CARE HOMES FOR OLDER PEOPLE
The Elms Staunton Coleford Glos GL16 8NX Lead Inspector
Mrs Ruth Wilcox Unannounced Inspection 14th November 2005 09:30 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 DS0000062586.V249978.R01.S.doc Version 5.0 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 DS0000062586.V249978.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Elms Address Staunton Coleford Glos GL16 8NX 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) 08453 455793 01594 837681 Brickjet Ltd Mrs Nicola Louise Warman Care Home 31 Category(ies) of Learning disability (1), Old age, not falling registration, with number within any other category (30) of places The Elms DS0000062586.V249978.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. To provide accommodation to one named service user under the age of 65 years. This condition to be removed once the service user becomes 65 years old or leaves the home. 5 August 2005 Date of last inspection Brief Description of the Service: The Elms is situated alongside the main road between Coleford and Monmouth in the Forest of Dean. The home is owned and managed as part of the Blanchworth Care group. The purpose built building is registered to accommodate 31 residents over the age of 65 years, who require personal and nursing care. The additional category for a person under the age of 65 years with a Learning Disability is for one specifically named resident only. The building is constructed on four-levels, has a shaft lift, and access to the building is ramped for wheelchair users. The ground floor accommodates the main office, reception, kitchen and laundry room. On the first floor, there is a large lounge/dining room and two smaller lounge areas, one being a pleasantly appointed conservatory. The upper floors have bedrooms, bathrooms and additional toilet facilities. All thirty-one rooms offer en suite facilities, with a hand basin and toilet. All rooms offer single accommodation. Spacious gardens surround the home and provide a pleasant area for residents to sit when the weather allows. The Elms DS0000062586.V249978.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. One inspector carried out this unannounced inspection over four hours on one day in November. The Registered Manager was present throughout the day, providing help as required. She and her staff were most welcoming and helpful to the inspector. Care records were inspected, and the care of two residents was particularly closely looked at. Fourteen residents and one visitor were spoken to directly, and their views regarding the care and services in the home generally were sought. Further to the specialist pharmacist inspection carried out in August, further checks were carried out on the systems for managing residents’ medications, in order to assess the home’s compliance with the requirements that were issued at that time. Progress with the establishment of a social activities programme was assessed, and the arrangements for residents to exercise personal choices in their daily lives, and to receive visitors and keep close links with their family and friends were considered. In addition the home’s policies regarding protecting and upholding the rights of residents were also assessed. The overall management of the home was inspected, and the provision of staff and the way in which they are supervised was considered; progress with the care staff NVQ training programme was also inspected. A tour of the premises took place, with particular attention to the standard of maintenance and cleanliness. Staff were observed at various times, whilst going about their duties and interacting with the residents. What the service does well:
The Elms provides a clean, well-maintained and comfortable home for the residents living there. There are very positive and inclusive relationships between the staff group and the residents, with residents’ satisfaction levels regarding their care and the attitudes of staff being high. The Elms DS0000062586.V249978.R01.S.doc Version 5.0 Page 6 Residents are assured of their privacy when they want it, and are freely able to maintain their close personal links with their family and friends. A social activities programme is offered, in which residents can participate on an optional basis, and the home is endeavouring to establish links within the local community, with many of the residents enjoying certain community functions. Thorough assessments and documented care planning is carried out, and this provides the staff with clear direction and instruction on how best to meet the residents’ health and personal needs. Residents themselves confirmed they were very happy with the ‘good care’ they received from the ‘lovely’ staff. The home has been registered to provide nursing care during this year, and the care and nursing team work together to meet residents’ needs in a timely and effective way. The current provision of staff will remain under review within the home, as the numbers and dependency levels of residents increase. The home is well managed, and was calm and very organised during this visit. The manager adopts a methodical and consistent approach to all aspects of managing the home, including the supervision and support to the staff, as well as delivering the care to the residents. What has improved since the last inspection?
