Inspection on 06/11/08 for The Elms Care Centre

This inspection was carried out on 6th November 2008.

CSCI found this care home to be providing an Good service.

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 30/11/06

The Elms Care Centre 10/01/06

The Elms Care Centre 20/07/05

The Elms Care Centre 07/12/04

The Elms Care Centre 31/08/04

Similar services:

The Vicarage

Fairfields Country Rest Home

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Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Extracts from inspection reports are licensed from CQC, this page was updated on 31/03/2009.

Inspecting for better lives Key inspection report Care homes for older people Name: Address: The Elms Care Centre 108 Grenfell Avenue Saltash Cornwall PL12 4JE     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Mandy Norton     Date: 0 6 1 1 2 0 0 8 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. the things that people have said are important to them: They reflect This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 26 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: The Elms Care Centre 108 Grenfell Avenue Saltash Cornwall PL12 4JE 01752846335 01752849587 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) The Aldington Group Ltd Type of registration: Number of places registered: care home 37 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category physical disability terminally ill Additional conditions: Service users to include up to 37 adults of old age (OP) Service users to include up to 6 adults with a physical disability (PD) Service users to include up to 6 adults with a terminal illness (TI) Total number of service users not to exceed a maximum of 37 Date of last inspection Brief description of the care home The Elms is one of thee homes privately owned by the Aldington Group Ltd, director Michael Freeland. It provides care for up to 37 older people, the majority of whom have nursing needs. The home is situated in Saltash. Whilst at a distance from the main shopping centre, there is a small supermarket is close by and there is a bus Care Homes for Older People Page 4 of 26 Over 65 37 0 0 0 6 6 Brief description of the care home service, which enables active service users to exercise some independence or assists relatives when visiting. Accommodation is provided on two floors linked by a shaft lift and step lift. The majority of rooms are for single occupation, half of which have an en suite facility. There is a choice of communal space downstairs, which comprises two lounges, a conservatory/ dining room and front hall/sun lounge. There is a patio area with seating and car parking in front of the home. The home presents as being well maintained and is clean and tidy inside and out with a display of seasonal flowers at most times. The previous inspection report is displayed in the entrance foyer. The current fees range from 466.74 to 555.74 pounds per week (correct November 2008). The Service Users contracts are dealt with by the groups administrator who issues them once a settling in period had been achieved. Care Homes for Older People Page 5 of 26 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: This unannounced inspection took place from 11.10 am to 2.45 pm on 6th November 2008. The inspection was conducted with the manager. A tour of the home was carried out and people who live at the home were spoken to and observed. Nursing and care staff were also spoken to and observed during the inspection. This report also contains information taken from Service User and staff surveys submitted to the Commission prior to the insepction. Care Homes for Older People Page 6 of 26 Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 8 of 26 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 9 of 26 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use this service currently have some information about the home in order to make an informed decision about whether the service is right for them. The personalised needs assessment means that peoples diverse needs are identified and planned for before they move to the home. Evidence: There is a copy of the Service Users Guide in each room for people to refer to. The manager said that the administrator checks them all on a monthly basis and updates them as required. The ones examined included a complaints procedure and a brief description of the services provided by The Elms. The last CSCI inspection report was seen displayed at the front entrance. The manager said that people are always assessed prior to moving into the home to Care Homes for Older People Page 10 of 26 Evidence: ensure their needs can be met, a completed pre admission assessment form was examined. It included a lot of detail about the individual. If people are publicly funded the completed social services care plan provided to the home prior to admission is also used to decide if the home can meet a persons needs. The current fee level ranges from 466.74 to 555.74 pounds per week (correct November 2008). Care Homes for Older People Page 11 of 26 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The practice regarding the planning and delivery of care means that people can be sure that their health and personal care needs will always be fully met Evidence: The care plans examined were up to date and had been reviewed regularly. Care plans and risk assessments, such as manaual handling and skin condition, are kept in peoples rooms so that so that care staff can use them to refer to when caring for people and document ongoing progress. The nursing staff then complete daily records (having received information from the crae staff) about a persons welfare and detail what is ongoing for them. Information was also included about visits made by health care professionals such as GPs, opticians and dentists. A tour of the home showed that equipment necessary for the promotion of tissue viability and prevention of pressure sores is available to meet peoples current needs. The manager said that they have enough equipment and that the provider will purchase more equipment if necessary to meet the needs of the people living in the Care Homes for Older People Page 12 of 26 Evidence: home. The nursing staff manage the administration of medicines. They medicines are kept in a locked trolley in a locked room. The drugs fridge has its temperature measured and recorded daily. The procedure for receipt, storage and disposal of unwanted medicines was demonstrated and is in accordance with laid down legislation. All creams and lotions seen in peoples own rooms had been individually prescribed for them and had opening dates written on them. Staff were heard and observed interacting with people appropriately and providing care and support in a discreet manner. Staff were knocking on doors before entering and doors remained closed whilst personal care was taking place. Care Homes for Older People Page 13 of 26 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. A range of activities within the home and the local community mean that people have opportunities to participate in stimulating and motivating activities. Meals and mealtimes are not rushed and staff are available to help make them an enjoyable and social occasion for people. Evidence: The manager said that since she started in July 2008 there have been opportunities to take some residents out on trips. The home raises money for the ammenity fund that is used for these trips and people have enjoyed them, she feels it is very important for those people who are able to have opportunity to go out for a change of scenary and it adds to peoples feelings of wellbeing. She said that people are encouraged to exercise choice in how they spend their time and activites are offered individually or in groups and are facilitated by the activity co-ordinator. Large flat screen TVs have been provided for both lounges and are able to be seen by anybody spending time in either room. Only one was on during the inspection. Many people also have their own radios and TVs in their rooms. The home has a fish tank, a cat and a budgie that some people take an interest in. The care plans are designed so that information about Care Homes for Older People Page 14 of 26 Evidence: peoples interests and hobbies can be recorded and can be used when trying to develop person centred care. Visitors are welcomed at anytime and some people regularly go out with friends or relatives. A number were seen coming and gong during the insepction. There is access to the patio area via a ramp. The area has seating and tables and a variety of pot plants and hanging baskets. The manager said that people often make use of the area in the good weather. A number of people have their meals in the dining room and some choose to eat their meals in their own room. The menus are on a 6 week rotation and are displayed within the home.The manager said that people are asked by the catering staff on a daily basis what they would like for their meal but that there are always alternatives available to what is offered. The manager said that breakfast and lunch are staggered so that staff are avalable to help people as required reducing the rush that can be involved at mealtimes and allowing everybody the time they need to eat there meal properly. Drinks and snacks are available 24 hours a day. Records are kept of what people eat to ensure they are receiving a balanced diet. Care staff were observed wearing proper protective clothing and helping people with their meals as required and in an considerate manner. Care Homes for Older People Page 15 of 26 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Formal complaints and safeguarding policies and procedures are in place and are available to staff at all times. All staff undertake safeguarding training. This means that people who live at the home are adequately safeguarded. Evidence: The complaints procedure was seen displayed in the home and is included in the Service users Guide, a copy of which is in each persons own room. It is comprehensive and gives options about who to contact and timescales for responses to be made. There have been no complaints made to the Commission or the home in the last 12 months. The manager said that people are seen by senior staff on a daily basis and hopes that any issues or concerns would be bought up at then. Completed staff surveys (4) all indicated that they knew what to do if a resident, relative or friend had a concern about the home. Completed Service user surveys (4) also said they knew how to make make a complaint. Staff files seen had certificates included in them showing that staff have training on safeguarding and reporting procedures. Care staff also have information about safeguarding when doing National Vocational Qualification (NVQ) training and during induction training. No safeguarding alerts have been made in the last 12 months. Care Homes for Older People Page 16 of 26 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have a comforatable, homely and safe environment in which to live. Evidence: The Elms is currently registered to take up to 37 people who may have both nursing and personal care needs. The home presents as homely and comfortable, whilst still having clinical equipment available around the home thats has to be used to help meet peoples assessed needs. A tour of the home showed that peoples rooms are personalised with furniture and momentos they bought in with them. People spoken to said they were happy with their current accommodation. The manager said that most of the beds are adjustable up and down and they have a number of profiling (electric) beds for use by people with high dependancy needs. There is a call bell system in use throughout the house. People seen in their rooms had their call bell within easy reach of them. Communal space consists of 2 lounges and a dining room, all on the ground floor. The dining room is also used for group activites and the hairdresser (on a Thursday). The manager said that a recent government grant has meant that carpets in the public areas have been replaced recently. Care Homes for Older People Page 17 of 26 Evidence: Many rooms have en-suite facilities and there are adapted bath and shower rooms and toilets on each floor. The laundry is suitable for the size of the home and contains washing machines (with a sluice and wash programme that reaches the required