CARE HOMES FOR OLDER PEOPLE
The Elms Nursing Home The Whitepost Health Care Centre Ranelagh Road Redhill Surrey RH1 6YY Lead Inspector
Kathy Martin Announced 25 July 2005 10:00 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 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 Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service The Elms Nursing Home Address Whitepost Health Care Centre, Ranelagh Road, Redhill, Surrey, RH1 6YY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 01737 764664 Dr P J David To be advised CRH N 49 Category(ies) of OP - Old Age - 44 registration, with number PD - Physical Disability - 40-65 years - 5 of places DE(E) - Dementia - over 65 - 17 SI(E) - Sensory Impairment - over 65 - 1 The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: Of the 49 (forty nine) persons accommodated, 44 (forty four) will be within the category (OP). Up to 17 (seventeen) may also be in the category DE(E). Only 1 (one) will be in the category SI(E). Up to 5 (five) persons may be accommodated in the (PD) category within the age range of 40-65 years. The home may offer day care providing this does not impinge on the accommodated service users. Up to 4 beds may be used for respite care. Date of last inspection 25/04/05 Brief Description of the Service: The Elms is a registered care home providing nursing care for 49 residents. The home can accommodate up to 44 older people (over 65 years) and 5 younger adults from 40-65 years. Up to 17 residents can be accommodated with a diagnosis of Dementia. The home is situated in a residential road in Redhill and is in the same site as another home separated from The Elms by internal doors. The Elms is owned and run by the Whitepost health care Group who also run other similar establishments. There are parking facilities and the home is close to local shops. Public transport can be accessed within walking distance to the home. The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This is the second inspection carried out at The Elms Nursing Home this year. The previous inspection took place on the 25/04/05. This inspection covered the remaining key standards not looked at the previous inspection. All the key standards have now been assessed over both inspections. The home was advised that the inspection was to take place in advance and the manager provided a pre-inspection questionnaire to the CSCI with relevant information used in this report. The inspection started in the morning when there was a lot of activity in the home with residents getting ready for the day and the staff were busy with their day-to-day tasks. The inspector was given opportunity to meet with several members of staff including the carers, the nurses and the activity organiser. The inspector spoke with several residents and two relatives who were visiting. Additionally feedback cards were sent for residents, staff and visitors to complete and return to the inspector. 14 feedback cards were returned with generally very good comments about the care (as written in the next section). However some other comments included issues such as: “I have had to draw attention to my (relative’s) condition, e.g. when sleepy” “ (Relative) has been given so little opportunity to socialise” “ I hope under (new management) the standards of care will improve” “The water is cold in the morning” These issues have been discussed with the manager and the deputy who would look into these with the relevant residents/ relatives. The inspector also looked at records and walked around the home to inspect the building. There is now a new manager in the home and she is currently applying to the CSCI for registration. The manager is thought of highly by all staff spoken with and it was encouraging to note that the team spirit is good. The staff and the residents were complimentary of the manager and the deputy. The inspector acknowledges that the staff and the deputy (who was acting up as manager) had met a few challenging times when the home was recruiting for a new manager and their efforts in running the home without a manager were recognised. The manager has made time for a weekly surgery for anyone who wishes to see her personally including relatives and staff. Both the manager and the deputy are in close contact with the residents on a daily basis. The inspector wishes to thank all the residents and relatives who either gave direct feedback on the day of the inspection or sent written comments directly
The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 6 to the CSCI; the management team of The Elms for providing support on the day of the inspection and the new manager, the deputy and the staff who contributed to much information reflected in this report. What the service does well: What has improved since the last inspection?
