CARE HOME ADULTS 18-65
Elms (The) 28 Elms Way Southbourne Bournemouth Dorset BH6 3HU Lead Inspector
Stephanie Omosevwerha Unannounced Inspection 8 February 2006 15:45
th DS0000063293.V283331.R01.S.doc Version 5.1 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 DS0000063293.V283331.R01.S.doc Version 5.1 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. DS0000063293.V283331.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Elms (The) Address 28 Elms Way Southbourne Bournemouth Dorset BH6 3HU 01202 431886 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) Elms Care Limited Mrs Ana Maria Greenwood Care Home 4 Category(ies) of Learning disability (4) registration, with number of places DS0000063293.V283331.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 14th June 2005 Brief Description of the Service: The Elms is a small home set in its own mature grounds and is in keeping with all the properties in its immediate vicinity. It is situated in a quiet, residential area of Southbourne and is close to local shops and amenities. Bus routes to Bournemouth and Christchurch are easily accessed. The home is registered to accommodate a maximum of four adults of both sexes with a learning disability and had no vacancies at the time of inspection. The property has limited access to service users with physical disabilities. However, the facilities are appropriate for the intended service group, i.e. adults with learning disabilities. Three residents have single rooms on the first floor and there is a further bedroom on the ground floor. Residents share the use of an upstairs bathroom and downstairs shower room. On the ground floor there is a large lounge with a separate dining area and kitchen. The home is well kept and furnished. Outside there is a garden that provides a seating area for eating out and a storage shed. Service users are offered a wide range of opportunities both within and outside the home. Most service users attend day centres whilst one service user has a daily programme provided by the home. DS0000063293.V283331.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over approximately 3 ½ hours during the evening when all the service users were home. It was the second annual inspection carried out as part of the planned inspection programme for care homes undertaken by CSCI. The inspection also addressed the requirements and recommendation that were made at the previous inspection. At the beginning of the inspection, the inspector had the opportunity to speak to the residents and the member of staff who was on duty. The inspector also looked around all communal areas of the home and saw two residents’ bedrooms. David Lallana and Paul Greenwood, two of the registered providers arrived at the home later and were able to assist the inspector looking at documentation and records including residents’ care plans, medication and financial records, and staffing files. The inspector also had copies of the home’s Statement of Purpose, Service User Guide and service users’ contracts, which were sent to CSCI offices after the last inspection. What the service does well:
The Elms offers a small, family-type environment. Residents are able to contribute to the running of the home and enjoy flexible routines that cannot always be offered in larger homes. Residents spoke positively about their care and were clearly able to voice their opinions in front of the registered providers indicating an atmosphere of openness and respect. The home liaises well with other professionals ensuring the necessary information is obtained from them in order to make informed decisions about any potential new admissions to the home. Good links are formed with families and residents are supported to maintain and develop relationships. For example assistance is given such as arranging transport and making telephone calls. The home is well run and benefits from a well qualified and experienced leadership team who have an excellent knowledge of adults with learning disabilities including those with more complex needs. There is a small, competent staff team who spend a great deal of time working with service users and treat them with dignity and respect. In addition to training in health and safety topics, staff undertake courses to give them the specialist skills they need to meet service users needs such as communication skills, challenging behaviours and epilepsy. Staff have a good understanding of working with vulnerable adults, promoting and protecting the welfare of service users living in the home.
