Inspection on 06/09/05 for The Elms Nursing Home

This inspection was carried out on 6th September 2005.

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

The inspector 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 31/08/06

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

CARE HOMES FOR OLDER PEOPLE The Elms Swains Road Bembridge Isle of Wight PO35 5XS Lead Inspector Janet Ktomi Unannounced 6 September 2005 th 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 H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Elms Address Swains Road, Bembridge, Isle of Wight, PO35 5XS 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) 01983 872248 01983 872248 Scio Healthcare Ltd Mrs Elizabeth Margaret Pearson Care Home 48 Category(ies) of Physical disability over 65 years of age (20), Old registration, with number age, not falling within any other category (40), of places Terminally ill over 65 years of age (7), Dementia, over 65 years of age (2) The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection N/A 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. All bedrooms are single with 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 Mrs Elizabeth Pearson. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The Elms was re-registered in August 2005 when Scio Healthcare Limited, a company formed by the previous proprietor and another care home proprietor, purchased the home. The home will therefore only have one unannounced inspection this inspection year. All core and many additional standards were assessed. The inspection, by two inspectors, lasted six and a half hours during which a tour of the building was undertaken. Discussions were held with a number of service users, visitors, the manager, responsible individual, nursing, care and ancillary staff on duty. Care records, staffing records and other records and documentation identified in the report were viewed. What the service does well: What has improved since the last inspection? The home has completed the alterations to the main entrance that now provides automatic opening doors, a pleasant reception area and improved office accommodation. The home has also continued its programme of planned maintenance and has appointed a gardener who is reinstating the previous pleasant gardens and external areas affected by last year’s building work. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 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 standard(s) 1, 2, 3, 4, 5 and 6. The home provides appropriate written information about its services with contracts and invoices clearly stating additional services provided. All potential service users are fully assessed prior to admission to ensure that the home is able to meet their needs. EVIDENCE: The manager provided the inspector with a copy of the home’s statement of purpose and service users’ guide. A copy of the service users’ guide is available within each bedroom and a specific appropriate information brochure in the intermediate care rooms. These documents were seen to contain all the required information and additional relevant information such as a guide to the uniforms worn by the various people employed in the home. During a tour of the building the inspector was able to see the service users’ guides within bedrooms, however a number of service users spoken with were unaware of these documents. The home provides nursing care and it may be that service users are informed on admission about these documents but are too ill or tired to remember this. Visitors did confirm that they had been provided with a pack The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 9 of information, including the service users’ guide, when they were arranging admission for their relative. Intermediate care service users do not pay for, or contribute towards, the cost of their care as this is funded by the health trust. This is clearly stated within the intermediate care brochure. They therefore do not receive a contract. A sample of the home’s terms and conditions for service users in the traditional nursing care beds was provided to the inspector. The information contained within this documentation is clear, concise and provided in accordance with the regulations and recommended standards. The inspector met with the administrator responsible for service users’ invoices and was shown the procedure for invoicing for service users’ assessed contributions and any additional services provided. These are invoiced separately with clear information as to what is included within the bills such as hairdressing or chiropody. Newspapers, if requested, are billed directly by the newsagents to the service user. During the unannounced inspection there was a meeting with a service user’s relatives and care manager to discuss the level of funding support that social services would be making towards the cost of an individual service user’s care at the home. The assessment of nursing care needs for individual service users is undertaken by a designated health service employed registered nurse, to ensure service users receive the correct financial arrangements for the re-payment of the nursing element of their fees. The pre-admission assessments and care plans for eight service users were viewed during the inspection. These indicated that potential nursing and intermediate care service users were fully assessed prior to admission and that this information was then used to formulate care plans. Assessments were based on a standardised format that covers all the relevant areas identified in the standards and includes specific assessments in relation to manual handling and pressure area needs. Discussions with the manager indicated that she would clarify information from the intermediate care nurses to ensure that the admission was appropriate and that the home would be able to meet the service user’s needs. Service users are often admitted directly from the hospital and one confirmed that the matron had visited her at the hospital prior to admission to The Elms. A visitor confirmed she had been involved in discussions about her relative’s care needs both prior to and since admission. Care and nursing staff stated to the inspectors that they felt able to meet the needs of service users and that appropriate numbers of staff are employed to ensure needs are promptly met. Due to the level of disability it was not possible to talk with all service users, however during a tour of the building the majority of service users were seen and all appeared happy and well cared for. Service users spoken with stated that they felt their needs were met and that appropriate numbers of care staff are employed at the home. Visitors stated that they felt their relatives’ needs were met and confirmed that they had been asked about care needs and felt that all care needs are met. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 10 Many service users are generally admitted directly from the hospital or other care settings, therefore visits to the home are not possible due to the level of disability or ill health of the potential service user. The matron confirmed that relatives are able to visit the home prior to admission and that either herself, or the deputy who is undertaking the pre-admission assessment for non intermediate care admissions visits the potential service user prior to admission. 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 provide 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 The Elms. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 11 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, 8, 9 and 10. All service users including intermediate care service users have individual care plans detailing how health, personal and social needs will be met. Care plans indicated and visitors, service users and staff spoken with confirmed that health needs are met and that staff treat service users with respect and that privacy is upheld. Medication is appropriately managed within the home however the home must ensure that Medication Administration Records are fully completed. EVIDENCE: During the unannounced inspection eight service user care plans were viewed. All service users have individual care plans compiled from information gained during pre-admission assessments and updated by named nurses, generally monthly and if care needs change. The care plan details the nursing and care the service user requires to ensure all aspects of health, personal and social care needs are met. Within the care plans are information and risk assessments to cover moving and handling, pressure areas and falls. Service users spoken with were generally unaware that written records and care plans are held by the home although due to cognitive limitations not all service users are able to participate in planning their care. The manager stated that where The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 12 this is the case family member or representatives are involved in care planning. A visitor spoken with confirmed that she has been involved in discussions about her relative’s care needs. During a tour of the building pressure relieving equipment was seen in use around the home. The matron, care plans and pre-admission assessments indicated that six of the eight service users with pressure injuries were admitted to the home with these injuries. The matron informed the inspector that one service user who developed a pressure injury did so after health occupational therapists removed his specialist wheelchair cushion. All service users admitted with pressure injuries are being appropriately managed and pressure injuries are improving. Care plans contain Waterlow pressure area assessments that were seen to have been updated monthly with details as to how service users at moderate or high risk would be cared for. Care plans were seen to contain information about visits by medical personal such as chiropodists, speech therapists, doctors and outpatient appointments. The service users’ guide details the services, such as chiropody or opticians, service users will have to pay in addition to the standard fees. Service users whose existing GP covers the Bembridge area are able to remain with their own GP following admission to the home. Service users whose existing GP does not cover the Bembridge area are registered with a GP from the local health centre who visits the home on a Monday and as requested by the trained nurses. Service users in the intermediate care facility confirmed that they have ongoing physiotherapy and that their rehabilitation needs are met. The health trust has a contract with a local GP practise to meet intermediate service users’ medical needs. During the inspection care and nursing staff were observed knocking on service users’ doors and to treat people with respect. 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 en-suite 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. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 13 The home has a policy and procedure for the administration of medications, with medication found to be stored in an appropriate locked facility. Records are kept in regard to all medications received into the home and administered by the qualified nurses. The inspector saw the arrangements for controlled medication, the storage and recording of which was found to be appropriate. Any unused medication is returned to the pharmacy for disposal and a record kept of these countersigned by the pharmacist. The home has a lockable fridge to ensure that medications that must be kept cool may be. Maximum and minimum temperatures are registered by an appropriate thermometer and recorded daily. Service users receiving intermediate care have a lockable facility within their bedrooms for the safe storage of medication and a written assessment of their ability to self administer their medication is completed. Intermediate care service users are encouraged to be as independent as possible in respect of their medication. The inspector viewed the medication administration records for all service users on the ground floor. It was noted that when a number of these had been re-written there was nothing recorded under allergies. The home must ensure that all sections on the medication administration records are fully completed even to state no allergies known. 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 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. