Inspection on 31/08/06 for The Elms Nursing Home

This inspection was carried out on 31st August 2006.

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 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 Nursing Home 06/09/05

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

CARE HOMES FOR OLDER PEOPLE Elms Nursing Home, The Swains Road Bembridge Isle of Wight PO35 5XS Lead Inspector Mark Sims Unannounced Inspection 10:00 31 August 2006 st 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 Elms Nursing Home, The DS0000064760.V300172.R02.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. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elms Nursing Home, The Address Swains Road Bembridge Isle of Wight PO35 5XS 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) 01983 872248 01983 875206 Scio Healthcare Limited Mrs Elizabeth Margaret Pearson Care Home 48 Category(ies) of Dementia - over 65 years of age (2), Old age, registration, with number not falling within any other category (40), of places Physical disability over 65 years of age (20), Terminally ill over 65 years of age (7) Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. One person may be accommodated in the category TI under the age of 65 years One named service user in the category Learning Disability may be admitted to the home for a period of three months, from the date of this certificate. 6th September 2005 Date of last inspection Brief Description of the Service: The Elms is a registered care home providing both residential and nursing care and accommodation to up to forty-eight people. The home accommodates generally older people, up to twenty of whom may have a physical disability, up to seven of whom may have a terminal illness and up to two may have dementia. The home is also registered for eight intermediate care beds, for which separate facilities are available, that may accommodate adults over the age of eighteen years. The home is located near the centre of the town of Bembridge with local bus stops and shops reasonably nearby. The home occupies an extended older property in its own grounds with car parking available to the front and side of the property. There have been several extensions to the original home, the most recent having been completed in June 2004, leading to 36 out of the home’s 48 bedrooms purpose built care home bedrooms. All bedrooms are single en-suite facilities of at least a wash basin and WC. Various communal facilities including three lounges, two dining rooms and a conservatory are provided. The home is owned by Scio Healthcare Limited and managed by Matron Elizabeth Pearson. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was the first ‘Key Inspection’ for The Elms Nursing Home, a ‘Key Inspection’ being part of the new inspection programme, which measures the service against the core and/or key National Minimum Standards. The fieldwork visits, the actual visits to the site of the home, were conducted over two days, where in addition to any paperwork that required reviewing the inspector met with service users, relatives and staff and undertook a tour of the premises to gauge its fitness for purpose. The inspection process also involved far more pre fieldwork visit activity, with the inspector gathering information from a variety of professional sources, the Commission’s database, pre-inspection information provided by the service and linking with previous inspectors who have visited the home. The new process is intended to reflect the service delivered at The Elms over a period of time as opposed to a snapshot in time. What the service does well: What has improved since the last inspection? The following is an indication of the areas where the service has improved its performance: • • • • Weekly fire checks are now being undertaken and recorded. A new care planning system has been introduced. New paths have been set out to the rear of the premises and the enclosed gardens. Carpeting in the lounge has been repaired, however the plan is for this to be replaced as part of the property’s ongoing maintenance schedule. DS0000064760.V300172.R02.S.doc Version 5.2 Page 6 Elms Nursing Home, The • Whilst not noted during the fieldwork visit, the company directors state that since the last inspection all doors have been fitted with automatic closure devises, which are designed to promote fire safety. 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. Elms Nursing Home, The DS0000064760.V300172.R02.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 Elms Nursing Home, The DS0000064760.V300172.R02.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 & 6. Quality in this outcome area is excellent. This judgement has been made using the available evidence, including a visit to this service. All service users are assessed prior to admission and provided with information relating to the service they can expect to receive whilst resident at The Elms. The Elms provides an intermediate care facility, which clients only access if referred via the local Primary Care Trust (PCT) Intermediate Care Team. EVIDENCE: The evidence indicates that all clients or patients are fully assessed by either the matron/manager or her deputy matron prior to admission to the home. The evidence also suggests that all clients are aware of the services and facilities available at the home and that their health and social care requirements are agreed prior to admission. Information gathered during the inspection process, which substantiates these judgements and findings includes: Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 9 • Pre-admission assessment tools: A number of completed pre-admission assessments sheets were seen during the case-tracking process (a review methodology used by the Commission’s inspectors during visits), when ten care plans and associated documents were scrutinised. The new care planning documentation was found to contain an assessment tool based on the ‘Activities of Daily Living’ (ADL) (a renowned nursing assessment and planning tool), although the home has modified the system and refer to it simply as the ‘Activities of Living’ (AOL). The new system, recently introduced by the deputy manager, clearly links the assessment stage of the admission process to the care plan development stage of the process, although some work is still