Inspection on 12/04/07 for The Elms Care Centre

This inspection was carried out on 12th April 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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

The Elms Care Centre 12/04/06

The Elms Care Centre 27/09/05

The Elms Care Centre 18/05/05

The Elms Care Centre 22/02/05

The Elms Care Centre 14/10/04

The Elms Care Centre 13/09/04

The Elms Care Centre 05/01/04

Similar services:

Byars Care Home

St Marys Nursing Home

Bramble Lodge

Parkmanor Residential Home

Thornham Grove

Hunter`s Lodge

London Road Neurological and Specialist Care Unit

Carlton Care Home

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

CARE HOMES FOR OLDER PEOPLE The Elms Care Centre Elm Drive Louth Lincs LN11 ODE Lead Inspector Julie Western Key Unannounced Inspection 12th April 2007 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 Care Centre DS0000002554.V337516.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 Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms Care Centre Address Elm Drive Louth Lincs LN11 ODE 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) 01507 350100 01507 350107 the.elms@fshc.co.uk www.fshc.co.uk Four Seasons (DFK) Limited (wholly owned subsidiary of Four Seasons Health Care Limited) Diane Howden Care Home 86 Category(ies) of Dementia - over 65 years of age (53), Old age, registration, with number not falling within any other category (33) of places The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. 5. The Oakwood Unit of the home should care for 29 people with dementia,over the age of 65 years who require nursing care. The dementia unit in the main house should care for 24 people over the age of 60 years who only require personal care. The Elms must care for 33 people over the age of 65 years, not falling within any other category, who require either personal care or nursing care. All service users who are assessed as suffering with dementia should only be placed in the two dementia units within the home. The maximum number of service users to be accommodated in the home is 86. 12th April 2006 Date of last inspection Brief Description of the Service: The Elms Care Home is set in the Lincolnshire town of Louth and is owned by the Four Seasons Health Care Group. The Elms Care Centre provides accommodation in 2 buildings called the Elms and Oakwood Unit. The Elms is a 2-storey building with a lift provided to enable service users to access the first floor. The building was a converted estate property, which was fully refurbished and extended in 2002. Oakwood Unit is a single storey building set in the same grounds as the Elms. There are large gardens surrounding the home and parking is provided at the side and rear of the care home. There are local transport services, which pass the care home. The home is registered as a care home providing services for 86 male or female service users over 60 years of age. Current fee levels in the home range from £335.00 to £522.00 per week. The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced, was carried out over 3 hours and took into account any previous information held by CSCI including the home’s previous inspection reports, its service history, pre-inspection questionnaires completed by the Manager and residents’ questionnaires sent to the home by the Commission prior to the inspection. The site inspection consisted of case tracking a sample of residents’ records and assessing the care given. Some policies and procedures were examined and some records concerning the safety of the home were also seen. Four residents, three care and ancillary staff and one visitor were spoken with. The Manager was present throughout the inspection. What the service does well: What has improved since the last inspection? A new manager has been appointed and Oakwood unit also has a new manager; this means that the management of the home is more co-ordinated. Four additional staff members have been also been recruited to work on The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 6 Oakwood unit and staff members commented that there were now no staffing issues. Medication procedures have been reviewed and staff members have received additional training in the distribution of medication. The manager audits medication records on a monthly basis. A new assessment format has been introduced to improve the assessment procedure. The majority of care plans have been reviewed and now reflect the needs of service users more clearly. 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 Care Centre DS0000002554.V337516.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 Care Centre DS0000002554.V337516.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): 3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home’s information has been updated and now clearly sets out how it intends to care for the residents. Residents and their carers have all the information they need to make an informed decision. A comprehensive initial assessment ensures that the needs of residents can be met. EVIDENCE: The admission procedures for the two most recent admissions on Oakwood were comprehensive and clearly identified the needs of the residents, including challenging behaviour and triggers. The other residents’ records were gradually being updated and the manager said she hoped to complete this work within three months. The Oakwood unit manager said she normally carried out pre-admission visits. The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 9 Residents spoken with said their relatives chose the home for them. A visitor said she and her relative were invited for afternoon tea before moving in permanently. The service user guide was not in an easy format for residents to read and the manager said she was looking at making this document more user friendly. The home does not provide intermediates care [see NMS 6]. The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 10 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. This judgement has been made using available evidence including a visit to this service. Although it is acknowledged that a majority of the care plans have been updated and revised, the remaining records need reviewing to ensure that all needs are identified and met. EVIDENCE: 3 care plans were looked at on Oakwood unit and one of these had been revised to give a comprehensive assessment of the resident’s care needs. The other two were in the process of being reviewed and did not contain enough information for carers to address the needs of residents. The manager said it was expected that all reviews on this unit would be completed within three months. The care plan that was inspected on the Elms unit clearly identified the resident’s health and personal care needs. The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 11 Residents spoken with could not remember being involved in their care plans but the visitor said there were regular meetings. The Elms Care Centre DS0000002554.V337516.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): Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. 