Inspection on 27/09/05 for The Elms Care Centre

This inspection was carried out on 27th September 2005.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

The Elms Care Centre 12/04/07

The Elms Care Centre 12/04/06

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 Mrs Sue Daniells Unannounced Inspection 27th September 2005 07:00 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.V253942.R01.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V253942.R01.S.doc Version 5.0 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 BetterCare Group Limited Susan Addison Care Home 86 Category(ies) of Dementia - over 65 years of age (43), Old age, registration, with number not falling within any other category (43) of places The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. All service users who are assessed as suffering from dementia should be placed only in bedrooms within the two dementia units in the care home. 18th May 2005 Date of last inspection Brief Description of the Service: The Elms Care Home is set in the Lincolnshire town of Louth and is now owned by the Four Seasons Health Care Group which has taken over the BetterCare Group Ltd. 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. The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection took place over one day in September 2005 with the visit lasting for seven hours. The inspector focussed on two of the three areas of the home, both caring for residents with varying degrees of dementia. Four residents were “case tracked” – a system that looks at the needs of the resident and follows this through by talking to the resident concerned and the staff who deliver the care. In total, eight residents, six members of staff and two relatives were spoken to. The inspection was a very positive one with relatives feeling very happy with the care their loved ones receive. “it’s nice here” and “the food is good” were typical of the comments made. What the service does well: What has improved since the last inspection? Staff morale has improved further and a new member of staff is about to be recruited to provide activities in the Oakwood Unit. Pre-admission assessments are thorough, with prospective residents or their relatives being assured that the home can meet their needs before admission. Care plans reflect all the needs of the residents and more care is now being taken over aspects of medication. In addition, residents and relatives know how to raise any concerns they may have. Staff “handover” sessions are now more comprehensive to ensure that staff are more knowledgeable and residents have better continuity of care. Dementia “awareness” sessions have increased for staff although more in-depth sessions are still needed. The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 Page 6 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 Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 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.V253942.R01.S.doc Version 5.0 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): 3 and 4. The outcome for Standard 6 does not apply to the home. Prospective residents have all their needs assessed by competent staff and are assured that the home can meet their needs in writing. EVIDENCE: Pre-admission assessments of four residents were examined. Assessments were varied, in that the three admitted prior to the take-over showed limited information and were basically of a “tick list” type for aspects of daily living, for example, eating, dressing, communication, etc. The assessment for the resident admitted since the take-over was much more comprehensive and evidenced the care that would be required to meet their needs. All had a dependency score and full risk assessment completed. A relative spoken to stated that they had been part of the assessment process. Letters are now sent to all prospective residents or their relatives, stating whether the home can meet their needs. The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 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 and 9 Residents care plans show all their needs and how staff are to meet them. Residents with health care needs have access to the appropriate health care professionals when required and are able to self-medicate, when this is appropriate, and after risk assessments have been completed. EVIDENCE: Because of the take-over of the home by Four Seasons, the care planning system in the home is being changed to a different set of paperwork and care plans currently show documentation from both systems. The staff are finding this confusing but feel that once completed it will be easier to use. The care plans were comprehensive and thorough, with one showing a good personal and social history, although the resident’s and/or relative’s wishes for their care at the end of their life was not documented. Reviews are undertaken every month to ensure that plans are updated if there are any changes in residents’ needs. The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 Page 10 Relatives and staff stated that health professionals visit the home on a regular basis e.g. GP’s, chiropodist; these visits are documented in the care plan. Residents are escorted to hospital appointments. One member of staff informed the inspector that if a resident asked to see a health professional, one would be called. A senior carer had a good working knowledge of the correct procedure for administering medication to residents requiring personal care only and had received appropriate training for this. Residents who self-medicate are risk assessed prior to this happening and keep drugs in a lockable drawer in their rooms. A “cylobin” has been provided for the disposal of waste drugs; this is replaced on a regular basis. The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 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, 14 and 15 Even though activities are provided and will increase in the near future, 44 hours a week is not considered sufficient for the number and different needs of the residents within the home. Resident’s with greater needs are not always helped to exercise choice over their lives and greater flexibility is required with regard to mealtimes. EVIDENCE: At the last inspection it was required that activities must be made available to all residents with particular emphasis on those with problems associated with dementia. During this visit it was found that residents in the main house have access to 24 hours of activities a week, over three days, in order to meet their social and recreational needs. Such events include bingo sessions, videos, manicures, writing letters and reading. A “T” dance had been held recently which the residents had enjoyed and a local vicar attends the home on a monthly basis. A new activity organiser for 20 hours per week in the Oakwood Unit will commence shortly; the combined activity hours for the home equating to 44 per week. The manager has asked senior management within the organisation for more hours of activities in the next budget. Staff for the annexe in the main house stated that routines were flexible for the residents to suit their individual needs; residents spoken to upheld this with one stating, “I do as I like”. Evidence in the Oakwood Unit showed that The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 Page 12 some residents had no choice about when they were changed into their nightwear or put to bed and four residents in the annexe were seen to be sitting in the dining room waiting for breakfast from 8.15 am when, on observation, this was not served until 9 am and one resident stated that they were hungry. On the day of the visit, the inspector was informed that the contract for domestic, laundry, kitchen and catering staff was ceasing and the home would employ their own