Inspection on 20/09/06 for The Elms Rest Home

This inspection was carried out on 20th September 2006.

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 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 Rest Home 20/09/07

The Elms Rest Home 05/01/06

The Elms Rest Home 10/08/05

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 Jean Stuart Unannounced Inspection 20th September 2006 10:00 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 The Elms Rest Home DS0000027222.V312754.R01.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. The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms Rest Home Address 142 Elm Walk Raynes Park London SW20 9EG 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) 0208 542 4181 0208 542 4181 Mrs Teresa Scully Care Home 10 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (10) of places The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th January 2006 Brief Description of the Service: The Elms is a registered care home for up to ten older people three of who 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’s owner has produced a service user guide, which includes information on the aims and objectives. The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. An unannounced inspection was carried out on the 20 and 21 September 06. A brief tour of the premises took place and care documentation for three service users was inspected. Ten residents and two members of staff were spoken to individually. The inspection took four hours and fifteen minutes. Ten survey forms for service users or their representatives, eight staff forms and five professional forms were left in the home, 7 resident survey forms were returned. A number of records were examined. Residents and their relatives reported that they are “happy with the care”. A resident reported, “staff are always available”. On the last inspection seven requirements were set out, three remain outstanding. Two of these have progressed but are not fully completed. Judgements made in this report are from evidence gathered during the inspection, which includes a visit to the service and takes into account the views and experiences of people using the service. The inspector found that the standard of care is adequate. What the service does well: What has improved since the last inspection? What they could do better: Efforts to improve the quality of the service must continue. To protect residents from abuse staff training must be ongoing, staff supervision carried out for all staff, and the report from the quality monitoring system must be produced. The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 Page 6 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 DS0000027222.V312754.R01.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 The Elms Rest Home DS0000027222.V312754.R01.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): 2,3,6. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to the service. Residents’ benefit from their needs being appropriately assessed before admission. EVIDENCE: There is an appropriate procedure to make sure that individual needs of residents are assessed before they move in. A Local Authority assessment of the resident will be completed by Social Services and placed on file. The assessments ensure that the individual’s needs are identified. When the Local Authority places a resident in the home they draw up and sign a request for the service, ensuring there is a contract with the home. The home does not provide intermediate care. The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 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 the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Records of care and medication are available but are poorly developed. For staff to be aware of the standard they are working to, recording must improve. EVIDENCE: Records show that health needs are met. A resident confirmed that the doctor visits. A resident said that “life is ok here”, another person stated they “are well looked after” and “the manager is approachable.” A resident was transferred from a chair in a hoist. To respect their dignity a blanket had been used to cover their knees. Another person using walking frame required assistance. A member of staff assisted with this and after ensuring the resident was safe moved away from the resident. The staff kept a watch-full eye on the situation. The resident’s right to independence was respected. The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 Page 10 Residents were observed in clothes reflecting individual choice staff used the term of address preferred by the resident. Staff were observed carrying out tasks for residents and explaining what was happening. An explanation of the process makes the resident feel more comfortable. The manager reported that there were people from similar cultures in the home and none presented diverse needs. Residents’ needs are not clearly documented in their care plans. The record of care provided does not document the required details to enable carers to give good care. Records are poorly set out and separate care issues have not been identified. Reviews are taking place but a statement is crammed into an area alongside the care plan. This limits the importance of the statement regarding a residents care. Risk assessments are completed and cover aspects of an individual’s care. There is poor practice in the recording of medication. The standard of recording must be improved to ensure all staff know how to complete the sheet in a consistent style. A medication recording error had been correctly interpreted, but the manager had not discussed this with either the doctor or the pharmacist. This was corrected by the pharmacist on the second day of the inspection. None of the current residents self administer their own medication. Staff must ensure they promote a positive and safe environment for all in the home, by their medication practice. The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 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 the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents are given the opportunity to take part in limited activities. EVIDENCE: Residents reported that at times they “watch TV, there is a supply of books they enjoy reading”, “staff are good to talk to and they pass the ball to each other”. Some residents chose to spend part of the day in their bedroom, other people are happy to sit in the lounge. A specialist person working with residents would improve activities available. Visitors call in to see their family and one person was spoken with. They reported “they are happy with the care given”. Several residents spoke very highly of the food, “it is nice to have it cooked for you” “the food is tasty” “it is good”. On the day of the inspection the food for the day was listed on a