DS0000063293.V283331.R01.S.doc Version 5.1 Page 6 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. DS0000063293.V283331.R01.S.doc Version 5.1 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 DS0000063293.V283331.R01.S.doc Version 5.1 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): 1, 2 and 5. Amendments have been made to the home’s information to ensure prospective and existing residents are aware of any differences that the change in ownership of the home has made and how this may affect them. The home liaises well with other professionals to ensure they will be able to meet the needs of any prospective residents, however, the home needs to ensure care plans are in place so that staff have clear guidance about residents care and support needs. EVIDENCE: It was identified at the last inspection that minor amendments were needed to the Statement of Purpose and Service User Guide concerning the numbers and sizes of bedrooms. Amended copies had been sent to CSCI after the last inspection and this standard is now met. There had been two new admissions to the home since the previous inspection and the care files for both these residents were examined. There was evidence of care management assessments and plans and further information from other healthcare professionals had been obtained. Relatives had also been consulted and an example of this included a recommendation that a service users wardrobe was screwed on to the wall so it wouldn’t fall if the resident had a seizure. One service user had moved in from one of the providers other home’s and their was written evidence that the social worker had been involved in this process. The service user told the inspector that she had
DS0000063293.V283331.R01.S.doc Version 5.1 Page 9 chosen to move homes and felt much happier with her present accommodation. The home had not yet set up a care plan for the other new resident and this needs to be drawn up with the service users participation to ensure staff have clear guidance about the residents support needs. This can then be reviewed as appropriate. The providers were required to set up new contracts with each resident after the last inspection to clarify the terms and conditions and ensure that they were aware of any changes to their contracts. This has now been put in place and a copy of the new contract was made available to the inspector. DS0000063293.V283331.R01.S.doc Version 5.1 Page 10 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): 7. Service users are encouraged to make choices in their daily lives with staff giving appropriate support according to each individual’s ability to understand and make decisions. EVIDENCE: There was evidence that resident’s were encouraged to make decisions about their daily lives. One service user discussed her decision to move to the Elms from one of the registered providers other homes. She also confirmed she could make decisions about choice of food, clothes, getting up and bedtimes and social/recreational activities. Observation during the inspection showed that service users could choose whether to spend time in the privacy of their rooms or in the communal areas of the home. One resident showed the inspector some of the artwork they had done for members of staff that had been put on display in the sleeping in room. DS0000063293.V283331.R01.S.doc Version 5.1 Page 11 A sample of service users financial records was checked. These were found to be up-to-date and accurate. All service users have their own banks accounts. Staff support three service users to manage their finances. One service user manages their own weekly allowance. It was recommended that the resident signs when money has been received to evidence this. DS0000063293.V283331.R01.S.doc Version 5.1 Page 12 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): 15. The home encourages service users to remain in touch with their families and assistance is given with transport arrangements and telephone contacts. EVIDENCE: Relatives’ details were recorded in individual files. The home’s Statement of Purpose states that the Elms operates an “open door” policy and welcomes relatives friends and representatives. Residents are encouraged to maintain and develop relationships with family and friends and the home can arrange transport to facilitate visits. This was confirmed by one resident who had arranged to visit a relative, the service user also said they were able to telephone their relatives from the home when they liked. DS0000063293.V283331.R01.S.doc Version 5.1 Page 13 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): 20. There are satisfactory arrangements in place for the administration of medication that promotes the general well being of the residents. EVIDENCE: The home’s medication is kept in a small locked cupboard in the kitchen. Medication records were checked as part of the inspection and these were found to be up-to-date and accurate. An appropriate policy is in place concerning the administration of medication and staff receive training in the safe handling of medication. DS0000063293.V283331.R01.S.doc Version 5.1 Page 14 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 and 23. Service users are aware of the home’s complaints procedure and feel able to use it to raise any issues/concerns they have so these can be acted on by the providers. Staff in the home have good awareness of adult protection issues and work effectively to promote and safeguard service users welfare. EVIDENCE: There was a requirement made at the last inspection to up-date the complaints procedure to reflect the change in ownership of the home. A revised copy was shown to the inspector and this is now prominently displayed in the home so all residents and visitors can see it. One resident confirmed they were aware of the process and knew whom they could talk to if they had any concerns. The home has good policies and procedures in place concerning the protection of vulnerable adults and there was evidence that staff know how to respond to allegations and deal with them correctly. The home has arranged for staff to undertake POVA training with Bournemouth Borough Council and is awaiting for spaces to become available. DS0000063293.V283331.R01.S.doc Version 5.1 Page 15 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. Recent investment had improved the living environment providing service users with an attractive and homely place to live. EVIDENCE: A tour of the premises was carried out as part of the inspection. All the communal areas were seen and 2 of the service user’s bedrooms. Several improvements to the environment were noted including a new sleeping in room for staff, new laminate flooring in the lounge/diner, which had also been redecorated, new furniture and blinds in the lounge area. The outside hedge has been cut letting in more natural light into the lounge. A requirement made at the previous inspection to repair a chest of drawers in one of the service user’s bedrooms had also been carried out. The inspector noticed the lock on the downstairs cloakroom/shower room had been removed. The providers said this was due to a risk assessment for one of the residents who was at risk of having a seizure. They had been unable to open the lock from the outside, which was necessary in an emergency. The provider said they would be replacing the lock with one that can be opened from the outside in case of emergency.