The home has appointed a new manager who was working well with her team. An action plan of urgent changes/ improvements has been underway following the manager’s audit when she arrived to the home. The staff were relaxed and talked openly to the inspector about their experience of working in The Elms. They seemed well supported and encouraged by their seniors. Staff were observed talking to each other with ease and were friendly. They also talked about some residents and indicated that they knew them well and were aware of their needs. The staff spoken with talked about their training and said “everyone works as a team”, “the manager is approachable”. 3 of the 4 requirements made at the previous report have been met. There is a new protocol for dealing with missing persons in the home although there have been no recent reports of absconding. The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 7 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 Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 8 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 Standards Statutory Requirements Identified During the Inspection The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 9 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 standard(s) n/a These standards were inspected during the previous inspection. EVIDENCE: The inspector was advised that the comments from the previous report remained current, as no changes have taken place. The assessment processes are still good. The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7 and 9 The service users benefit from a wide range of visiting professionals who come to the home and they are able to access community specialists as per their needs. There are good policies and procedures for dealing with medication management in the home. EVIDENCE: The care plans sampled were of good standard and offered a good range of documentation and assessments of individual needs. Residents are reviewed regularly including social services reviews and notes are maintained. The manager and the deputy regularly discuss care of residents with their next of kin to involve them and obtain their support. Arrangements are made for residents to benefit from the community health care professionals such as chiropodists, dentist, opticians as well as their own doctors. It was noted and discussed with the manager and the deputy that the current care planning recording systems could be improved to allow all relevant recording to be maintained together. A recognised care planning system is therefore advised. The medication policies and procedures were in place. Registered nurses were responsible for this and have to abide by their own NMC guidelines on
The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 11 medication management and protocols as well as the home’s. The inspector was advised that currently no residents self-medicated due to their level of needs and many have difficulties with short-term memory. The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 14 a 15 Residents are encouraged to maintain as much control as possible over their lives often helped by relatives and friends or solicitors. The home encourages residents to remain as active as possible in accordance to their wishes although this is not always realistic due to frailty and health conditions. The home offers internal catering and reports on food quality and the presentation was good. EVIDENCE: It is acknowledged that several residents are very frail and need much support to make decisions with very simple tasks due to their illnesses and mental frailty. However staff are given training from induction to deal with offering choice, maintaining dignity and encouraging residents to exert their rights of independence. Many residents have power of attorneys, relatives, solicitors and friends who assist them in maintaining control over their lives. It was apparent from relatives’ feedback questionnaires that they were very involved in the residents’ lives and knew them well to complete their feedback for the inspection. The manager takes records of conversations with relatives and friends of residents and was able to demonstrate to the inspector that the staff took their comments seriously and acted on them to ensure the principles of care were not ignored.
The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 13 There is a new activities co-ordinator in place who spoke with the inspector about the group and one to one activities organised. The interactions in the lounge where activities were taking place indicated that those who were participating were enjoying their time. The home offers in house catering. There is a varied menu, which offers 3 main choices but the cook is versatile and will offer an alternative if residents do not fancy what is on the menu. There are three main meals a day (breakfast, lunch and supper) and snacks are available at any time including night time. Those spoken with all reported that the quality of the food was good. The catering team also catered for special diets and pureed food. The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) n/a This section was assessed during the last inspection. Please refer to this report. EVIDENCE: The inspector was advised that there had been no further incidents investigated under the Protection of Vulnerable Adults (POVA) procedures since the last inspection. The issue raised at the previous inspection had been dealt with appropriately. All staff received training in POVA. The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 26 The home was clean and tidy during the inspection. There is a dedicated team who is responsible for domestic duties. EVIDENCE: One requirement was made under Standard 26 to provide bins with covers for the staff toilet. There have been no structural changes to the home since the last inspection. The home is maintained in a reasonable state of décor. Repairs are conducted immediately. Two identified window restrictors (see Standard 38 comments) need to be fixed and a requirement has been made to this effect. The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 16 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 and 30 The home is operating to full establishment and has a working off duty rota in place suggesting that care hours were appropriate to the level of care. The recruitment procedures were good. Staff training is offered although thought needs to be given to how it is arranged to ensure maximum participation from staff within the home. The NVQ qualifications need to be provided for more staff to attain