required to iron out glitches in the new system and to ensure that staff appreciate and understand the difference between the previous care planning package and the new one. The matron/manager and the deputy matron are however, aware of the need to work with and support staff during this transitional period and the need to implement an internal auditing system to monitor staff adherence to the new system and the changing documentation style required. • In conversation with service users/patients it was established that people recalled being visited either at home or in hospital and that generally they remember discussing their current health needs and circumstances, although some people could not recall anything associated to their admission. Five service user comment cards, returned prior to the fieldwork visits, provide further evidence of the time spent with service users prior to their admission, with all five comment cards ticked to confirm that the person ‘received enough information about the home before moving in so they could decide if it was the right place for them’ and that they had ‘received contracts’. One client’s additional comments were so positive that it was felt important to include these in the report: ‘As well as being paraplegic, at the time of being admitted to The Elms, I was also not mentally in a state to make my own decisions. The care manager showed me The Elms and I am so pleased now that I am fully recovered that The Elms was chosen for me’. A service user’s relative, who also made an additional remark on the comment card returned, observed: ‘The Elms were happy to Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 10 accommodate my sister (once changes in registration had been agreed) and continue to support my mother and I as well’. On checking the Commission’s database it was evident that variations received from the home are accompanied with details of the home’s own pre-admission assessment and where possible copies of professional assessments and plans. • During the second fieldwork visit day the inspector observed a family being shown around the home by a staff member, this family visiting the home on behalf of their next of kin. In further discussions with patients and/or their relatives it was established that this was a common occurrence and that people’s families often visited the home on their behalf, establishing the suitability of the environment and collecting information packs, whilst on the visit. A tour of the premises established that the intermediate care facility and the main care home, whilst linked, are separate entities with staff allocated to work independently within the intermediate care wings. Access to the home is via the main reception area, which is staffed continuously throughout the day and provides both a security and administrative function, the administrator/receptionists responsible for directing visitors to the right location and for ensuring they sign in, etc. In the last report the intermediate care facility was described in terms of being: ‘The home has eight dedicated intermediate care bedrooms that meet all the required standards in terms of accommodation, fixtures and facilities. There is a separate lounge adjacent to the intermediate care bedrooms and therapist/treatment room. The matron and care staff confirmed that carers allocated to the intermediate care unit are trained to NVQ level 2 or 3 with physiotherapists, occupational therapists and assistants visiting the home most weekdays to supervise and advise the home’s staff. Medical care for intermediate care service users is provided by the local GP, contracted by the health commission, and by hospital consultants. Intermediate care service users spoken with during the inspection confirmed that they were very happy with the facilities and appeared to understand the reasons for admission to The Elms’. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 11 At this visit it was established that nothing has altered in respect of the intermediate care facility and comments from a professional involved with this specific service described the facility and its operation as providing: • • • • • • • Good clear lines of communication Senior staff always available Private space/amenities to see clients in Staff on duty who demonstrate a clear understanding of their clients needs Staff are able to follow specialist advice and guidance Properly managed medications A service where no complaints have been received. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 12 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, 9 & 10 Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to this service. The home’s new care planning system appears promising and in time will ensure the service users receive a consistent and individualised approach to care delivery. The health and social care support needs of the clients is well managed internally and is clearly meeting people’s needs. The home’s medication system is not being appropriately managed as records continue to be poorly maintained. The service users feel they are treated with respect and dignity and that their rights to privacy promoted by the staff and general ethos of the home. EVIDENCE: The evidence indicates that all clients or patients are provided with an individualised care plan, although the system is new and should be consistently and regularly monitored whilst the staff adjust to the changing format. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 13 1. 10 care plans were reviewed and found to include: • • • • • • • • • • • • • • • • An admission checklist A resident’s profile An admission information sheet Activities of Living (AOL) assessment Waterlow Assessment Nutritional Assessment Moving and Handling Assessment A Communications Report Professional Involvement Report Medical Visits Social Activities Profile Social Activities Plan Care Plans Evaluation Sheets Discharge summary/report (in case of admission to hospital, etc) Pre-admission Assessment. 2. Comment cards from professional sources, a care manager, indicating that her client has a care plan available on her visits and that this is always updated and reviewed. 3. Previous inspection reports: ‘All service users including intermediate care service users have individual care plans detailing how health, personal and social needs will be met’. 