Inspection on 10/08/05 for The Elms Rest Home

This inspection was carried out on 10th August 2005.

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

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

Other inspections for this house

The Elms Rest Home 20/09/07

The Elms Rest Home 20/09/06

The Elms Rest Home 05/01/06

The Elms Rest Home 27/07/04

The Elms Rest Home 21/04/04

The Elms Rest Home 27/02/04

Similar services:

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Queen Elizabeth House

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

CARE HOMES FOR OLDER PEOPLE The Elms Rest Home 142 Elm Walk Raynes Park London SW20 9EG Lead Inspector Liz OReilly Unannounced 10th August 2005 10:00 am 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 Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION Name of service The Elms Rest Home Address 142 Elm Walk Raynes Park London SW20 9EG 0208 542 4181 0208 542 4181 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) Ms Teresa Scully CRH Care Home 10 Category(ies) of OP Old Age (10) registration, with number DE (E) Dementia (3) of places The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 26th July 2004 Brief Description of the Service: The Elms is a registered care home for up to ten older people three of whom may suffer from dementia. The home is situated in a residential area of Raynes Park. The property consists of two houses which have been joined together to form the home. Communal rooms are situated on the ground floor with residents bedrooms on the ground and first floor. This home does not have a passenger lift. Parking is available at the front of the home with unrestricted parking in the street. Public transport and a small group of shops are close by. The home owner has produced a service user guide, which includes information on the aims and objectives of the service. The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on the 10th August 2005 by one regulation inspector over four hours. The inspector had the opportunity to speak with seven of the nine residents living at the home at the time of this visit and one regular visitor to the home after the visit. Records and part of the environment were examined. What the service does well: What has improved since the last inspection? What they could do better: A care plan is produced for each resident setting out individual needs and wishes. However the care plans do not include clear information on how these The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 6 needs and wishes will be met by staff or other professionals. Further work is needed to ensure that care plans are expanded so that residents and staff are aware of how needs will be met as well as setting out outcomes. Staff must ensure that the timing of daily activities is arranged in accordance with the wishes of residents. Staff have been provided with training in a number of areas, however there are a number of new staff in the home and these staff members need to be provided with appropriate training relating to the health and welfare of the residents in the home. In particular staff must be provided with training, including updates where applicable, on moving and handling, food hygiene and first aid. 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 Rest Home G54-G04 S27222 The Elms V243331 080805 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 Rest Home G54-G04 S27222 The Elms V243331 080805 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) 3, 4 & 6 Residents can be confident that staff take clear steps to ensure that they can meet the needs of any prospective resident through the pre admission assessment process. Further training needs to be provided for staff to ensure that the full needs of residents can be met by the staff group. EVIDENCE: The home ensures that the needs of any new resident to the home can be met by carrying out a pre admission assessment. If a resident is placed by a local authority the home is also supplied with the care management assessment. The home owner/manager is careful to ensure that the home can supply the care and or support required to any new resident. The home has a number of new staff and to ensure that the full needs of residents are met a review of the training needs of individual staff needs to be carried out. New staff need to be provided with appropriate training including working with people with dementia. This home does not offer intermediate care therefore Standard six does not apply. The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7, 8 & 9 Residents can be assured that their needs are known to staff by the provision of individual care plans. This documentation needs to be improved to include how individual needs and wishes will be met along with outcomes. The health care needs of residents are mostly met. Staff need to ensure that where it is noted that a resident is losing weight or is of low weight action is taken and recorded of referral to health care professionals. EVIDENCE: Each resident is provided with an individual care plan which sets out the physical, social and emotional needs of individuals. Care plans were seen to include the wishes and interests of residents. In order to ensure that the needs and wishes of individuals are fully met the care plans need to be expanded to include clear information on how all needs will be met and outcomes. Monthly reviews were seen to be taking place. These reviews must also be expanded to include information on outcomes for each area of need. Two of the three care plans examined had been signed by the resident concerned. The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 10 Staff were seen to maintain good daily records which provided information on the activities of residents each day. All residents are registered with local GP practices. Residents are able to remain with their own GP as long as the doctor is able to visit the home. Should any resident require nursing input this is provided by the district nursing service. District nurses also provide pressure relieving equipment if needed. Staff monitor the weight of residents on a monthly basis. It was noted that records indicated that one resident was of a low weight and in another instance staff had recorded that one resident appeared to be losing weight. In order to promote the health needs of residents are fully met the registered person must ensure that any concerns regarding residents weight is referred to the GP with a record retained of any actions required on the care plan. Arrangements are in place for residents to access