12,13,14,15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. While activities are adequate for the needs of residents on the Elms unit, the activities co-ordinator has yet to commence in post on the Oakwood unit and activities are consequently still basic and not always suited to individual residents’ needs. Residents receive a choice of food that is balanced and well presented. EVIDENCE: The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 13 Residents on the Oakwood unit whose records were looked at were unable to talk in depth about the activities and events but were able to demonstrate that they were happy with the activities. The unit manager for Oakwood unit said that an activities co-ordinator had recently been appointed but was not yet in post. The manager said that training in activities for people with a dementia would be given once she was in post. The activities recorded for residents were very general and were not tailored to suit individual residents’ needs. A sensory room was in the process of being developed and residents were already able to use some of the equipment in it. Activities on the Elms unit were displayed on the entrance hall notice board and included bingo sessions, films, various entertainers and manicures. A resident said ‘I like the singers best’, referring to a singing duo who visited the home regularly. A visitor said ‘there always seems to be something going on here’. The menu was well balanced and offered a daily choice; residents were seen eating breakfast and said they enjoyed the food served. The food for the Oakwood unit was transferred from the main building by hot trolley. Several residents had pureed food and this was given in a sensitive and dignified way. Environmental Health Officers had given the home a Gold Award in their food safety award scheme. The 3 kitchen staff on duty all had basic food hygiene qualifications and the cook was a trained chef. The Elms Care Centre DS0000002554.V337516.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 good. This judgement has been made using available evidence including a visit to this service. Residents receive personal and health care, including medication, in a way that is sensitive and safe. EVIDENCE: Care staff members spoken with said they had recently undergone training on the safe handling of medication; training records and discussion with the manager confirmed this. Medication was recorded appropriately and the manager said that she now carries out a monthly audit of medication procedures. Residents spoken with said they felt happy with the way staff gave them medication; one said ‘They do look after us well here’. Staff members on both units were observed caring for the residents with sensitivity and regard for their dignity, particularly when attending to their personal needs. Residents were seen happily chatting and joking with staff in a relaxed manner. The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 15 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 good. This judgement has been made using available evidence including a visit to this service. Residents live in a pleasant and safe environment that is suitable for their needs. EVIDENCE: The parts of the home visited during the inspection were generally well maintained and safe. A keypad system operates in the Oakwood unit. There is a rolling maintenance programme for the bedrooms, which are redecorated on vacation. The home employs one maintenance worker who sub-contracts the work. Rooms 30,31 and 32 in the main building are currently not in use as a recent fire risk assessment carried out by the organisation’s estates department The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 16 showed them not to have a safe escape route. The manager said that this was being addressed. Staff spoken with said they thought the building was safe to work in and for residents. Residents spoken with all liked their rooms; one resident said ‘It’s lovely here and I have a lovely view of the gardens out of my window’. The Oakwood unit in particular had pleasant, well-tended grounds with open views from the communal areas. The home smelled fresh and was clean throughout. The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 17 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 good. This judgement has been made using available evidence including a visit to this service. There are enough staff numbers to meet the needs of residents safely. Staff members are trained and competent to undertake their tasks. EVIDENCE: The staff rotas showed that there were enough staff members to meet the needs of the residents both on the Elms unit and on Oakwood unit, where four members of staff had recently been recruited. Staff members spoken with said that this had made a considerable difference to the unit. The manager said that six additional staff had been recruited and were commencing their duties soon. A unit manager was also appointed in November 2006 and staff said that this had made the unit more cohesive. The training plan showed that training in care planning and medication had taken place, with future training including first aid, POVA, moving and handling and fire wardens. The Oakwood unit manager said that all staff members on this unit have undergone dementia awareness training and staff members spoken with The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 18 confirmed this. Four staff members had also received training on dementia care mapping with Bradford University trainers. Three staff members currently had achieved the National Vocational Qualification [a nationally recognised award] at level 2 with a further six undertaking it and two had achieved it at level 3 with a further two working towards it. Residents said there were enough staff to meet their needs; one said ‘they’re lovely people – I got an Easter egg from one them today’. The most recent staff member to be employed confirmed that she had given references, completed an application form and been interviewed. She was currently undergoing induction training and was shortly to commence the NVQ at Level 2. The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 19 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): 31,33,38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is managed competently and the staff team are supported in carrying out their respective roles. The views of residents are listened to and they are involved in decisions affecting them. EVIDENCE: The manager has been in post since September 2006. She has worked in care management for 32 years. For the last five years she has worked at the Elms. She has regular supervision from a regional manager. The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 20 The manager’s office has been moved to the front of the building so that she is more visible to residents, staff and visitors. Staff and residents spoken with said she was approachable and did her best to resolve and issues. A visitor said ‘It’s improved since the manager came here, particularly staff numbers’ and a staff member endorsed this. Following an adult protection issue concerning the use of hoists and a health and safety audit, a new hoist was purchased for the Oakwood unit. A comprehensive health and safety policy is in place. Regular checks are carried out by the organisation to ensure that the health and safety of the residents and staff is protected. Staff members spoken with said they thought the environment was safe and residents said they felt protected from harm. Minutes of staff and residents meetings were seen and residents said they were able to have a say in the running of the home. The manager carries out a very comprehensive three-monthly self-audit; this demonstrates that the home is pro-active about quality assurance. The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 22 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 2 Standard OP7 Regulation 15[1] 16[2] m, n Requirement All care plans must be updated to reflect the care needs of the residents. The activities provided must be suited to the assessed needs and abilities of each service user. Timescale for action 22/06/07 22/06/07 OP12 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 OP1 Good Practice Recommendations The service user’s guide should be written in a format suitable for the residents to understand. The Elms Care Centre DS0000002554.V337516.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Care Centre DS0000002554.V337516.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. 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