4. Staff who describe the new care planning system as an improvement and confirmed that the matron and deputy matron were supportive when introducing change, although some staff felt it had increased the amount of documentation they need to complete. This however, is where the management need to monitor the usage of the new system, as staff are clearly duplicating work and need additional guidance and support. The staff also stated that meetings had been held prior to the implementation of the new care planning system to discuss how it is intended to operate. The one failure of the new system noted by the inspector is the lack of risk assessments, which clearly needs to be addressed, as risk assessments are fundamental tools used to record the decision-making process when addressing issues of potential harm and their management. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 14 The evidence gathered also suggests that clients are able to access appropriate health and social care services and that the staff monitor both the outcome of such contacts and the need for further/future interventions or visits. 1. The care plans, as listed above, documenting the visits of all health, social care and medical professionals. 2. The care planning files including evidence of the treatment plans followed re-referrals or follow up appointments. 3. The health and social care professionals comment cards returned indicating that people are generally happy with the service provided to service users. One person adding: ‘Well organised and managed nursing home, good liaison and relationships with staff who are helpful and supportive’. 4. Four comment cards returned by service users, stated or confirm, in response to the question ‘Do you receive the medical support you need’, ‘Always’. The remaining person not entering a response in the boxes provided. 5. The Health related assessment and monitoring tools available on the clients care plans, as listed above: • • • Waterlow Assessment Nutritional Assessment Moving and Handling Assessment, etc 6. Direct feedback from service users and relatives, who felt the standards of care to be high and confirmed that access to medical attention / practitioner’s was appropriate. 7. The dataset also indicated that people are involved with opticians, dentists, chiropodists and other allied health care professionals, accessible via the intermediate care team. Whilst the information gathered is positive in respect of the health and social care elements of a client’s care, the home was found to be failing to maintain its medication records appropriately, despite this being an issue at the last inspection: ‘It was also noted that on a number of records there were spaces where prescribed medications had not been signed as being administered. The home has a code sheet detailing the reason why a particular medication may not have been administered and this must be used whenever a medication is not Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 15 administered as a blank box does not inform other nurses or medical staff if a medication has been given and not signed for or not given and why’. On the second fieldwork visit the inspector focused on the home’s medication system and whilst most elements of its operation were found to be appropriate: • • • • • • • Storage Checked in on receipt from pharmacist Correct disposal Individually held and/or stored medications Bulk prescription arrangements/protocols Monitoring of medication fridge temperatures Availability of medication policies and guidance texts The Medication Administration Record (MAR) sheets were noted to be littered with gaps, which again do not or cannot inform other nurses or medical staff if a medication has been given and not signed for, or not given as the result of a particular problem encountered or issue raised by the patient. In discussion with the matron/manager it was evident that she was perplexed by the situation, the matron/manager stating that she had met with the staff following the last inspector’s report and had reinforced with the staff the need to ensure records were accurately maintained. However, it is evident that neither the matron/manager nor the deputy matron have been monitoring staff adherence to the home’s policy or their own professional code, as the same pattern of errors is still present. The matron/manager must, as with the care plans, introduce an internal auditing programme, designed to pick up on such fundamental problems and to address these with the nursing staff in their entirety, as no single individual is responsible for the continued errors and all qualified staff must accept a collective responsibility for their, and their colleagues’, actions. It was also evident, on reading through the information provided alongside the dataset (training records), that none of the qualified nursing staff have received any updated medication administration training and perhaps this should be considered as part of their professional development. During the last inspection the visiting inspector noted and recorded in her report that: ‘During the inspection care and nursing staff were observed knocking on service users’ doors and to treat people with respect. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 16 Visitors and service users confirmed this to be the case, stating that the home’s staff are pleasant and helpful. The registered nurse responsible for training confirmed that new staff are instructed during their induction period as to how to appropriately treat service users with respect at all times. All accommodation at the home is provided in single occupancy rooms with ensuite facilities, thereby affording service users a high degree of dignity and privacy during the delivery of personal care and specific health care treatments. The intermediate care facilities have a therapist room providing a private area for consultations, treatments and professional meetings. All bedrooms have telephones that may receive incoming calls. Some service users have private telephone lines to their bedrooms and the public pay phone is located in a quiet area where conversations may not be easily overheard. Service users confirmed that they receive their personal mail’. During this visit many of the practices or environmental features