dental, optical and chiropody services on a regular basis. Staff support residents to attend health care appointments. The health and welfare of residents in relation to medication was seen to be protected. Medication is appropriately stored with up to date records of all medication administered in place. A record of all medication received into the home and returned to the pharmacy is in place. Four of the staff have completed accredited training on the management of medication since the last inspection of the home. The home owner informed the inspector that arrangements were to be made for the remainder of the staff to complete this training. The pharmacist for the home is available to provide advice if required. Medication is supplied in a monitored dosage system. It was noted that the information supplied by the pharmacist did not include a description of the medication. The home owner should contact the pharmacist to request all medication supplied in the monitored dosage system is supplied with a description of the medication. This will ensure that staff are provided with sufficient information to comply with residents requests should a resident decline a particular tablet. The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12 & 15 Residents stated they were happy with the activities and daily life in the home except in one area. The registered manager needs to ensure that residents make their own choices regarding the time they go to bed. Residents are provided with a varied diet with individual likes and dislikes catered for. EVIDENCE: The home produces an activities programme with a number of alternatives available. The likes and dislikes of residents were seen to be recorded. Residents stated that they were happy with the activities available. One resident stated she enjoyed listening to music. One resident enjoyed outings to a local garden centre and café. One resident stated they enjoyed assisting with the washing up in the home. Staff record the activities individuals participate in as part of the daily recording. Residents confirmed they can meet with visitors in the privacy of their own room should they wish to meet in private. Arrangements were seen to be made for visits to the home from religious representatives. One resident requested that a board be available to remind residents of the day and date. This is something the registered persons should consider. The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 12 Two residents stated that on occasion staff have requested they go to bed at an early hour. The registered person must review the working practices in the home to ensure that the timing of daily living activities such as going to bed, getting up, bathing etc. are in line with individual residents wishes. Residents made very positive comments on the quality and quantity of the food provided in the home. The menu for the home was seen to provide a varied diet. Alternatives to the main menu are available at each meal time. Hot and cold drinks were seen to be provided throughout the day. At the time of this visit one resident required assistance with eating. The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 To ensure that residents and or visitors to the home can feel confident that complaints will be addressed the home has in place a clear complaints procedure. Policies and procedures are in place to protect residents from abuse. Arrangements must be made for all staff to receive training on the protection of vulnerable adults. EVIDENCE: Residents are provided with information on the home’s complaints procedure. The complaints procedure was also seen to be on display in the home. Two residents spoken to stated that they had never had cause to complain but felt confident that if they did the owner would listen to what they had to say. Systems are in place to record any complaint received by the home along with actions taken and outcomes. This ensures that a record of any investigation is retained. At the time of this visit no complaints were recorded. The manager and three members of staff have attended training on the protection of vulnerable adults. In order to ensure the protection of residents in the home arrangements must be made for all staff to receive this training. A copy of the London Borough of Merton policies and procedures for reporting any concerns is available in the home. The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19, 21, 25 & 26 Residents are provided with comfortable, domestic style communal space. The home is clean, tidy and free from offensive odours. EVIDENCE: Residents have access to a comfortable lounge/dining area, which is partly divided into two sections. Since the last inspection of the home hallways, one bedroom and the kitchen area has been redecorated. Plans are in place for the exterior of the home to be redecorated in the autumn of this year. The home owner has carried out improvements to the environment year on year. The garden is accessed via sliding doors from the lounge area. Residents have access to a very well maintained garden area with a large patio area furnished with seating a large table and awning gazebo. Residents who express an interest are encouraged to assist with the gardening . The home owner has arranged an assessment of the property by a qualified occupational therapist to ensure that appropriate aids and equipment are available to meet the needs of the resident group. The home owner informed The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 15 the inspector that all recommendations made following this assessment have been complied with. Covers have been fitted to all radiators accessible to residents. This ensures that no resident can suffer a burn should they fall against a radiator. At the time of the last inspection of the home a requirement for appropriate locks to be fitted to bedroom doors was made. The installation of these locks had not been completed at the time of this inspection. This requirement is therefore carried forward. Residents were seen to be provided with a clean and tidy environment. The home has a separate laundry area which is situated appropriately. The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27, 29 & 30 Residents were seen to be supported by sufficient staff to meet their needs at the time of this inspection. Residents are protected by recruitment procedures which include checks on the identity and most recent employment. Evidence needs to be available to show that all staff are provided with appropriate up to date training to meet the needs of the residents in the