temperature) and driers that manage the amount of dirty laundry produced. The home has a mechanical sluice disinfector as required. Policies and procedures around infection control are up to date and available to staff at all times. Training on the importance of infection control is routinely offered to staff. Care Homes for Older People Page 18 of 26 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The staffing levels and skill mix are satisfactory meaning peoples needs are being met at all times. The robust recruitment procedure means that people who live at the home are being looked after by appropriate staff and their welfare is not at risk. Evidence: The manager, nursing and care staff are supported by administrative staff, an activity co-ordinator, catering, domestic, laundry and maintenance staff. The manager and the duty rota seen confirmed that there are 4 care staff, and a trained nurse plus the manager (during the week), who is supernumery, on duty during the day and overnight there are 3 waking care staff and 1 trained nurse. This is seen as sufficient for the number of people who currently live at the home and is based on their dependancy levels. Three of the four completed staff surveys indicated that they feel there are usually enough staff and one indicated that there are sometimes enough. The manager said that new staff have an induction that covers health and safety, fire safety, safeguarding and basic care practices. They then continue to work under supervision until seen as confident and competent to be working on their own. Two comleted staff surveys indicated that their induction covered everything you needed Care Homes for Older People Page 19 of 26 Evidence: to know to do the job when you started very well and two indicated that it mostly did. The Elms (owned by The Adlington Group a small local provider) have a robust recruitment procedure. The staff files examined (3) all contained a completed interview question form, 2 written references, a CRB check and certificates for training courses/study days atended. The manager said that she interviews prospective staff and then the administative part of the process is carried out by the groups administrator. Care Homes for Older People Page 20 of 26 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The systems and procedures now in place are designed to meet the needs of the service as they strive to improve the service the home offers to the people that live there. The attitude to health and safety shown by the providers, care and anciliary staffmeans that people generally live in a safe and well maintained environment. Evidence: The current manager has been in post since July 2008 following the retirement of the previous manager. She is experienced in managing a care home. She is a level 1 registered nurse and currently has an application with CSCI to be formally registered as the manager. She said that she has spent the time since she started learning about how the home runs and making some small changes aware that too much change too quickly is not welcomed by staff or residents. She has started to ensure that people who are able to are invited out on trips that are being arranged as she feels a change Care Homes for Older People Page 21 of 26 Evidence: of scene and mixing with different people has long term good effects. She has an open door policy and welcomes staff, residents and relatives to come and talk to her to discuss any issues they may have. She has arranged (with the help of other staff memebers) some evenings , such as an omlette evening, designed to raise money for the residents ammenity fund but also for relatives and representatives who are not available during the day to have the opportunity to meet her and get to know her. People spoken to said that staff are appraochable and that they are always cheerful. A formal quality assurance system is in place and consists of the administrator sending out satisfaction surveys to 2-3 people (or their representatives) who are picked at random on a monthly basis. The responses are collated and fed back to the provider and the manager. The provider also carries out monthly visits to the home and prepares a report as to the generla environment and running of the home. These reports are made available to the Commission as required. The manager showed that money held on behalf of the current residents is kept securely and records are kept of income and outgoings with receipts kept as evidence of the transactions. The balance is checked by 2 people each weekend. Residents have access to their money at all times. The manager said that all staff have statutory training that includes health and safety, first aid, lifting and handling and food hygeine. She has a training file that helps her keep up to date with who is due to have what training. She said that she is carrying out at least one supervision session with all of the staff so she can undersatnd their ongoing needs and concerns. Supervision sessions will then be delegated to the most appropriate person to carry them out for a staff member, for example the night sisters will do the night staff sessions and will then be maintained at one session every 8 weeks. A number of routine servicing and maintenance documents and the fire log book were examined and found to be up to date. The maintenance man checks the maintenance book regularly and carries out repairs as requested. He also carries out ongoing in house and outdoor routine maintenance tasks. During a tour of the home it was noted that one small radiator was not covered or had a guaranteed low surface temparature. The manager said she would investigate why it was not covered. Care Homes for Older People Page 22 of 26 Care Homes for Older People Page 23 of 26 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 24 of 26 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 38 The provider should ensure that all radiators are coverd or guaranteed low surface temperature design to reduce the health and safety risk from hot surfaces. Care Homes for Older People Page 25 of 26 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 26 of 26 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!