Since the last inspection, the home’s Statement of Purpose and Service User Guide has been revised and updated, to take into account that The Elms now is registered to offer nursing care. The home has done well to address a number of improvements that were required by the CSCI inspecting pharmacist, with the manager and staff effecting the necessary changes to the systems for managing medications. Some areas have been redecorated, and many of the bedrooms have been fitted with new curtains. A small range of medical equipment has been purchased, and certain items of linen have been replaced. The home has recently conducted individual risk assessments on each resident, with a view to identifying those who would be most at risk from hot water temperatures. However, as a consequence of this the home is now required to take risk reducing measures for those who have been identified as being at risk of a scalding injury. The Elms DS0000062586.V249978.R01.S.doc Version 5.0 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Elms DS0000062586.V249978.R01.S.doc Version 5.0 Page 8 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 DS0000062586.V249978.R01.S.doc Version 5.0 Page 9 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): 1 & 3. All residents have access to comprehensive information about the home, and are admitted on the basis of a full assessment of their needs, ensuring that they can receive the care that they require. EVIDENCE: Since the last inspection the home’s Statement of Purpose and Service User Guide has been updated to reflect the home now being registered to provide nursing care; revised copies have been supplied to the CSCI. The manager or the residential care coordinator performs assessments for prospective residents prior to admission to The Elms. The pre-admission assessments for four recently admitted residents were inspected, and each was comprehensively recorded. Each assessment was clearly linked to the resident’s plan of care following admission. The Elms does not provide intermediate care. The Elms DS0000062586.V249978.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 9 & 10. There is a clear and consistent care planning system in place, which provides staff with the information they need to meet residents’ health and personal needs. The systems for the administration of medications are good, with clear arrangements in place to ensure residents’ medication needs are met; however some unsecured storage could compromise the safety of residents. Care and support is offered in such a way as to promote the privacy and dignity of the individual. EVIDENCE: Each resident has an individual plan of care, which is based on an assessment of all their needs; two were selected as part of the case tracking exercise. Care plans are well written, are done so in consultation with the resident concerned, and are regularly reviewed. Each plan that formed the case tracking exercise contained clear instructions as to how each individual’s health needs are to be met, with visual evidence confirming that this is carried out.
The Elms DS0000062586.V249978.R01.S.doc Version 5.0 Page 11 The statutory requirements issued following a specialist pharmacy inspection were reviewed in order to assess the home’s compliance with them. Good progress has been made in this regard. The manager is currently devising a medication audit tool, so that a regular review can be undertaken in respect of the safe management of medications. The storage of medications and associated equipment is currently under review in the home, with a view to re-siting everything into one location within the home. A priority must be the storage of certain items in the conservatory area, which is an unsecured room to which residents and visitors have access. Staff were very attentive to the residents, and demonstrated a respectful but friendly approach to them. One resident said that the staff ‘are marvellous’, whilst many others confirmed that staff were kind, respectful and attentive. Other comments reflected that residents were very satisfied with the care they receive and the manner in which it is given. A visitor said that she was very happy with the care her relative was receiving in the home. Care was delivered in privacy, and a resident was taken for consultation with their general practitioner in privacy also. Residents have been offered a lock for their bedroom doors, but only one has chosen to have one fitted for her privacy. The Elms DS0000062586.V249978.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13 & 14. An activities and entertainments programme is offered, in order that residents are provided with regular and varied opportunities for social activity. Respect is shown to residents’ personal choices, in order that they can maintain close social links with family and friends, and can maintain some control over their lives wherever possible. EVIDENCE: Although standard 12 was inspected in detail at the last inspection, arrangements to sustain an appropriate social programme for the residents were looked at again. A regular social activities programme is available, which shows a variety of social opportunities for the residents. A named person is allocated on a daily basis to coordinate a group activity. Records are also kept of all of those choosing to participate. Residents were seen pursuing personal interests, with some reading their newspaper, listening to music or doing crosswords. Visitors are free to visit residents at any time of theirs or their relative’s choice. One visitor confirmed that she felt very welcome in the home; she felt that the staff were helpful.
The Elms DS0000062586.V249978.R01.S.doc Version 5.0 Page 13 The manager is considering trying to introduce a relative’s support group. Families and friends are welcomed and encouraged to participate in the life of the home, and most recently were invited to attend a Halloween party with their relative, and to join in the forthcoming Christmas celebrations. Links have been forged within the local community also, with residents attending local functions. Residents were seen spending time in the lounge or their room, with respect shown by staff to how and where they were choosing to spend their time. Individual assessments in the care records demonstrated consideration to their personal choices and preferences. Residents are able to exercise their personal choices in their own rooms, with some having introduced personal items. They also exercise choice with their meals by having regular opportunities to discuss menus with the staff. The manager is currently planning a resident meeting, which is seen as another opportunity for residents to have a say in how their home is run. Two residents made particular mention of how staff respect their personal choices, saying that that ‘they can choose what they do and when, whilst still having the support of the staff’. A small number of residents are able to manage their own affairs, and this is fully respected by the home wherever it is applicable. The Elms DS0000062586.V249978.R01.S.doc Version 5.0 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 The home’s Adult Protection policies help to provide a safe environment for the residents, however additional training focus in this area for a small number of staff will increase their awareness further. EVIDENCE: The home has written policies and procedures for the protection of vulnerable adults. Staff receive training in abuse at induction and are expected to attend further mandatory training in this regard. Staff were asked about their awareness of what might constitute abuse and about the Whistleblowing procedures to follow if they had any concerns. One member of staff appeared slightly vague, despite having attended training, and the manager resolved to address this during supervision. Training records showed some isolated training gaps in this area, with three staff not having attended. The Elms DS0000062586.V249978.