board in the lounge. A record is maintained all food served. Residents are offered nutritional food, and the meal was served hot. Special diets are attended to, The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 Page 12 for one resident gluten free meals are provided. The meal was unhurried with residents given sufficient time to eat. The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 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 the following standard(s): 16,18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Clients feel safe and confident in the staff that provide the service. EVIDENCE: None of the residents spoken to had any concerns at the time of the inspection visit. A resident reported that if they were any issues they “would take these straight to the manager” a visitor supported this. The visitor expressed confidence in the home to deal with any concern or complaint they might have. The home keeps a record of any complaint and actions taken. There has been no complaints received since the previous inspection visit. Complaints are dealt with promptly. Information on what action needs to be taken should there be an allegation or suspicion of abuse is in place. Staff are trained in- house in the signs and symptoms of abuse and the protection of vulnerable adults. Formal training by the Local Authority is also completed; four staff are yet to do this. The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 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 the following standard(s): 19,21,22,26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The home has a well-maintained environment. Many bedrooms are on the first floor, residents must have a degree of mobility to manage the stairs. EVIDENCE: The communal areas of the home are comfortable, the lounge / dining area provides a pleasant area for residents to use. Many of the residents were observed using walking frames to get around, ensuring they are safe when walking. One resident sitting by the patio windows said they “enjoy sitting here it is light and they is beautiful sunshine coming through the window” another resident joked “it is always good to be the first down as you can get the best seat”, but “is happy sitting by their spouse”. The home does not have a passenger lift. Some bedrooms are on the ground floor, other rooms are upstairs restricting the use of the room to a person with reasonable mobility. Some bedrooms are shared, one person said “it is good to The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 Page 15 have the company of someone else”. For this individual privacy is not an issue. Many of the residents have a degree of confusion it is difficult to assess if sharing a room was at their request. All rooms were very clean and free from offensive odour. The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 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 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 adequate. This judgement has been made using available evidence including a visit to the service. Residents benefit from a staff group who are clear regarding their role and what is expected of them. EVIDENCE: Residents reported that staff are “good, they look after us” Staff were observed talking with residents. At the time of the inspection the home had ten residents; the manager and two staff were on duty. There is little use of temporary or agency staff. The service recognises the importance of training and delivers where possible a programme that meets statutory requirements. Two staff were spoken with. They reported positively on the level of training. One carer reported that they have the National Vocational Qualification (NVQ). Other carers have/are completing (NVQ) level two. The service recognises when additional training is required. Staff had in the last year, attended courses on dementia and vulnerable adults. All staff must attend these courses to have adequate knowledge to care for residents. Staff files contain certificates from attending relevant courses. Three staff files were sampled and were found to follow a comprehensive recruitment procedure. The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. The manager has the required qualification and work in partnership with family of residents and professionals, resulting in a better service for residents. EVIDENCE: The manager has the required experience and qualifications to run the home, and works continuously to improve the service. The manager is resident focused and the welfare of service users is protected. The home has a good system for resident’s personal monies, when possible responsibility for a person’s money is shared with a relative. The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 Page 18 Staff supervision sessions have commenced for some but not for all staff, however supervision is not regularly taking place. Supervision is a structured and dedicated time set-aside for a member of staff to receive support from their manager that must be carried out at least six times a year. This ensures that staff are familiar with working practices of the home. A quality assurance system has been developed. The information is yet to be drawn together into a report. This information can be used to inform an annual development plan for the service. The manager agreed to complete the survey and produce a report. The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 Page 19 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 3 3 x x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 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 2 3 X 3 3 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 2 X 2 2 x x The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 Page 20 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 OP7 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. The previous time scale of 1/4/06 was not achieved. The registered person must ensure that the arrangements for the recording of medication are satisfactory. The registered persons must ensure that all staff are provided with training on the protection of vulnerable adults. The previous time scale of 1/4/06 was not achieved. The registered person must ensure that a quality monitoring report is produced, and provided to the Commission. The previous time scale of 1/5/06 was not achieved. The registered person must ensure that staff are appropriately supervised. Timescale for action 30/11/06 2. OP9 13(2) 20/10/06 3. OP18 13(6) 31/03/07 4. OP33 24 31/12/06 5. OP36 18(2) 30/11/06 The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 Page 21 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Elms Rest Home DS0000027222.V312754.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London 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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