home. EVIDENCE: Residents are supported by a minimum of two staff at all times during the day. At night one member of staff is awake throughout the night with a second member of staff asleep on the premises who can be called upon for assistance. These staffing levels were seen to be adequate to meet the needs of the resident group in the home at the time of inspection. Catering staff are not employed in the home, the staff on duty cook all meals. As noted in previous inspection reports the staffing levels in the home must remain under review. Should the needs of residents increase then additional care, domestic or catering staff must be employed. The home owner takes steps to ensure the safety of residents by carrying out checks on new staff prior to them working in the home. These include Criminal Records Bureau checks and checks on references. Since the last inspection of the home the owner has ensured that evidence of qualifications, two written references, a copy of passport and an up to date photograph is retained on file for each member of staff. One member of staff has achieved NVQ level two qualification in care and is planning to commence NVQ level three training. Three new staff have The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 17 completed induction training. As noted previously an assessment of the training needs of all staff in the home now needs to be carried out with appropriate training provided to ensure that staff have the relevant knowledge and skills to meet the needs of residents in the home. The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 18 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 35 & 38 Residents benefit from a well managed home. Further work needs to be done to carry out an annual review of the care provided. Systems are in place to ensure the safety of cash or valuables deposited in the home for safekeeping. The health and safety of residents is protected by regular checks being carried out within the home. EVIDENCE: The home owner is also responsible for the day to day management of the home. Residents spoken to at this visit expressed confidence in the manager and gave very positive comments on the approach of the manager. The home owner has commenced development of quality monitoring systems in the form of questionnaires for residents and or families on the service they The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 19 receive. These questionnaires have not been distributed to residents or families yet. A questionnaire for other professionals who have contact with the home has yet to be produced. In order to ensure that residents are consulted on and have their views taken into account the registered person must ensure that an annual review of the care provided in the home is carried out. This review should include the opinions of residents and others involved in the home as a way of measuring success in meeting the aims and objectives as set out in the statement of purpose for the home. The results of residents questionnaires should be published and made available to residents in the home and any prospective residents. Residents can deposit valuables or small amounts of cash in the home for safekeeping. Individual records are retained for any cash deposited. Records were seen to be up to date and accurate with all transactions recorded and receipts retained for any expenditure. Staff in the home do not act as appointees for any of the residents. Staff carry out regular checks on the building, furnishings and equipment to ensure the health and safety of residents and visitors to the home. Checks were seen to be carried out on the fire detecting equipment with regular fire drills being carried out to ensure that staff and residents are aware of the action to be taken should a fire occur. To ensure that health, safety and welfare of residents and staff in the home the registered person must ensure that all staff are provided with up to date training on moving and handling and food hygiene. Sufficient staff must be provided with appropriate first aid training to ensure that a qualified first aider is on duty on each shift. The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 x 15 3 COMPLAINTS AND PROTECTION 2 x 3 x x x 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 2 x x 2 x 3 x x 2 The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 21 yes 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. Standard 7 Regulation 15 Requirement The registered person must ensure that care plans are expanded to include how all individual needs and wishes will be met by staff. Care plans must include outcomes which are reviewed on a monthly basis. The registered person must ensure that in any instance where concerns are raised regarding the weight of a resident a referral is made to their GP with a record retained. The registered person must carry out a review of working practices to ensure that activities of daily living are carried out in line with residents wishes. The registered persons must ensure that all staff working home are provided with training on the protection of vulnerable adults. The registered person must ensure that bedroom locks are changed to allow residents to lock their door and staff to have access in an emergency. (timescale of 31.08.04 not met) Timescale for action 10th October 2005 2. 8 13(1)(b) 12(1) 1st September 2005 3. 12 12(2)(3) 1st September 2005 10th October 2005 10th October 2005 4. 18 13(6) 5. 19 13(4)(a) The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 22 6. 7. 30 33 18(1)(c ) 24 8. 38 18(1)(c ) 13(4) 12(1) The registered person must carry out a review of training needs for each individual staff member. The registered person must ensure that quality monitoring is carried out as part of an annual review of the service. A copy of the report produced following the annual review must be provided to the Commission. The registered person must ensure that all staff are provided with up to date training on:Moving and handling Food hygiene First aid 10th October 2005 10th January 2006 10th October 2005 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 9 Good Practice Recommendations The registered person should ensure that medication provided in a monitored dosage system is accompanied by a description of each tablet. The Elms Rest Home G54-G04 S27222 The Elms V243331 080805 Stage 4.doc Version 1.40 Page 23 Commission for Social Care Inspection Ground Floor - CSCI 41-47 Hartfield Road Wimbledon SW19 3RG 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. 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