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 14 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) 12, 13, 14 and 15. The home meets service users’ social and leisure needs in a flexible and varied manner. Contact with family and friends is encouraged and supported and a varied, nutritious diet is provided which meets individual needs. Service users are actively encouraged to exercise control and choice over their lives. EVIDENCE: Service users confirmed that the daily living routines within the home are flexible and that there is choice as to times for getting up/going to bed, what they eat and where they spend their time within the home. Breakfast times are flexible, between 6.30 and 10.30 a.m., with the main lunchtime and evening meals at set times. Service users confirmed that choice is available at all meals and that these may be taken either in the dining rooms, lounges or their own bedrooms as they wish. If service users do not want main meals at the usual times, meals and snacks are available at other times. Care plans were seen to contain information about the times that people usually get up or go to bed. All bedrooms contain a pin board on which a list of the month’s planned activities and outings and main menus were noted. Many of the home’s service users are too frail to enjoy external activities however these are still organised for service users who are able to participate with one service user stating that he had enjoyed outings for cream teas, Island trips, and a pub lunch. In house The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 15 activities are also organised. Newspapers are delivered from the village for which service users pay individual bills direct to the newsagents. The service users’ guide states that pets are allowed at the discretion of the matron. One service user has a budgie in his bedroom and he confirmed that staff look after the budgie for him. During the unannounced inspection people were noticed visiting service users throughout the day with no restrictions imposed by the home. Visitors are requested to sign into the home on arrival and to sign out on completion of their visit. Information in respect of the home’s visiting policy and contact details is 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. Within the new extension there is a lounge and also the small dining room, that could be available for receiving visitors in private other than in the service users’ bedrooms. The contract/terms and conditions information makes it clear that service users can bring in items of a personal nature and includes advice about insurance of valuable objects. During a tour of the building it was evident that many people had brought personal items with them into the home. Service users spoken with during the inspection were positive about the food they receive at the home. Service users reported that they have a choice at all meals that may be taken wherever they wish, within their own rooms, the dining room or one of the lounges. Care staff were seen during the inspection asking service users their choices for the evening meal. The inspectors were able to see meals being taken to the intermediate care service users that contained different foods on each tray indicating that choice was being respected. The main lunchtime menu was seen on pin boards around the home and in service users’ bedrooms. Menus seen provided a good variety of different main meals with the chef confirming that fresh fruit and vegetables are used whenever possible. Meals served during the inspection were of a good size and based upon knowledge of the likes and dislikes of the service user. Service users confirmed that they have access to snacks and hot and cold drinks in between meals. The manager confirmed that special diets are catered for and healthy eating advice is provided to service users. Support is required by some service users and was provided in an unhurried, discreet manner. All required records were in place and found to be compliant with the regulations. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 16 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) 16 and 18. Service users or their representatives are able to complain if they are unhappy with the service provided at the home. Staff are aware of adult protection issues and would respond appropriately if they had concerns in relation to adult protection. EVIDENCE: 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. The home’s complaints policy and procedure fully complies with the requirements of the Care Homes Regulations 2001. Information as to how to complain via the Commission for Social Care Inspection is included in the service users’ information. Discussions with service users and visitors indicated that they felt able to complain and indicated that they would do so to either the manager or administrator. Preinspection questionnaires received from relatives confirmed that they were aware of the home’s complaints policy and had not made any complaints. Staff were aware of the action they should take should a service user or visitor wish to make a complaint. At the time of the announced inspection no service users or their visitors had any complaints or concerns to report to the inspector. The home has an adult protection policy which links to the Isle of Wight Adult Protection policy and procedure. The home has appropriate policies for whistle blowing and gifts to staff. Discussions with the matron and staff showed that they had an understanding of adult protection issues and were clear about The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 17 their responsibilities and actions that should be taken if abuse is suspected. Discussion with staff confirmed that they had received training about adult protection during both induction and NVQ courses and were aware of the actions they should take if they suspect abuse of a service user may have occurred. Two of the home’s qualified nurses have attended training provided by Isle of Wight Social Services. The home encourages service users or their representatives to manage individual service users’ personal finances and the home’s invoices clearly state what services people are being billed for. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 18 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) 19, 20, 21, 22, 23, 24, and 26. The home is warm and clean, providing appropriate accommodation, both private and communal to meet service users’ needs. The home must fit automatic door closures to the remaining bedroom doors and ensure that all areas of the home are maintained to the high standard of the new parts of the building. EVIDENCE: The premises has operated as a care home for a number of years and over time has been adapted to meet the needs of the client groups accommodated. A new extension providing an addition seventeen bedrooms was completed in June 2004 and provides accommodation to a high standard. The reception area, including automatic opening doors, is now completed and provides a very pleasant entrance area to the home. The home itself is generally well maintained although parts of the building are now in need of redecoration to ensure the high standard within the new extension is reflected throughout the whole building. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 19 The home provides a variety of communal areas and space appropriate for the service users. There are two dining rooms, three lounges and a conservatory, one of the lounges being within the intermediate care facility. In addition there are a number of areas around the home where people may choose to sit and where chairs have been provided such as near the front entrance. Communal areas are pleasantly decorated and contain furniture and fixtures appropriate to the service users’ needs providing a comfortable atmosphere. The carpet within the main dining room is in need of attention as it is now separating at some of the joined areas due to normal wear and usage. The home has a no smoking policy with smoking only allowed outside the building. The home does not have a designated private visiting or meeting room however at the time of the inspection neither of the lounges in the new extension were being used by service users so could have been available if required. Externally the home has car parking to the front and side of the property with pleasant gardens with level access to the side and rear of the property. All bedrooms within the home are for single occupancy and have en suite facilities providing at least a WC and washbasin. The home has assisted bathing facilities located close to all service user bedrooms. Separate WC’s are available also located conveniently around the home close to communal areas such as lounges and dining rooms. WC’s and bathing facilities are appropriate for the service users within the home. Two passenger lifts are provided, one to each upstairs wing. As stated the home has been in existence for a number of years and has over the course of that time been adapted to meet the changing needs of the service users. Adaptations include assisted bathrooms, grab rails, hoists, standaids, wheelchairs and other items of moving and handling equipment. Staff and staff training records confirmed that they have received training in the use of specialist equipment. The new extension has been designed to provide all modern aids and adaptations with assisted shower and bed and bathrooms of appropriate dimensions to ensure all equipment may be used and storage areas for equipment provided. The matron confirmed that all equipment has regular servicing contacts and is fully maintained. The proprietor continues to make adaptations to the building to better facilitate service users with mobility needs such as the automatic doors at the front entrance to the home. During a tour of the building the majority of bedrooms were viewed and were seen to be individualised by service users with their own possessions. Bedrooms were noted to be well equipped with all the required items of furniture and fixtures. Service users spoken with during the inspection confirmed that they liked their bedrooms and had been able to bring personal items with them into the home. A number of bedroom doors within the original part of the building were seen to be held open with wooden wedges. These doors were not fitted with the automatic door closures seen in the newer parts of the home. The home is required to undertake risk assessments and ensure The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 20 that any bedroom doors that service users prefer to keep open during the day are fitted with automatic door closures. The home was found to be clean, tidy and free from offensive odours at the time of the unannounced inspection with service users spoken with confirming that this was always the case. The home employs a domestic staff team who work under the direct supervision of the housekeeper. On site laundry facilities are appropriate to the needs of the home. Appropriate policies are in place for the infection control and management of clinical waste with sluicing facilities in place. Liquid soap, paper towels, plastic disposable aprons and gloves were seen located in all bathrooms and WCs around the home. Discussions with the matron, trained nurses, care staff and ancillary staff showed a clear understanding of the need to maintain good infection control procedures. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 21 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, 28, 29 and 30. The home employs appropriate numbers of registered nurses, care staff and ancillary staff to meet the needs of service users. A comprehensive recruitment, induction and training programme should ensure that unsuitable people do not wok in the home and staff have the necessary skills required to meet service users’ needs. EVIDENCE: The Department of Health has yet to publish staffing guidelines for Nursing Homes. Staffing rotas confirmed the manager’s opinion that the home provides sufficient staff numbers to meet the needs of service users. In addition to the care staff employed the home also employs catering, domestic, maintenance and administrative support staff. Service users and visitors spoken with during the inspection reported that staff were prompt in answering call bells and that they felt care staff had sufficient time to meet their needs. Staffing rotas seen during the inspection and provided with pre-inspection information confirmed the manager’s statement concerning staffing numbers. Care and nursing staff stated that there were adequate numbers of staff employed at the home to meet service users’ needs and that everybody worked together as a team. The matron was clear that she would not admit new service users if she felt that there were insufficient numbers of staff to meet their needs. The administrator described the home’s recruitment procedure that starts with adverts in local papers, job centres or word of mouth. All potential employees The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 22 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. The home employs a qualified nurse with a background in nurse education to provide and organise training within the home. During the unannounced inspection the inspector was able to spend time with the trainer who showed the inspector the home’s training records and programme. This demonstrated that all staff receive induction and foundation training including an evaluation test following specific training such as fire awareness and infection control. Training is provided both individually and in small groups and also includes practical skills and supervised practise. Care staff spoken with confirmed that training is provided within work time and a recently appointed member of care staff confirmed that she had received appropriate induction during her first days at the home. Qualified nurses are able to access training via St Mary’s hospital and the trainer showed the inspector the courses nurses had been booked onto. Qualified nurses confirmed that they had attended update training to meet PREP requirements. The matron and training co-ordinator confirmed the information in the preinspection questionnaire that fifteen of the home’s thirty-one care staff have at least NVQ level 2 with many having a level 3 qualification. At the time of the unannounced inspection three care staff were undertaking NVQ level 2 training. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 23 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) 31, 32, 33, 34, 35, 36, 37 and 38. The home has a management structure which all staff are aware of and creates an open, positive and inclusive atmosphere. The home must initiate a procedure to ensure that all staff have an annual appraisal and supervision sessions at least every two months. The home must ensure that all records within the home are fully maintained. EVIDENCE: The home has been re-registered in July 2005 when the existing proprietor and the proprietor of another Island nursing home formed a new company Scio Healthcare Ltd. The registered manager/matron is a Registered General Nurse and has NVQ level 4 in management. The manager meets all the training requirements to achieve NMC Prep requirements with details of mandatory and service user specific training undertaken supplied with the pre-inspection questionnaire. The manager has successfully managed The Elms for the past ten years and stated that she has a full job description. During the inspection The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 24 the management arrangements within the home were discussed and there are clear lines of accountability covering all groups of staff and management. During the unannounced inspection the inspector was able to talk to Scio Healthcare Ltd responsible individual, Mr Kevin Dannatt, who was clear about his responsibilities a the company’s responsible person. All levels of staff met during the inspection stated that they felt able to discuss any concerns or issues with members of the management team including the Matron and directors of the company. 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. There are regular staff meetings for registered nurses, care staff, ancillary and management. Discussions with the responsible individual confirmed that the home is financially viable. There has been considerable investment in the home in recent years and during the inspection there was evidence of ongoing upgrading to facilities around the home. At the time of the unannounced inspection the home was fully occupied and the matron confirmed that there was a waiting list with frequent enquires received from potential new service users or their representatives. During the inspection, all indications demonstrated that the home is financially viable. The company business and financial plans were seen as part of the registration process undertaken earlier in the year. Insurance certificates were seen during this unannounced inspection and were appropriate for the business. 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. The chef confirmed that he regularly visits service users to ensure that they are enjoying their meals and seek their suggestions to changes in the menu. 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. The training co-ordinator undertakes regular supervision of all care staff. This takes the form of both formal supervision and supervised practise. Care staff confirmed that supervision does occur. Trained nurses’ meetings do occur during which issues are discussed and may be considered as group or peer supervision. 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 The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 25 procedure to ensure that all qualified nurses have supervision at least every two months. During the unannounced inspection a variety of records was inspected. These included, care plans, risk assessments, Medication Administration Records, staffing rotas, recruitment and staff files, invoices, menus, food records and the fire detection equipment book. As already mentioned there were gaps within the Medication Administration Records and also within the fire detection equipment book. All records were found to be appropriately stored. The home is required to ensure that the Medication Administration Records are fully completed and that weekly checks of the fire detection equipment are undertaken and recorded. 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. 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. The home must ensure that the carpet within the dining room where the joins are coming apart is attend to as this currently presents a trip risk to people walking in this area. The home must ensure that doors are not wedged open and should fit appropriate automatic door closing devices to any fire doors that need to be held open. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 26 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 3 3 3 3 3 3 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 4 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 2 x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 4 3 3 3 3 2 2 2 The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 27 no Are there any outstanding requirements from the last inspection? 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 9 and 37 24 and 38 Timescale for action 13 (2) Medication Administration immediate Records must be fully completed. 6-9-05 23(4)(c(ii) Bedroom doors must not be immediate wedged open. Appropriate 1-10-05 automatic door closures must be fitted. 18 (2) The Registered Manager must 1-12-05 develop a process to ensure that all staff have an annual appraisal and supervision occuring at least every two months. 23(4)(c(v) The Matron must ensure that a immediate procedure is introduced to 1-10-05 ensure that the weekly checks of the fire detection equipment are undertaken in the abscence of the maintanance man. 23(2)(b) The dining room carpet must be 1-10-05 repaired or replaced where the joins are presenting a trip risk to people walking over this area. Regulation Requirement 3. 36 4. 37 and 38 5. 38 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. The Elms Refer to Standard Good Practice Recommendations H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 28 1. The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 29 Commission for Social Care Inspection Mill Court Furrlongs Newport 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 The Elms H55H04_S64760_The Elms_V243500_060905 Stage 4.doc Version 1.40 Page 30 - 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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