mentioned in the last report were observed to be the same and the service users, both via direct contact and the comment cards find the staff ‘supportive, caring and pleasant’. People adding remarks to their comment cards, such as: ‘The staff are very good and are always willing to help’. It was also evidenced via the relative and health/social care professionals’ comment cards that private facilities for meeting with service users are made available within the home, all ten comment cards returned confirming this in response to the question: ‘can you visit your relative/friend/patient in private’. It was also pleasing to note within the dataset information supplied (training record) that staff receive training around: • • • • Value based care The ethos of the home Basic human rights Communication. The latter perhaps helping to explain why all fifteen comment cards returned, service user, relative and professional, indicate that they are happy with the overall level of care provided at The Elms Nursing Home. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 17 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, 13, 14 & 15. Quality in this outcome area is excellent. This judgement has been made using the available evidence, including a visit to this service. The service users enjoy a varied social activities programme, which meets their needs and preferences. The visiting arrangements at the home meet the needs of both the residents and their relatives and good community links are maintained. The service users are helped to exercise choice and control over their lives. The meals are nutritionally well balanced and appetising. The menus varied and appealing. EVIDENCE: The evidence indicates that all service users are afforded the opportunity to participate within a varied and diverse range of activities and entertainments, as demonstrated by: • The dataset, which included a copy of the activities plan for July 2006, the activities available including: DS0000064760.V300172.R02.S.doc Version 5.2 Page 18 Elms Nursing Home, The 1. 2. 3. 4. 5. 6. 7. 8. 9. Two mini bus trips Nail technician Quiz and games Two sing-a-long sessions Communion Poetry reading Songs and entertainment Activities afternoon A strawberry Cream Tea, open to all residents, relatives and visitors. Copies of the August activities programme were observed around the home, affixed to notice boards and available at the front reception. • Conversations with several service users where it was established that the outings undertaken in the mini bus are always enjoyable occasions and are regular weekly events. One person discussing his enjoyment of the recent trip to the steam railway at Havenstreet, which brought back pleasant memories, as evidenced by his then recollection of the steam age and the local station house, which he recalled fondly. • The five comment cards returned by service users indicating that generally activities are provided to meet their needs, four ticking the ‘always’ response and one the ‘usually’ response to the question ‘are there activities arranged by the home that you can take part in’. One person adding how they appreciate that: ‘the staff are always ready for a laugh and a joke’. • The inspector’s observations and participation in ongoing activities, the first fieldwork visit allowing the inspector to observe staff involving clients in a sing-a-long, the second day the inspector assisted clients in a game of musical bingo, which people both enjoyed and were obviously stimulated by. Again it was evident that the visiting arrangements at the home met both the service users and/or their relatives/visitors needs: • The previous inspector recording within her report that ‘during the unannounced inspection people were noticed visiting service users throughout the day with no restrictions imposed by the home, although visitors are requested to sign into the home on arrival and to sign out on completion of their visit. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 19 Information in respect of the home’s visiting policy and contact details are provided within the service users’ information guide. During a tour of the building the inspector was able to talk with several visitors who confirmed that the staff made them welcome and that refreshments, including lunch, were available if requested. Pre inspection questionnaires returned by visitors confirmed that they are made to feel welcome when visiting the home. • Again this inspection established or re-confirmed many of the findings of the last visit, with all six relative comment cards confirming that people are made welcome on arriving at the home. One relative spoken to in particular stating that she visits her husband two or three times a day, as she resides within the assisted bungalows within the grounds, and that she is always made to feel welcome, offered hospitality and can remain for meals should she wish, although it was explained there is a small fee for the latter service. • Throughout both fieldwork visit days the inspector observed numerous people arriving at the home to call upon their next of kin and/or friends, one person noted on both days to be assisted in taking the service user out for a short walk around the grounds, etc. The activities schedule, referred to above, also included details of communion visits undertaken by the local priests and advertised the ‘Strawberry Tea’, which was clearly open to all service users and their visitors. In conversation with the matron/manager it was evident that such events are regularly scheduled or arranged and that the local community are welcome to attend and participate. The latter perhaps going someway towards explaining why a service user within their comment card remarked: ‘Within the area The Elms has a very good reputation and having always lived in Bembridge The Elms was the only home I would have considered moving to’. The home’s approach to supporting people exercise their rights to choice and self-determination have already been evidenced throughout the report: • Comments from service users – ‘Within the area The Elms has a very good reputation and having always lived in Bembridge The Elms was the only home I would have considered moving to’. Participation in activities – choice of activities internal and external. DS0000064760.V300172.R02.S.doc Version 