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 25 & 26. The standard of the environment at The Elms is good, and provides the residents with a pleasant and comfortable place to live; however corrective measures to control certain risks in the environment are needed to improve safety for some. The home is very clean, with some appropriate observations regarding the control of infection for the welfare of the residents. EVIDENCE: The home employs a full time maintenance person, and remedial works to address maintenance issues are ongoing. The home has undergone some refurbishment, and as such is well presented. Since the last inspection some redecoration work has been carried out and many of the bedrooms have been fitted with new curtains. A new security system has been fitted to the front door, in order to protect those living at the home. Some additional linen has been purchased, and a small range of medical
The Elms DS0000062586.V249978.R01.S.doc Version 5.0 Page 16 equipment has been purchased in view of the home becoming registered to provide nursing care since the last inspection. Individual risk assessments have been recorded for each resident regarding the hot water temperatures from the outlets accessible to them. At least three of these have identified the person as being at significant risk from a scalding injury; there is no control measure to address this risk, other than hot water warning signs. The home is cleaned to a good standard, and all areas were fresh and odour free. There is good provision of appropriate and accessible equipment to ensure that staff can adhere to good infection control procedures. However, in respect of the home now providing nursing care, it does not have appropriate sluicing disinfection facilities. Clinical waste is managed appropriately and safely. The laundry room washing machine is able to sluice and disinfect any foul or infected laundry, and the room was very clean and orderly. The Elms DS0000062586.V249978.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 & 28. Staffing provision is adequate to meet the needs of the residents currently living in the home. In the absence of NVQ qualified care staff, the home has definite plans to work towards achieving this as soon as possible, so that staff develop a greater understanding of their roles. EVIDENCE: Since the last inspection, the home has been registered to provide nursing care, and now there are qualified nurses on duty twenty-four hours a day. Staff rotas make provision for three care staff to be on duty with a registered nurse during the day, with one carer overnight. Due to changing dependency levels, the manager has arranged for an additional carer to be on duty with the night staff until 10pm, to meet residents’ needs at this time. It is recognised that additional staffing will be provided as resident numbers increase and dependency levels increase. The home was calm and organised during this visit, with residents’ needs clearly being met in a timely manner. Residents themselves spoke very positively about the staff team as a whole. There are currently no staff qualified to NVQ level 2 standard, with the exception of the residential care coordinator who is qualified to level 4 standard. To address this, there are currently six care staff training on the NVQ programme, with another one reported to be due to start.
The Elms DS0000062586.V249978.R01.S.doc Version 5.0 Page 18 The Elms DS0000062586.V249978.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 34 & 36. There are very good management and supervision systems in place to ensure that the interests, health and safety of the residents are safeguarded. EVIDENCE: The home manager is a first level nurse, who has been registered with the CSCI for her role. She is currently undertaking the NVQ 4 Registered Manager’s Award, and also continues to ensure her professional development through additional clinical training. She was appointed as the manager four months ago, and works collaboratively with the home’s residential care coordinator for the benefit of the residential and nursing residents. The manager has clear lines of accountability to her line manager, (the Director of Nursing), and the managing company. All business and financial planning is managed at the head office. The manager has no involvement in
The Elms DS0000062586.V249978.R01.S.doc Version 5.0 Page 20 the financial planning for the home directly, but is able to make requests for expenditure to the head office, which is reported to be well received. The company was satisfactorily assessed as part of the registration process at the end of last year, and has the necessary valid insurance cover. There is a good system for ensuring an appropriate level of formal supervision for the staff. Supervision primarily includes care practice issues and developmental needs for the individual. An individual matrix is maintained, in order to monitor progress with the programme, and there are records kept for each supervision session. The Elms DS0000062586.V249978.R01.S.doc Version 5.0 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 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 2 3 X X X X X 2 2 STAFFING Standard No Score 27 3 28 3 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X X 3 X 3 X X The Elms DS0000062586.V249978.R01.S.doc Version 5.0 Page 22 Are there any outstanding requirements from the last inspection? No 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 OP9 Regulation Requirement Timescale for action 31/12/05 2 3 OP18 OP25 4 OP26 13(2)(4.a) The registered person must ensure that all medication related items and equipment, which are currently in the conservatory, are locked in a secure location. 13(6) All staff must attend abuse and adult protection training. 13(4.a. c) The registered person must have temperature control devices fitted to hot water outlets, which are accessible to those residents who are identified as being at risk of scalding injury. 23(2.k) The registered person must ensure the provision of a sluicing disinfector. 31/01/06 31/01/06 28/02/06 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 DS0000062586.V249978.R01.S.doc Version 5.0 Page 23 The Elms DS0000062586.V249978.R01.S.doc Version 5.0 Page 24 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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