must ensure that the specialist dietary requirements are met for all individual service users in accordance with guidance from DS0000023063.V295030.R01.S.doc Timescale for action 30/09/06 2. OP9 13 20/07/06 3. OP14 12 20/07/06 4 OP15 12 31/07/06 The Elms Version 5.2 Page 22 5 OP25 13 external health care professionals where necessary. The repairs to the remaining rooms must be completed. This is an unmet requirement of the previous report and a new timescale has been set. 30/09/06 6. OP27 18 The manager must ensure that 20/07/06 the staffing rota reflects a sufficient number of staff on duty at any one time. This should also reflect the names of the staff on duty. All staff must have training in specialist areas pertinent to the needs of individual service users within the home. A programme to enable 50 of staff to achieve the National Vocational Qualifications in Care at Level 2 or above must be implemented. This is an unmet requirement of the previous report and a new timescale has been set. It is a requirement that fire call point testing is carried out weekly. 31/08/06 7. OP30 18 8 OP28 18 30/09/06 9 OP38 23 30/07/06 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.V295030.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Aylesbury Area Office Cambridge House 8 Bell Business Park Smeaton Close Aylesbury HP19 8JR National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Elms DS0000023063.V295030.R01.S.doc Version 5.2 Page 24 - 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!