DS0000063293.V283331.R01.S.doc Version 5.1 Page 16 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): 34 and 35. The home’s recruitment procedure is robust ensuring service users welfare is safeguarded. Staff at the Elms are competent and well trained which ensures they have the appropriate knowledge and skills to meet service users’ individual and collective needs. EVIDENCE: There had been no new staff recruited since the last inspection. A sample of 2 staff files was examined as part of the inspection. There was evidence that appropriate recruitment procedures had been followed with application forms, references, proof of ID and CRB checks in place. Staff receive terms and conditions of employment. It was noted that some staff work also work in the providers’ other home and domiciliary care agency, however, they are given contracts for each position so there terms and conditions are specific to their place of employment. This was confirmed by a member of staff who was on duty during the inspection. Service users have also been involved in the recruitment and selection of staff including being part of the interview panel. Staff files contained evidence of their qualifications and courses attended. These included first aid, food hygiene, makaton, manual handling, fire training, epilepsy and challenging behaviours. An in-house induction programme had
DS0000063293.V283331.R01.S.doc Version 5.1 Page 17 been introduced specific to working at the Elms. Most staff working in the home had achieved some sort of professional qualification e.g. Registered Nurse (LD), Diploma in Social Work and NVQ 3. It was recommended, however, that the provider looks into training that follows the LDAF framework particularly the induction and foundation courses that would be useful for any new staff joining the team. DS0000063293.V283331.R01.S.doc Version 5.1 Page 18 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): 37 and 39. The home benefits from an experience and qualified leadership team who have excellent knowledge of the needs of adults with learning disabilities. EVIDENCE: The registered manager of the Elms is Ana Greenwood. She has substantial experience of working with adults with learning disabilities and is a Registered Nurse (LD). She has previously managed homes for adults with severe learning disabilities and complex challenging behaviours and additional health needs within the health authority. Her past experience included staff supervision and training, and recruitment and selection. She has completed the Registered Managers award (NVQ 4 in management). Ana is supported in her role as manager by the other registered providers, Paul Greenwood, David and Sharon Lallana who are also all Registered Nurses (LD). The current registered providers took over the ownership of the Elms in April 2005. Since then they have worked on improving the quality of the living environment. This has included redecoration and replacing furniture and
DS0000063293.V283331.R01.S.doc Version 5.1 Page 19 creating a new sleeping in room for staff. There have been changes in occupation of the home with one resident leaving and an additional room being registered so the home can now accommodation four residents. The providers have devised a service user questionnaire and also one to send out to their relatives to get their views on the service. This then needs to be collated into an annual development plan to review the quality of service and plan future service development. DS0000063293.V283331.R01.S.doc Version 5.1 Page 20 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 Standard No Score 1 3 2 2 3 X 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 X 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score X 3 X X X LIFESTYLES Standard No Score 11 X 12 X 13 X 14 X 15 3 16 X 17 X PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score X X 3 X 3 X 2 X X X X DS0000063293.V283331.R01.S.doc Version 5.1 Page 21 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. Standard Regulation Requirement The registered provider must ensure all service users have a written care plan that sets out their support needs and how these are to be met by the home. A suitable lock (that can be accessed in case of emergency) needs to be fitted to the downstairs cloakroom/shower room to ensure sufficient privacy is provided. The registered provider must develop an annual development plan based upon seeking the views of service users and other interested parties, to ensure success in achieving the aims and objectives of the home. Timescale for action 1 YA2 15 01/05/06 2 YA24 23 01/05/06 3 YA39 24 01/06/06 DS0000063293.V283331.R01.S.doc Version 5.1 Page 22 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA7 Good Practice Recommendations It is recommended that service users sign their financial records where appropriate to evidence when they have received their money. It is recommended that the provider looks into training that follows the LDAF framework particularly the induction and foundation courses that would be useful for any new staff joining the team. 2. YA35 DS0000063293.V283331.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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