Inspection on 05/01/06 for The Elms Rest Home

This inspection was carried out on 5th January 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 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 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 Elms Rest Home, The 142 Elm Walk Raynes Park London SW20 9EG Lead Inspector Liz O`Reilly Unannounced Inspection 5th January 2006 11:00 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 Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Elms Rest Home, The 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 Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 10th August 2005 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. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 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 over four hours on 5th January 2006. The inspector had the opportunity to speak with six residents and the registered owner/manager. A sample of records were examined. What the service does well: What has improved since the last inspection? What they could do better: To ensure that residents are supported by a well informed staff group action needs to be taken to provide all staff with training on dementia care and the protection of vulnerable adults. The owner must ensure that sufficient staff have been provided with training on first aid to make sure that a qualified first aider is on duty at all times. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 Page 6 Further work needs to be done to carry out an annual review of the quality of care provided in the home taking into account the views of residents, relatives, visitors and other professionals connected with the home. Work needs to continue to develop the care planning. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&4 Assessments of individuals are carried out before they are admitted to the home which makes sure that the home can meet the needs of each new resident. Staff need to be provided with further training on dementia care. EVIDENCE: Before anyone is admitted to the home an assessment of their individual needs is carried out by either staff from the local authority or by staff from the home. This ensures that the home is able to meet the needs and wishes of prospective residents. The assessments seen were of a good standard. These assessments are used to set up an initial care plan. Staff need to be provided with training on caring for people with dementia. This will ensure that staff have the knowledge, skills and understanding to meet the full needs of the resident group. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 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, 9 & 10 Each resident is supplied with an individual care plan which provides staff with information on the needs of each resident. The majority of medication was seen to be managed well. One error was seen to have been made in the records. Residents confirmed that they felt their privacy was respected by staff. Staff need to ensure the privacy and dignity of residents when they are assisting them with any personal care. EVIDENCE: Each resident is provided with an individual care plan which sets out the physical, social and emotional needs of individuals. Care plans include the wishes and interests of residents. At the time of the last inspection a requirement for the care plans to include clear information for staff and residents on how all the needs and wishes of residents would be met along with outcomes was made. This work is in progress and needs to be completed. Where possible residents and or their relatives sign the care plans to indicate their agreement. Monthly reviews take place. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 Page 10 In all but one instance medication was seen to be well managed to ensure the health and welfare of residents. One medication was not signed as given. This appears to have been caused by confusion over the labelling provided with this particular tablet. Staff must ensure that if there is any doubt about any medication then this must be reported to the manager and the pharmacist or GP without delay. Regular checks should be made on the medication administration sheets to make sure that all medication is signed for at the time of administration. Residents gave positive comments on the approach of staff and said they felt their privacy was respected. When using a hoist to assist residents staff must take care to protect the privacy and dignity of residents either with the use of screening or blankets. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 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): 13 & 14 Residents confirmed they can have visitors at any time. Residents said they made their own choices on day to day activities. EVIDENCE: Residents said they could meet with their visitors in the lounge area or in the privacy of their own room. They felt staff were always welcoming and that they could have visitors at any time. Discussion with the manager indicated that staff viewed working to develop good relationships with the family and friends of residents as important. All of the residents in the home at this time have contact with family and or friends. Since the last inspection of the home the manager has consulted with residents on working practices in the home to ensure that activities of daily living are carried out in line with residents wishes. The manager stated that discussions had taken place with staff on the importance of providing residents with choices in their day to day activities and ensuring that care is delivered in a way and at a time according to individual wishes. Staff support residents to take part in activities within the home. Since the last inspection the manager has arranged for a person from outside the home to attend once a week to provide additional activities. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 Page 12 At this visit residents confirmed that they made their own choices in relation to getting up, going to bed, activities and meals. All residents spoken to were satisfied with the way in which they were cared for by staff. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 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 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. Further work needs to be done to make sure that all staff have received training on the protection of vulnerable adults. EVIDENCE: The complaints procedure is on display in the home. Residents spoken to at this visit said they had no complaints about the service. 