of staff; previously the contract for these staff and the production of meals had been outsourced. Choices at all meals were available. Residents spoken to about the food offered in the home were complimentary and a relative stated “there’s nothing wrong with the food here” and “it’s lovely” The food offered at breakfast and lunch was seen by the inspector and were seen to be wholesome and nutritious with generous portions served. The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 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 Staff and relatives are confident that any issues of concern will be dealt with satisfactorily. Staff are trained in regard to adult protection and would ensure residents are protected. EVIDENCE: The home has a complaint’s policy and procedure in place, which is clearly displayed. All residents and relatives have been provided with a copy of this. Staff and a relative spoken to, knew what to do if they received a complaint and residents said they would talk to the manager and felt that it would be resolved to their satisfaction. The home also has an adult protection policy and a copy of the most recent guidelines for Lincolnshire. Staff spoken to had received training on this subject and had a good awareness of issues relating to adult protection; they stated that they would inform a senior member of staff if they suspected any form of abuse. The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 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 Residents live in an environment that is well maintained. although those in the main house are at risk because of poor security. EVIDENCE: The parts of the home visited during the inspection were generally well maintained and safe, although there was concern regarding the ability to access the first floor of the house, without the knowledge of anyone. Residents are particularly at risk when the doors are opened for staff early morning and no receptionist or administrative staff have commenced duty. This was brought to the attention of the manager during the feedback session at the conclusion of the inspection. A rolling programme of decoration is in place for all parts of the home and any urgent maintenance is generally attended to within 24 hours. The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 Page 15 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 and 30 Currently, the resident’s needs are met by suitable numbers and skill mix of staff who are trained and competent to do their jobs. EVIDENCE: The majority of staff spoken to felt that they could meet the needs of the residents with the current numbers of staff, and residents upheld this. One relative also stated that they felt happy with the numbers of staff on duty during the day. A member of staff on the Oakwood Unit stated that they would prefer it if there was an extra carer in the mornings as it can be very busy. At night, a total of 2 qualified nurses and 5 carers are on duty; these numbers are split between the three different areas of the home. The manager informed the inspector that staff numbers would increase as the home’s occupancy increased, to ensure that resident’s needs were met. Since the manager has been in post, a comprehensive plan of continuous training has been in place and on the day of the inspection future sessions on adult protection and fire prevention had been placed on notice boards. Residents and relatives were complimentary of the care that was given by the staff and felt that “they know what they’re doing”. Staff promoted to “senior carers” have all been enrolled on NVQ (National Vocational Qualification) level 3 One relative said of the overseas nurses “they’re brilliant”. The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 Page 16 Staff spoken to in both of the areas inspected had received some training in dementia, although one said that they felt they would benefit from a more detailed course. A member of staff was upset that some of the overseas staff, when on duty together, talk in their native tongue and this they found isolating and intimidating. Furthermore, the residents would not understand them. This was brought to the attention of the manager. The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 Page 17 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 and 38 The manager is respected by staff, is fully aware of her responsibilities and runs the home in the best interests of service users. the health, safety and welfare of both residents and staff is protected. EVIDENCE: The manager has recently been registered by the Commission and has made a number of positive changes in the home including a very positive attitude towards training. The staff spoken to felt supported by her and stated that she was approachable and “gets things done”. She is aware of her responsibilities to residents and staff and sees the relationship between herself and the Commission as a partnership. Staff morale has further improved since the last inspection, and residents know they can talk to her about any issues they wish to raise. The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 Page 18 Staff and residents have regular meetings, which are minuted and any items brought up are actioned by the most appropriate person. Staff felt that they knew what was happening in the home and also that the home was run for the benefit of the residents. One relative felt that they were involved in all aspects of their loved one’s care and “that’s great”; another said that “things have improved a lot, it’s much better for my brother” A variety of regular checks are carried out in the home to ensure that the health and safety of the residents and staff is protected including hoists, fire equipment, emergency lighting, hot water, fire alarm tests. These were found to be up to date. The manager undertakes random audits for care plans. The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 Page 19 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 3 x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 x x x x x x x STAFFING Standard No Score 27 3 28 x 29 x 30 3 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.V253942.R01.S.doc Version 5.0 Page 20 Are there any outstanding requirements from the last inspection? Yes 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 OP12 Regulation 12 (3) Requirement Residents must be helped to exercise choice over when they get changed into nightwear and when they go to bed. Times of meals must be flexible in order to suit individual needs. Access to the first floor of the main house must be limited in such a way that residents are always safe from harm. Timescale for action 31/10/05 2 3 OP15 OP19 16 (2) (1) 13 (4) (a) (c) 31/10/05 31/10/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard 12 Good Practice Recommendations Because of residents varying abilities,it is recommended as good practice that activity hours available to the residents are further increased to ensure that they have their social and recreational needs catered for. As good practice it is highly reccomended that all staff who DS0000002554.V253942.R01.S.doc Version 5.0 Page 21 2 30 The Elms Care Centre 3 30 deal with residents with dementia receive appropriate, comprehensive training following on from an “awareness” session. It is strongly recommended that the organisation put policies in place so that foreign staff only communicate in English when on duty. The Elms Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Lincoln Area Office Unity House, The Point Weaver Road Off Whisby Road Lincoln LN6 3QN 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 Care Centre DS0000002554.V253942.R01.S.doc Version 5.0 Page 23 - 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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