5.2 Page 20 • • Elms Nursing Home, The • Previous inspection report comments/observations In addition to the information already contained within the report the inspector also found that: • • Care planning files include details of service users preferred rising and retiring times and/or preferred forms of address, etc. Menus are available for breakfast, lunch and supper time and that the catering staff visit all newly admitted clients to discuss meal preferences, likes and dislikes, evidence that this is taken note of was observed in the kitchen where the chefs use a blackboard to list any dislikes down, etc. Conversations with a service users, with one particular conversation establishing how far the staff are prepared to go to support a client’s choice/desire. The service user explaining how she loved seafood and crab especially, and how surprised she’d been one mealtime to be presented with a freshly prepared and dressed crab. Conversation with one of the directors, who whilst discussing plans for the future direction of the company and the home, mentioned how they would like to make some structural alterations to the premises (new fire escape, etc.) but would not consider this as one long-term client loved her room so much they could or would not consider offering her an alternative room just so they could commence the work envisaged. The five comment cards returned by the service users also contain evidence of the fact that people’s choices, etc. are supported by the home and the staff, with all five people confirming ‘always’ to the question ‘do staff listen and act on what you say’. • • • As mentioned above the catering needs of the clients are well managed, as evidenced by: • • • • The care plans, which contain nutritional assessments for all clients admitted to the home. The efforts of the catering staff to meet all clients and list their likes, dislikes and preferences. Comments from service users – see above. The dataset, which includes samples of the lunch and supper time menus Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 21 • Observations of mealtimes, which evidenced that meals are appropriately served and well presented. The observation of mealtimes also established that sufficient staff are available to support the clients, the home operating two dining rooms, with one dining room used by those clients that are more dependent and thus has a greater ratio of staff, the second being used by those clients requiring less input and therefore overseen by fewer staff. During the mealtime observations the staff were noted to be very vocal and supportive of the service users, discussing the meals they were eating and informing them of what was on the fork, etc., as it was offered to them. Drinks were also observed to be available, with squashes etc. on the tables during mealtimes, whilst teas and coffees etc. are provided by the ‘tea maid’ an internal position created by the company, the person’s responsibility being to supply drinks and snacks to clients and visitors. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 22 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 & 18. Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to this service. The service users and/or their relatives feel they are listened to and can approach the staff and management with concerns or complaints. Service users are protected from abuse. EVIDENCE: The evidence indicates that generally the service users and/or their relatives are happy to raise concerns or complaints with the home and are confident that the issues will be appropriately handled and addressed. • The five service users’ comment cards returned confirming/ticked ‘always’ in response to the question ‘do you know how to make a complaint’. Four of the of the six relative comment cards indicating that people knew how to make a complaint, all six confirming they had never needed to use the process. The four professional comment cards indicating that they had never received a complaint about the home. • • Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 23 • Details of the home’s complaints process were included in the dataset information provided to the Commission, along with a summary of the home’s complaints activity over the last twelve months: 1. 2. 3. 4. 5. Three complaints received in twelve months Two complaints substantiated One unsubstantiated complaint All complaints responded to within the 28 day timescale All complaints resolved. Information relating to each of the complaints is maintained by the home within its complaints log, along with details of the investigation and copies of the response to the complainant. • The previous inspector’s report indicated that: ‘The home provides service users with information as to how to make a complaint within the service users’ information and this information is also displayed on the wall within the entrance hallway’. Information relating to the service is still readily accessible within the reception area of the home, with copies of the said documentation available to service users and visitors if the require. The evidence indicates that the service users’ welfare is promoted and that the management and/or staff seek to protect people from abuse and harm by their practices. • The dataset evidences that adult protection training is available for staff and that the last update or ‘introduction to adult protection’ took place in November 2005. All new employees are required to complete a full and detailed induction programme, which addresses all of the units defined by ‘Skills for Care’ under the new ‘Common Induction Standards’, as evidenced by the training co-ordinator during a conversation with her. In discussion with staff, whilst none specifically mentioned the abuse training, it was established that the company provides access to numerous educational and skills development courses, the home employing a training co-ordinator and the company a training and development manager. As already mentioned within the body of the report, relatives feel the home is meeting the needs of their next of kin and no concerns regards their safety or wellbeing was identified. • • • Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 24 • Observations also demonstrate or support the belief that people feel happy and safe within the home, service users and staff interacting well throughout the fieldwork visits. The dataset also provides a clear statement of the fact that the staff are provided with access to an adult protection policy and procedure and that within the last twelve months no adult protection incidents have been referred. • Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 25 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 & 26. Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to this service. The home is well maintained both internally and externally and evidence exists of the ongoing refurbishment and redecoration programme. The home was found to be clean and tidy throughout and domestic staff observed on duty during both days of the fieldwork visits. EVIDENCE: The evidence indicates that all service users live within a well maintained, clean and tidy environment that meets their immediate and long-term care needs. • A tour of the premises evidenced that the home is clean, tidy and generally well maintained throughout, although some remedial work is required to the paintwork to the rear of the property and ramps leading DS0000064760.V300172.R02.S.doc Version 5.2 Page 26 Elms Nursing Home, The from two bedrooms at rear of the property have yet to be installed, this is however, in hand according to the maintenance manager. • The grounds and exterior areas of the property were noted to be pleasant, neatly arranged and accessible to service users, with newly constructed pathways arranged around the garden, providing level access to all service users and visitors. A director, during the second fieldwork visit day, discussed the home’s/company’s 2006/2007 development programme/objectives, which included or incorporated details of both cosmetic and functional works to be carried out to the premises. Elements of which were alluded to within the ‘daily life’s and social activities section of this report’. • During the tour of the premises the maintenance personnel were observed around the home, involved in a number of repair/remedial jobs and an upstairs corridor was in the midst of being redecorated. It was established during the fieldwork visit days that the company employs both a central maintenance team, under the direct control of an ‘Estates Manager’, as well as individual maintenance personnel within each of its properties, ensuring both minor and major jobs/works can be addressed immediately. • Remarks on the cleanliness of the home included within the service users comment cards indicate that: 1. 2. 3. 4. 5. • ‘The home is always nice and clean’. ‘Everything is spotless and fresh’. ‘Cleanliness cannot be faulted the girls work hard’ ‘Always smells clean on arrival’. ‘The cleaning staff are excellent and so friendly. • During both fieldwork visit days members of the home’s domestic staff team were observed around the home, cleaning and tidying both communal areas and individual people’s bedrooms, the work of the domestic staff team is overseen by the ‘Housekeeper’ and the company’s ‘Hotel Manager’. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 27 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, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to this service. Staffing levels are sufficient to meet the needs of the service users. The home has achieved the target of 50 of the care staff trained to National Vocational Qualification (NVQ) level 2 or above. The recruitment and selection practices of the home are sufficiently robust and designed to ensure that the wellbeing and safety of service users is assured. In-house training and development opportunities for staff are good. EVIDENCE: The evidence indicates that the company employs staff in sufficient numbers to meet the needs of service users and that a comprehensive recruitment and selection, induction and training programmes are available thus ensuring that people do not work in the home unless they possess the necessary skills and/or experience to meet service users’ needs. • Copies of the staffing rosters, supplied as part of the dataset information, indicate that the home is well staffed and that sufficient nursing and care staff are available, across the twenty-four hour period. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 28 • Observations, on both fieldwork visits days, provided further evidence of the fact that adequate staff are available to meet people’s health and social care needs, this being particularly evident during shift changes when the numbers of staff commencing work and those completing their duties are most noticeable. It was also evident during mealtimes, when adequate numbers of staff were noted to be available to support the service users with their meals, as reported within the ‘Health and Personal Care’ section of the report. • In discussion with staff it was established that carers normally work on allocated units, the home subdivided into three sections, two floors and the intermediate care unit. Working roles/tasks, etc., are allocated before each shift commences, with a folder available to staff informing them of their allocated unit and areas of responsibility. The nursing staff work alongside the care staff but as their responsibilities differ on a day-to-day basis their work is not allocated in the same way, although the qualified nurses are also allocated a unit to cover. • Service users’ relatives generally consider there to be sufficient staff available with all six comment cards returned recording that ‘in my opinion there are always sufficient numbers of staff on duty’. Professional comments would also appear to support the fact that sufficient and appropriate staffing levels are maintained, people’s testimonies indicating that: ‘there is always a senior member of staff to confer with’ and that people are ‘satisfied with the overall care provided to the service users’. • Staff training is the responsibility of the home’s training co-ordinator, although this role operates in tandem with the matron/manager and the deputy matron roles, the management team responsible for appraisal and the supervision of staff. In discussion with one of the company directors it was established that a new corporate post has been created and that a ‘Training and Development Manager’ has been appointed, the person’s role is to liaise with the training coordinators and matron/managers of each home. As part of the dataset information provided the matron/manager included copies of the home’s forthcoming teaching session and details of both the mandatory and non-mandatory courses completed by all staff since their employment. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 29 Mandatory:• • • • • • Infection Control Food Hygiene Fire safety Manual Handling First Aid Health and Safety Non-mandatory:• • • • • • • • • • • • • • Record keeping Falls Prevention Introduction to Adult Protection Communication Skills Values Ethos Roles and responsibilities Confidentiality Implementing policies and procedures Basic Human Rights Motor Neurons Disease Challenging Behaviour Managing Constipation Supra Pubic Catheters New staff, as highlighted within the ‘Complaints and Protection’ section of the report are also expected to complete the ‘Skills for Care’ Common Induction Standards, as part of the introduction to care work and the home, an induction proforma shown to the inspector during the second fieldwork visit day. In discussion with staff it was quickly established that training is continuously available at The Elms and that Scio encourage staff to continually update and develop their skills. Members of the home’s qualified staff team also discussed how they are able to access clinical development courses via ‘St Mary’s Hospital’, as part of the ‘Intermediate care’ contract. Staff are also being supported to access National Vocational Qualifications (NVQ) level 2 courses or equivalent, with the information supplied by the home, via the dataset, indicating that the home has met and surpassed the 50 ratio recommended within the National Minimum Standards, the actual percentage holding an NVQ 2 or above being 61 , this ratio does include six Romanian nurses employed as carers. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 30 The home’s recruitment and selection process has at previous inspections always been found to be satisfactory and has been considered therefore to support and protect service users. The last inspection report indicating: ‘The administrator described the home’s recruitment procedure that starts with adverts in local papers, job centres or word of mouth. All potential employees complete an application form, involving full work history, two references, recorded interview, Criminal Records enhanced level and POVA check, health declaration and trial shifts. All new employees have a three-month probationary period, full induction programme and terms and conditions of employment. The records in respect of the most recently appointed staff and a number of others were seen during the unannounced inspection and corresponded to the process described above. A copy of the employees’ handbook was provided to the inspector. In the case of qualified nurses their PIN numbers and registration details are confirmed with the NMC. The home employs five European qualified nurses as senior care staff. The home ensures that staff employed from overseas have all the required documentation and permits to allow them to legally work in the UK’. At this visit the files of three newly appointed staff were reviewed and each was found to contain the following information: • • • • • • • • • • • An application form Details of interview Contracts Induction information Employment correspondents Two references Protection of Vulnerable Adults clearance Criminal Records Check outcome Supporting identification and documents Home Office documentation Recruitment agency details and original paperwork from country of employment. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 31 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, 35, 36, 38. Quality in this outcome area is good. This judgement has been made using the available evidence, including a visit to this service. The manager possesses both relevant nursing and managerial qualifications and is an experienced leader. The home’s quality assurance systems ensure the home is run in the best interests of the service users, although some internal monitoring of the staffs performance is required. The arrangements for handling service users’ monies are satisfactory and designed to ensure people’s financial interests are safeguarded. The staff receive both regular supervision and annual appraisals. The health, safety and welfare of both the service users and staff team are appropriately managed and promoted. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 32 EVIDENCE: The evidence indicates that the home is well run and managed and that the service users, their relatives and staff are appropriately protected from harm and injury. • Information contained within the previous inspection report indicates that the matron/manager possesses both a Nursing Qualification and the Registered Manager’s Award (RMA). Evidence gleaned from the dataset and other documentation provided prior to the fieldwork visit, provides further evidence of the matron/manager’s qualifications and experience and indicates that she regularly accesses additional courses to maintain her own skills and knowledge basis. In addition to the registered manager, the home also employs a deputy matron, who was available throughout the first fieldwork visit day and conducted herself in a professional and capable manner. In discussion with the deputy matron it was established that she has worked within a managerial position previously and that she is enthusiastic and keen to work with the matron/manager on improving the service to patients. • Comments provided by relatives of the service users indicate that the manager is both approachable and supportive, with people’s returned comment cards recording: ‘I am very impressed by all the aspects of The Elms’ and a request that the inspection report include ‘please note in your report our thanks for looking after Mom so well and thoughtfully’. A professional comment card also addressed the management of the home, the professional concluding: ‘well organised and managed home, good liaisons and relationships with staff’. Service users and/or their relatives are afforded the opportunity to comment on the service provided at the home via the internal client satisfaction survey, which it is understood is an annual survey conducted internally by the matron/manager. In addition to this process the heads of each internal department, catering, domestic and the matron/manager, etc., make themselves available to clients on a daily basis thus ensuring that people have a daily opportunity to comment on the service delivered. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 33 • • • • • Remarks within the comment cards returned by five service users indicate that staff ‘listen to the service user’s request’, as highlighted within the ‘Daily Life and Social Activities’ section of the report. The previous inspector recorded within her inspection report that: ‘Service users, visitors and staff described the home as being a happy place and that support is always available from the management team. Staff felt that they could make suggestions about changes within the home’. ‘Service users and visitors confirmed that they have regular contact with the matron who ensures that they are happy with the service they are receiving. Within the service users’ guide pack there is a questionnaire for quality assurance monitoring’. • • Another important element of any quality auditing system is the work undertaken with the staff, which from a training and development perspective is very good, as evidenced earlier within the report. Staff also confirmed, during conversations, that team meetings and appraisals are regular occurrences and that generally they found or considered these events useful and productive. However, at the last inspection the need to review the home’s supervision process and to ensure staff receive regular supervision was made: ‘The Matron confirmed that at present supervision of the home’s qualified nurses is not occurring and she is required to implement a policy and procedure to ensure that all qualified nurses have supervision at least every two months’. At this visit it was established with the staff and the matron/manager that supervision sessions have yet to be fully implemented in accordance with the previous requirement, although plans have been drafted around how the matron/manager and her deputy can provide the staff with appropriate formal supervision sessions. • Evidence from previous inspection reports suggest that no changes have occurred in how service users’ monies are managed at The Elms and that previously the home’s management of service users’ finances was considered appropriate and satisfactory. • The administrator explaining that it is the policy of the company not to become involved in managing the finances of the services users, the company preferring instead to offer people the opportunity to have items DS0000064760.V300172.R02.S.doc Version 5.2 Page 34 Elms Nursing Home, The purchased on their behalf and invoices sent for these items alongside their monthly fees. This as stated also being identified at the last inspection, where it was reported: ‘The administrator explained the home’s policy and procedure in respect of service users’ personal finances and invoices. The home does not involve itself in individual service users’ personal finances with all invoices clearly stating the services the service user or their representative are being expected to pay for. Secure facilities are provided for the safe keeping of money and valuables within service users’ bedrooms. The home records when money or valuables are stored in their safe and encourages valuables to be passed on to relatives where possible’. No immediate health and safety concerns were identified with regards to the fabric of the premises and full health and safety policies, etc. are made available to staff employed at The Elms, according to the dataset. Health and safety training is also clearly made available to staff, with the dataset evidencing that staff complete first aid, fire safety, moving and handling, infection control and food hygiene. The availability of the maintenance personnel is also a benefit to the home, as this ensures that the general fabric of the environment is kept up together and does not pose an immediate risk to people. Access to paper towels and liquid soaps within bathrooms/toilets/en-suite, etc. are indicators of attention to infection control, as is the availability of a specific infection control policy, as listed within the dataset. The service users’ comments should also be considered as evidence, the home described as ‘clean and fresh’, etc. as reported within the ‘Environment’ section of the report. The previous inspector also noted within her report that the home was a safe and well managed environment that posed no immediate threat to clients, visitors or staffs wellbeing: ‘The home is generally a safe place for staff, visitors and service users. The home provides a clear set of health and safety guidelines, copies of which are available for staff. COSHH data sheets were appropriately maintained along with full environmental risk assessments. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 35 Staff training records confirmed that staff receive induction and update training in moving and handling, fire safety, first aid, food hygiene and infection control. Pre inspection questionnaire information confirmed that the relevant maintenance and safety checks are completed’. Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 36 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 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 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 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 37 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. Standard OP9 Regulation 13(2) Requirement Medication Administration Records must be fully completed. This was a requirement at the last inspection. Timescale for action 29/10/06 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 OP33 Good Practice Recommendations The management should undertake internal audits to ensure staff are adhering to company guidelines when completing and updating records (carer plans, medication charts, etc.). Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 38 Commission for Social Care Inspection Southampton, Portsmouth and Isle of Wight Ground Floor Mill Court Furrlongs Newport, IOW PO30 2AA 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 Elms Nursing Home, The DS0000064760.V300172.R02.S.doc Version 5.2 Page 39 - 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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