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. The complaints procedure gives timescales for completing investigations and includes the contact details of the CSCI. The home follows the London Borough of Merton procedures for dealing with any allegations of abuse. Certain staff have been provided with training on abuse. The manager is aware of the need to report any suspicion or allegation of abuse. All staff working in the home must be provided with training on the protection of vulnerable adults. This will make sure that all staff are aware of their role and responsibilities in reporting to the appropriate persons any concerns they may have. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 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 & 26 Residents benefit from a well maintained environment. The home was found to be clean and tidy. EVIDENCE: The Elms provides a homely environment for residents. Furnishings in communal areas are comfortable and of good quality. This home does not have a passenger lift. The building is well maintained with a rolling programme for redecoration in place. Residents have access to a comfortable lounge/dining area. The home has an enclosed garden to the rear of the property with a patio area which residents use in the warmer weather. Residents are encouraged to help in the garden if they express an interest. Since the last inspection of the home new, more appropriate locks have been fitted to bedroom doors and all residents are offered a key to their room. This Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 Page 15 improves the opportunity for residents’ privacy while still allowing staff access in an emergency. All areas of the home were found to be clean, tidy and free from offensive odours. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 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 & 30 Sufficient staff are on duty at any one time to meet the needs of the present resident group. Staff are provided with opportunities for further training. Further work needs to be done to make sure staff are provided with appropriate training. EVIDENCE: A minimum of two staff are on duty during the day. At night one member of staff is awake in the home with a second member of staff asleep on the premises who can be called upon to give advice or assistance. These staffing levels must be kept under review. Should the needs of residents increase then additional care, domestic or catering staff will need to be employed. One member of staff has completed NVQ level two training in care and this member of staff is in the process of completing level two food preparation and handling. Three members of staff are to commence NVQ training in care in January 2006. The training record for two members of staff was examined. Recent training had included moving and handling, fire safety, and in one instance the protection of vulnerable adults. The Registered Person must ensure that all staff are provided with training on caring for people with dementia and the protection of vulnerable adults. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 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): 33 & 38 Further work needs to be carried out to make sure an annual review of the quality of the service is carried out. Staff carry out regular checks on the building and equipment to ensure the health and safety of residents, staff and visitors to the home. A review of the training provided must be carried out to make sure a qualified first aider is available at all times. EVIDENCE: Progress has been made in seeking the views of residents and their families on the quality of the care provided. This needs to be continued. Feedback should be sought from others who visit the home such as GPs and district nurses. Once all the information has been received the manager must produce an annual assessment and development report. A copy of the report must be sent to the CSCI and the result of resident surveys need to be made available to present and prospective residents. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 Page 18 Staff carry out regular checks on the building and equipment to ensure the health and safety of residents. The records of testing of fire alarms, fire drills, hot water temperatures and hoist maintenance were up to date. Staff keep a record of any accident in the home along with information on any actions taken. A review of the training provided to staff on first aid needs to be carried out to make sure that a qualified first aider is available at all times. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 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 x 3 2 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 x 9 2 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 2 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 2 x x x x 2 Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 Page 20 Are there any outstanding requirements from the last inspection? yes 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 The Registered Person must ensure that care plans are expanded to include how all individual needs and wishes will be met by staff. 2. OP9 13(2) The Registered Person must ensure regular checks are carried out on the medication administration sheets to make sure medication is signed for at the time of administration. Staff must be reminded that should there be any doubts regarding any medication these must be reported to the manager without delay. 3. OP12 12(2)(3) The registered person must ensure that staff take care to protect the privacy and dignity of residents at all times including when using the hoist. 01/03/06 01/04/06 Requirement Timescale for action 01/04/06 Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 Page 21 4. OP18 13(6) 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 all staff are provided with training on dementia care. 01/04/06 5. OP30 18(1)(c ) 01/06/06 6. OP33 24 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. 01/05/06 7. OP38 18(1)(c) 13(4) 12(1) 01/04/06 The registered person must ensure that a qualified first aider is available at all times. 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 OP9 Good Practice Recommendations The registered person should ensure that medication provided in a monitored dosage system is accompanied by a description of each tablet. Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 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. Extracts may not be used or reproduced without the express permission of CSCI Elms Rest Home, The DS0000027222.V279212.R01.S.doc Version 5.1 Page 23 - 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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