Inspection on 20/09/07 for The Elms Rest Home

This inspection was carried out on 20th September 2007.

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 Rest Home 20/09/06

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 Liz O`Reilly Key Unannounced Inspection 20th September & 3rd October 2007 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.V354215.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.V354215.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) 020 8542 4181 F/P 020 8542 4181 Mrs Teresa Scully Post Vacant 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.V354215.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th March 2007 Brief Description of the Service: The Elms is a registered care home for up to ten older people three of who may be living with 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. Fees for this home are £445 to £470 per week. Additional charges are made for hairdressing, toiletries, newspapers and magazines. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out by one regulation inspector and consisted of two visits to the service, discussion with people who use the service and discussion with the owner/manager. Questionnaires were provided for people who use the service, staff and visitors/relatives. Information gathered from all of these sources, the owner’s own assessment and observations made by the inspector have been used to make the judgements in this report. What the service does well: What has improved since the last inspection? What they could do better: Staff need to continue with the improvements in the care planning system. They must ensure that all care plans and reviews are signed by all those involved and dated. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 6 A review of the menu must be carried out to make sure that a good variety of food is provided along with information on alternatives. Any food opened and stored in the fridge must be marked with the date of opening and the “use by” date. Staff need to make sure that the record of residents meetings shows what people who use the service discussed and outcomes. Consideration should be given to providing documents in a more accessible format particularly the service user guide and the complaints procedure. A review of the activities should be carried out in consultation with people who use the service. The manager must ensure that the recruitment procedure is up dated. 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 summary of this inspection report can be made available in other formats on request. The Elms Rest Home DS0000027222.V354215.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.V354215.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 5 & 6 People who use this service receive good quality out comes in this area. This judgement has been made using available evidence including a visit to this service. Admissions are not made to the home until a full needs assessment has been carried out. For those people who are self funding the pre admission assessment is carried out by the home manager. This home does not provide intermediate care. EVIDENCE: We saw that before anyone is admitted an assessment of their needs is carried out. Once an individual comes to live there an initial care plan is written based on the assessment. Where social services are not involved with the admission the owner/manager will carry out the assessment. Consideration should be given to gathering more person centred information which can assist in setting up a more person centred care plan from the start. Otherwise the assessment is carried out by staff from social services and the home is supplied with a copy of the document. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 9 People who use the service told us that they or their relatives had the chance to visit and meet with the manager before they made any decision about moving in. This home does not provide intermediate care. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 People who use this service receive good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Care plans include some good information on the personal preferences of individuals. However they could be more person centred. The health care needs of people using the service are met. Medication is well managed. People who use the service feel they are treated with respect. EVIDENCE: Each person is provided with an individual care plan. We found that staff have made improvements in the quality of information on the plans which helps towards providing person centred care. Staff have added some of the likes and dislikes of individuals. However this could be further improved with more detail of the individual needs and strengths of people who use the service. At times information is very general for example with regard to personal hygiene one entry informed staff that they needed to give assistance and supervision. Observations at the time of this visit and discussions with the manager showed that staff have a great deal of knowledge about the personal preferences of The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 11 individuals but this is not always recorded on care plans. Staff must ensure that all care plans and reviews are signed and dated. Staff are keeping good daily records. People who use the service are registered with local GP practices. At the time of this visit people were using three different GP groups. Arrangements are in place for regular dental, optical and chiropody services. Staff ensure that each person is provided with a health care check at least once a year. If needed community nursing services provide general and psychiatric nursing support. Medication is safely stored. Records are kept of any medication coming into the home and being returned to the pharmacy. Staff keep good records of any medication given or refused. Staff were seen to treat people in a respectful manner and to take care to protect the privacy of individuals. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 People who use this service receive adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People are offered a range of activities with opportunities to join in the domestic daily activities of the home. The range of activities could be improved. Visitors are welcome in the home at any time. Improvements need to be made on the variety of meals available. EVIDENCE: A variety of in house activities is available, we saw people watching TV, reading newspapers and magazines, knitting, writing and playing dominoes. One person was helping staff in the kitchen. People told us that they occasionally went out but a number of people told us that they would prefer not to go out in the winter. We saw staff working with individuals to support and join with them in activities of their choice. People told us that the home usually provides activities which they want to join. As recommended in previous reports a dedicated member of staff for activities would improve the opportunities for a more varied activity programme. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 13 Regular visits are made by representatives of local religious groups. A communion is held every week with people making their own choice about joining in or not. People who use the service told us they could have visitors at any time. Visitors told us that staff were friendly and welcoming. People told us they enjoyed the food provided. Examination of the menu showed it to be repetitive. The manager must carry out a review of the menu in consultation with people who use the service to provide a more varied menu with clear alternatives available at each mealtime. The kitchen is open twenty four hours so people can get snacks or drinks at any time. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 People who use this service are provided with good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. Systems are in place to record and take action on any complaints. Training in abuse awareness supports staff in protecting people living at the home. EVIDENCE: There are suitable procedures in place for dealing with complaints. The complaints policy and procedure is part of the guide for the people living there. Consideration should be given to providing key procedures in more accessible formats. No complaints have been received since the last inspection. Staff are provided with training on safeguarding adults. This ensures that they can recognise abuse and are aware of their responsibilities to report any allegation or suspicion of abuse. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 People who use this service receive good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The environment is well maintained. All areas of the home are kept clean and fresh. EVIDENCE: We saw that the home generally provides a pleasant and well maintained place for people to live. There is a large lounge/dining area which is partially divided into two. People who use the service were seen to make their own choices about where they spent their time either in the lounge or in their own room. The home owner has a programme for the regular redecoration of all areas. Plans are in place for showers to be installed in the first floor bathrooms. New armchairs have been purchased and the outside of the home has been redecorated in the last twelve months. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 16 We found all areas of the home to be clean and fresh. People who use the service told us that the home is “always” clean and tidy. There is no lift and so people who have rooms on the first floor need to be able to climb the stairs. A large enclosed garden with a raised patio area is available. Individuals can help with the gardening if they choose. People who use the service told us they enjoyed sitting out on the patio in the warmer weather. Others liked to sit in the lounge and look out on the garden. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 People who use this service receive good adequate outcomes in these areas. This judgement has been made using available evidence including a visit to this service. There are sufficient staff on duty to meet the needs of people who use the service. Good opportunities are available for staff to take part in training. People who use the service are protected by the staff recruitment procedures. EVIDENCE: A minimum of two care staff are available at all times. The manager is also available on most days. People who use the service told us that staff were “always” available when they needed them. Comments on the staff group were positive. Staff were described as “always helpful and hard working”, “very nice”, “patient and nothing is too much trouble for them”. Two staff have completed NVQ level 2 training. One person is in the process of doing NVQ level 3 and another level 4. Two staff are in the process of completing level 2. Over the last twelve months two staff have completed training in dementia care, first aid, moving and handling and the management of medication. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 18 Staff records are generally up to date with most pre admission checks including Criminal Records Bureau checks being carried out. The manager needs to ensure that contact is made with previous employer to check why the person left if they were caring for vulnerable adults or children. A written statement should be signed by all staff which confirms that they are physically and mentally fit to do this type of work. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 People who use this service receive good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People live in a home which is well run. The health and safety of everyone in the home is protected by staff carrying out regular checks on the building and equipment. EVIDENCE: The manager has considerable knowledge and experience of running a care service for older people. Comments about the manager included “she is always available to give advice”, “she is very good” and “very friendly”. The manager closely supervises the day to day care provided. The manager carries out a quality monitoring and assessment of the service to ensure that they are meeting the needs and wishes of individuals. This The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 20 includes seeking the views of people who use the service, relatives and visitors and others concerned with the home. Regular meetings are held with people who use the service. The records of these meetings need to reflect what was discussed and agreed. It is recommended that people who use the service are asked what they would like on the agenda for these meetings. A record of any accident or incident is kept and reviewed by the manager. People who use the service can deposit small amounts of money with the manager for safekeeping. Good records are kept of any money spent or received. Regular checks are carried out to ensure the health and safety of people in the home. The fire alarm system is checked regularly both by staff in the home and a professional maintenance company. Staff check and record the temperature of hot water to protect individuals from scalding. The hoist used to support people with moving and handling is serviced every six months. Staff must ensure that where food is opened and kept in the fridge it is marked with the date or opening and the “use by” date. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 X X 3 The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 22 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 Timescale for action 20/12/07 2. OP15 17(2) schedule 4 (13) 19 schedule 2 (4) 3. OP29 To ensure that evidence is available to show that care plans are compiled and reviewed on a regular basis in consultation with people who use the service and or their representatives, staff must ensure that plans and reviews are signed and dated. To make sure that people who 20/12/07 use the service are provided with a varied and nutritious diet a review of the menu must be carried out. To ensure the safety of people 20/12/07 who use the service the manager must, where a person has previously worked in a position which involved contact with children or vulnerable adults, seek written verification of the reason why they ceased to work in that position. 20/12/07 4. OP38 13(4)(b)(c To ensure the health and safety ) of people who use the service the manager must ensure that any food opened and kept in the fridge is marked with the date of opening and the “use by” date. DS0000027222.V354215.R01.S.doc The Elms Rest Home Version 5.2 Page 23 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. 2. 3. 4. Refer to Standard OP7 OP12 OP16 OP33 Good Practice Recommendations Staff should continue to improve the information available within the care plans to produce a more person centred plan. A review of the activities on offer should be carried out in consultation with people who use the service. Key procedures including the complaints procedure should be provided in easily accessible formats. Staff should ensure that the record of meetings of people who use the service reflect the subjects discussed. The Elms Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 Rest Home DS0000027222.V354215.R01.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!