a 50 level of achieved NVQ qualification. EVIDENCE: Standard 27: the inspector inspected the off duty rota with the manager. This document indicated that the home was using appropriate levels of care and nursing staff. However when speaking with the staff the inspector denotes that staff felt they were always short of staff. It is recommended that the manager also reviews the care hours spent dealing with tea rounds as currently this task is undertaken by care staff and often nursing staff which is not considered a good use of their skills and resources. Under Standard 29, the home benefits from the head office human resources office, which offers assistance when recruiting new staff. The new manager has indicated that she wants total involvement in the recruitment process from the start. The files are kept securely and in accordance with regulations. CRB checks are undertaken before the staff are in post. Copies of certificates and references are also held. The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 17 Under Standard 30, a previous requirement for the plans for NVQ training to be sent to the CSCI was outstanding. The manager explained that some staff had not returned the information she requested when auditing. Therefore this is still to be collated and to be sent to the CSCI. A requirement has been made for the home to ensure that at least 50 of care staff obtains a level 2 NVQ by next year. The manager also explained that due to staff movement the percentage of qualified NVQ staff does fluctuate. It is acknowledged that the home organises several training events for all the other homes in the group including The Elms. The Elms is a popular venue. Sometimes however the staff in The Elms are not always able to attend and it is therefore recommended that training be arranged when staff of the home are also able to attend. There is a training manager in post who was introduced to the inspector. The manager will work closely with him in the future to ensure training needs are met. The inspector was informed that Greenwich University has recently conducted an assessment on the home nurses to establish if the home can be used as a training placement. The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 18 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 and 38 The home obtains regular feedback from residents, relatives and others to ensure it is run in the best interest of residents. There are good financial practices for managing residents’ monies. There are procedures for health and safety to manage risks in the home. EVIDENCE: As the new manager had only started, Standard 31 would be looked at the next inspection. The new manager has relevant qualifications to hold this post and has several years of experience in clinical posts in senior management. An application to register with the CSCI has been made. Under Standard 32, it was a requirement that the management team conducts monthly, unannounced visits under Regulations 26 and reports to the CSCI and the manager about the conduct of the home. It is however fair to say that the line manager is very closely involved in the home for support and advice. The
The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 19 manager and the deputy thought highly of their senior managers and stated that they had a good working rapport. Under Standard 33, the manager holds a weekly surgery to encourage all residents, relatives and staff to talk to her and give feedback on their experiences. There are regular discussions between residents and their relatives with the staff and also reviews are held to discuss the residents’ placement and their care. Standard 35: The home has policies and procedures to deal with residents’ finances and to protect them from financial abuse. Mostly the home would encourage residents to manage their finances if able to do so or their relatives/ solicitors tend to assist. Standard 38: The home has relevant policies to deal with all aspects of health and safety. All repairs are undertaken promptly. The fire equipment is serviced regularly and records are maintained to this effect. The other equipment used such as hoists and bathing equipment are also regularly serviced. The staff are offered training in all aspect of health and safety relevant to their jobs. These two requirements were made regarding health and safety during the tour of the home: 1. The staff toilet flooring to be made safe as the surface is slippery. 2. To make arrangements to cover the 2 garden ponds in accordance with the Health and Safety risk assessments. The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x x x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 x 14 3 15 3
COMPLAINTS AND PROTECTION x x x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score x x x x 3 3 x 3 x x 2 The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 21 Are there any outstanding requirements from the last inspection? Requirement no. 4 The home will submit NVQ plans 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 30 32 Regulation 18(1)(a) 26 Requirement For 50 of staff to obtain a level 2 NVQ. For the management team to conduct unannounced visits under Regulations 26 and report to the CSCI and the manager of the conduct of the home The staff toilet flooring to be made safe as the surface is slippery To make arrangements to cover the 2 garden ponds in accordance with the Health and Safety risk assessments. To repair the window restrictors to windows on the staircase that leads to Lincoln Unit. To provide bins with covers for the staff toilet. Timescale for action 30/08/06 30/09/05 3. 4. 38 38 13(4)(a) 13(4)(a) 30/09/05 30/10/05 5. 6. 38 26 13(4)(a) 13 (3) 30/10/05 31/08/05 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 30 Good Practice Recommendations Arrange training to actually enable staff in the home to participate
h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 22 The Elms Nursing Home 2. 3. 4. 32 27 7 Ensure copies of the CSCI reports are made better available to all staff on a regular basis and in places that are more accessible and conducive to reading. Review the care hours spent on undertaking tea rounds rather than using the catering staff. Use a recognised care planning system for recording to be done in a consistent manner The Elms Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection The Wharf Abbey Mill Business Park Eashing Surrey GU7 2QN 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 Nursing Home h09-h58 s13358 The Elms v227164 250705 stage 4.doc Version 1.40 Page 24 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
