Inspection on 15/10/07 for The Elms [Staunton]

This inspection was carried out on 15th October 2007.

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 [Staunton] 18/02/08

The Elms [Staunton] 01/11/06

The Elms [Staunton] 14/11/05

The Elms [Staunton] 24/05/05

The Elms [Staunton] 11/01/05

Similar services:

Fairfields Country Rest Home

Poldhu

Queensmount

Trevaylor Manor

Didsbury Court Rest Home

Belma

Hunters Care Centre

Manor Lodge

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

CARE HOMES FOR OLDER PEOPLE The Elms Staunton Coleford Gloucestershire GL16 8NX Lead Inspector Sharon Hayward-Wright Key Unannounced Inspection 04:30 15th October 2007 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.V350433.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 DS0000062586.V350433.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms Address Staunton Coleford Gloucestershire 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 Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. To accommodate a named 41yr old female service user. This arrangement must be reviewed by the CSCI after 3 months from the date of agreement should the service user still be living at The Elms. 1st November 2006 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 older people, who require personal and nursing care. 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 people to sit when the weather allows. Current fees are 480 to £685.00 per week inclusive of the Registered Nurse Care Contribution Scheme (RNCC). Hairdressing, chiropody, escort and personal toiletries are charged extra. The home is able to provide people with a copy of their Statement of Purpose and Service Users Guide. Copies of previous inspection reports are available in the home. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. Two Inspectors carried out this inspection over two days in October 2007. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes in to account the views and experiences of people using the service. The manager was available during the inspection as were other members of the home team. A total of 25 standards were inspected. People who use the service were spoken with to ascertain their views on the care and services provided. Surveys were sent to relatives/representatives of the people living at the home prior to the inspection to obtain their views. The comments received from the surveys returned and from speaking to people during the inspection have been used in the report. The manager and care staff were spoken with throughout the inspection and were helpful and co-operative. Feed back on the inspection findings was given on completion and were received in a constructive and positive way by the manager. One requirement has not been complied with since the last inspection. On this occasion the timescale has been extended as indicated in the requirements made. However, unmet requirements impact upon the welfare and safety of residents. Failure to comply by the revised timescale may lead to the CSCI considering enforcement action to secure compliance. What the service does well: The home has systems in place to ensure the needs of people are assessed prior to admission and the home can be certain they can meet these needs. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 6 People who use the service and relatives who completed our surveys all praised the staff in the home saying they are friendly and helpful. The homes activities coordinator provides people who use the service with activities that meets their interest and choices. What has improved since the last inspection? What they could do better: Improvements are needed with the medication systems used to reduce any risks to people who use the service. This includes handwritten entries not being checked and signed by a second member of staff, using ‘as directed’ on the Medication Administration Records and gaps left in the recording of medication so it is difficult to determine if the medication has been given. Staff need to ensure the privacy and dignity of people who use the service when they are undertaking personal care. Poor infection control procedures were observed that could potentially place people who use the service at risk of cross infection. The home must ensure they are disposing of incontinence pads as directed by the Waste Regulations. Several areas that relate to the safety of people who use the service and the environment need to be improved to reduce any risks. This includes propping open doors to people’s rooms at night, which could be a fire risk, and the hot water temperatures in taps that people have access to is above the recommended safe limit. A recent Fire Service visit highlighted areas that need improvement to ensure the safety of people who use the service. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 7 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 DS0000062586.V350433.R01.S.doc Version 5.2 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.V350433.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. Prospective people have their needs assessed by the home prior to admission to ensure their needs can be met. EVIDENCE: The manager was able to provide evidence that she assesses prospective people prior to them moving into the home unless they are an emergency admission. The homes enquiries folder was examined and this contained a number of enquiry forms and assessments completed by the manager. All were detailed and contained information about the needs of people. The manager said that the procedure for emergency admissions is to ask Community and Adult Care Directorate (CACD) to fax a copy of their The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 10 assessment of the person to the home and where able the manager will speak to a member of the person’s family. During the inspection a Social Worker contacted the home about the possible admission of a new person and a completed assessment form was faxed to the home for the manager to read. If suitable for the home, the manager was going to arrange to visit the hospital to complete an assessment. As part of case tracking a person who was new to the home was selected and their pre admission assessment examined. This contained information about their medical history, diagnosis and care needs. The letter informing people that the home can meet their needs is sent from Blanchworth Care head office along with the contract; therefore this was not examined at this inspection. The homes Annual Quality Assurance Assessment (AQAA) states that people can bring pets into the home as the Cinnamon Trust had assessed them as being pet friendly. The Elms does not provide intermediate care. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 11 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 the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care people receive is based on their individual needs, however not all staff are conducting personal care in a manner that ensures people’s welfare are met and the principles of respect, dignity and privacy are not always put into practice. EVIDENCE: A case tracking exercise took place where four people had their care examined in detail. This includes reading care records, speaking to the person where able and speaking to staff. All four people had an assessment of need and from this care plans were devised that mentioned individual care for each person. Frequent reviews were seen for each person. Risk assessments were in place for people’s individual risks as well as the staff using the set formats. The set formats include; falls, nutrition, pressure sores, moving and handling and mouth care, again frequent reviews of these were The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 12 seen. Evidence was seen in one person’s care records of the family agreeing the care plans with the manager. The home has a ‘key worker’ system where care staff are allocated people. A list of people and their key workers was seen. A member of staff spoken to about the care of these four people demonstrated good knowledge of their needs. Evidence was seen in all four people’s care records that the home involves other health professionals in people care. This includes the GP, chiropodist, dentist, physiotherapist and one person has input from the Community Learning Disability Team. Referrals were seen to the local Primary Care Trust requesting pressure relieving equipment. A random inspection took place in September 2007 following a notification form that was sent to us detailing one person who had unexplained bruising. This notification was sent one month after the bruising was found and we should have been informed immediately. The cause of the bruising has not been identified but the home did contact the local GP. This random inspection found that a number of another people who use the service have unexplained marks and minor injuries that were all recorded. The manager has started to undertake supervision sessions with all staff to ensure they are handling people correctly and safely to help minimise further incidents. During this key inspection one inspector observed the care staff during their night rounds as they assisted people. This was due to concerns we had received about the care people who use the service receive at night. The inspector was careful not to impose on people’s privacy and dignity. The staff communicated well with people in explaining what they were doing; however they did not explain when they were going to put the light on and remove their bedding. One person said they were cold but the staff did not immediately address this. The care staff also left a door open on one occasion whilst changing one person’s incontinence pad and they had pulled their bed clothing off leaving them exposed. This compromises people’s privacy and dignity and is very poor practice and care staff must close the door and where possible keep people covered up. Whilst changing people’s incontinence pads they did not wash people if they had only been incontinent of urine and only replaced their pads and any soiled clothing and bedding. This can place peoples’ skin integrity at risk and lead to possible skin damage and a pressure sore could develop, and for comfort of the person they must be fully washed. Again this is poor practice. The care staff wore protective clothing and changed their gloves between people but not their aprons or washed their hands. This is an infection control risk and is mentioned later in the report. The care plans examined mentioned that staff must respect people’s privacy and dignity. The homes AQAA states, “that efforts are made to ensure that privacy and dignity are maintained at all times whilst personal care is provided”. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 13 The medications systems used were examined. Records were seen for medication received into the home and any that needed to be returned. The manager confirmed that only qualified nurses administer the medication in this home and they all receive training as part of their induction programme. The home has a trolley to transport medication around the home and a medication round was observed in the main lounge. The trolley is stored securely when not in use. The nurse was careful not to touch the medication and used a spoon to help people put the medication into their mouths. All but one person has a photograph included with their Medication Administration Records (MAR). Allergies are listed. The home uses blister packs where able and boxed medication and liquid medication examined had dates of opening on them and some had dates received into the home. The home has a medication fridge in the office that is locked and the temperature is monitored. The temperature is also monitored in each of the medication rooms. The Medication Administration Records were examined and it was found that there were a number of gaps in the recording of medication. Hand written entries were not routinely checked and signed by a second member of staff. Two printed entries had ‘as directed’ and no instructions for use; this must be changed to ensure people receive their medication as prescribed by the Doctor. One person had requested to self-medicate their morning medication and the required consent and risk assessments were in place. The person said they store their medication in their locked draw in their room. The homes controlled medication was checked and all was correct and evidence was seen of stock checks. The home has a medication reference book but it is dated November 2006 and consideration should be given to obtaining a more up to date book. A copy of Blanchworth Care medication policy and procedure is stored with the Medication Administration Records as well as a list of staff signatures and initials. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 14 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 the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service are able to make choices about their daily life and a range of activities are provided to meet their recreational interests. EVIDENCE: The home has an activities coordinator who plans the activities for people who use the service. People where able can make their own activities and have a choice whether to participate in the ones provided by the home. From discussions with the activities coordinator she has attended an activities meeting with Blanchworth Care Group where they were given examples of the types of activities to provide. A poster advertises the week’s activities and one inspector sat in on the activities on the first day of the inspection where a number of people were enjoying skittles. One person was knitting and another person was doing word puzzles by themselves. People spoken with said they enjoyed the activities provided and are able to choose if they want to take part. One person said they enjoy the skittles and darts best. The activities coordinator said she spends time with people who do not wish to participate in the group activities. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 15 The hairdresser was visiting the home on the second day of the inspection. The manager said the home is able to meet peoples’ spiritual needs, a monthly service from the local vicar takes place and another person’s family help them to meet their spiritual needs. Each person has a personal profile and the activities coordinator maintains records of the activities people take part in. A number of comments were received on surveys sent to relatives of the people who use the service and they felt the home could provide more outings. The home now has two people who could drive the mini bus for them so this is one area they are looking to improve. One person spoken with said they are able to go out alone or they can request a staff member to go with them if they wish. Members of staff said that family members of other people who use the service also take their relatives out. Visiting to the home is not restricted and several visitors were seen during the inspection. People confirmed that they are able to make choices about their daily lives. Members of staff were observed asking people what they would like for breakfast. A number of rooms belonging to people who use the service were seen and their personal possessions were on display. The homes AQAA says that advocate support is available to people who use the service. The home displays a copy of the menu in the main lounge/dining area, however when people who use the service were asked if they knew what was for lunch they did not know. Also the menu is in small lettering and it may be difficult for people to read, consideration should be given to using a larger font. Breakfast was observed on one day and people were seen to be enjoying their meal and socialising with other people. One person was seen with the supervision of staff laying the tables ready for meal times. On the second day of the inspection one person had an alcoholic drink with their lunchtime meal. People who use the service were asked if they enjoy the food provided, some people said very much and another person said ‘can’t complain’. The manager said that recently the home has put a lot of input into their meal provision and feel this is now improving and said that on certain days of the week people who use the service can have a cooked breakfast. A member of staff was observed assisting one person to eat and they were talking to another person and caused the person they were feeding to choke, it is important that staff observe the person they are feeding to prevent this from happening. A discussion with the cook took place and he has just completed his NVQ 2 in catering. Health and safety checks were in place. The cook said he has a list of people who require therapeutic diets to include diabetics and at times provides The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 16 alternatives to the menu to meet their dietary needs. One person has a vegetarian diet and alternatives are provided if people do not like what is on the menu. In the main lounge/dining area snacks are available for people to help themselves. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 17 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 the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service have access to a complaints procedure that is accessible to everyone and systems are in place to protect people from abuse. However people are not always being protected from possible risk of harm. EVIDENCE: The home has a copy of their complaints procedure on their notice board in the main reception area and this has information on how to contact us. A copy is also included in their Statement of Purpose and Service Users Guide. Records relating to complaints received by the home were examined and letters sent to the complainants. We had also received some concerns about the care given to people on nights and this was followed up at this inspection. The concerns related to how people were cared for at night. Whilst not all the concerns were substantiated as detailed through out this report other issues were found about the care of people as described in Health and Personal Care. We also received concerns about the care of one person and this was passed to the Adult Protection Agency. Survey’s sent to relatives of people who use the service said that the majority of people knew how to make a complaint, but one person said they could not remember. One comment said ‘so far I have never needed to make a The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 18 complaint in the last 4 years’. Another comment said ‘any problems or query has always been acknowledged’. The homes Annual Quality Assurance Assessment (AQAA) states they are looking at ways to reduce the number of complaints by holding monthly relatives meetings where suggestions can be made by relatives and people who use the service and by opening the channels of communication with external agencies. Blanchworth Care Group provides in house training for staff in relation to abuse and challenging behaviour and this is normally undertaken during the induction training. Policies and procedures are in place and this includes whistle blowing. Staff confirmed they have undertaken training about abuse. Reference numbers were seen as evidence that POVAfirst and Criminal Records Bureau Disclosures (CRB) are undertaken for new staff. The home has referred one person who uses the service to the Adult Protection Agency and following this an increased input from external health professionals has improved the situation. A random inspection was undertaken prior to this key inspection following concerns that an incident was reported to us one month after the event and no investigation by the home had taken place. We wrote to the company and asked them to investigate this and it was noted that the GP had been contacted. The random inspection found that the home is aware of the reporting procedures to us and it appears to be an error why we did not receive it. Several people were found to have ‘unexplained’ bruising and marks, however the manager felt this was due to moving and handling of people and their condition. However we are unable to determine the cause. Records of these injuries are maintained and were examined along with the notifications we receive. Care plans and risk assessments are in place. The manager has started supervision sessions with staff about correct moving and handling techniques. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 19 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, 25 & 26 People who use the service experience poor quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service live in a comfortable environment, however improvements to safety and infection control are required as these potentially place people at risk. EVIDENCE: A tour of the environment took place with some rooms belonging to people who use the service seen. One of the concerns received about the care people receive at night said that when people were receiving personal care they were washed with cold water as no hot water was available. Several empty rooms were checked during the night and it was found that hot water was available but at times the taps needed to be run for a while. Night staff spoken with confirmed that hot water is available at night. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 20 Bathrooms on each floor were examined; one of the bathrooms is out of action on the top floor as it has tiles missing from the sink area. Another bathroom on the top floor had part of pipe exposed as the other part was covered. The flooring was uneven in places and it looks like the floor has cracks coming in it and the bath is also stained. The décor in the other bathrooms examined looked ‘tired’ in places. The strip lights by the main door are missing covers and the bulbs are visible. During the tour of the environment at night it was noticed that three people had their doors propped open, this is a fire risk and despite risk assessments being completed and identifying the appropriate equipment is needed to ensure people are safe; this has not been obtained and the staff are still putting people at risk by propping them open. One of these rooms has a ‘star lock’ and the key is left on the outside and if locked from the outside there is no means of escape from the inside. This could potentially place this person at risk as another person could come along and lock the door. Records were seen of the testing of water temperatures and it was found that in a number of rooms the temperature of the water exceeded 60°C where the recommended safe limit is 43°C. Risk assessments were seen in several people’s care records in relation to scalding. Despite risk assessments being in place water temperatures this high can potentially place people at risk. The home is in the process of having a new call bell system fitted. The home has received a grant to provide a sensory garden. Several people who use the service were asked if they were happy with the cleanliness of the home and they said yes. On entering the main lounge/dining area in the night it was noticed as being odorous, however the night staff said the domestics clean this room early in the morning before people use the room. This was found to be the case. The laundry was inspected and systems are in place for managing soiled linen. A strip has been placed along the floor to repair the damage. The staff was asked how they dispose of incontinence pads. They are placed in white bags and then into black bin liners. This is not the correct way to dispose of these as directed by the Lists of Waste Regulations 2005 and the European Waste Catalogue Codes. This must be rectified. Protective clothing is available for staff to use, however whilst accompanying the night staff it was observed that whilst they were wearing gloves and aprons, only the gloves were changed between people and they did not wash their hands. When the staff had finished attending to people only one member of staff was observed to wash their hands. This poor practice could potentially place people who use the service at risk of cross infection. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 21 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 the service experience adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The home is confident that they have sufficient numbers of staff to meet the needs of the people in the home. However some staff would benefit from further training to ensure people who use the service at risk at not put at unnecessary risk. EVIDENCE: The duty rotas were examined and a discussion took place with the manager regarding numbers of staff on duty. The home is confident the needs of the people who use the service are being met. Ancillary staff are available to support the care staff. Staff have to sign the duty rota book and the manager checks this. Any changes to the duty rotas are also written in this book. Staff who were spoken with said they enjoy working at the home as they have a good team spirit and all work well together. They all said they enjoy their jobs. Relatives were asked in their surveys if they felt the staff have the right skills and experience to look after the people, of those that answered that question four said’ always’ and three said ‘sometimes’. Comments include, “generally a caring atmosphere and the carers show great patience’, ‘management and The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 22 staff very helpful’ and ‘very friendly place and nothing is too much trouble for staff’. The home has an allocations board that informs staff what they will be doing and another board with specific information about each person that the staff must be aware of. The AQAA states that one member of staff has NVQ 2 and seven are working toward this. The personnel records for two recently appointed staff were examined on Blanchworth Care computer system. Evidence was seen of all the required checks except that the interview form for one of these said they had explored employment gaps, however their was no dates next to this information and the person had only filled in years on their application form and not months. The home uses an induction book based on the Skills for Care common induction standards. Blanchworth Care have not registered with the Skills for Care council. All new staff undertake a three-day induction training with Blanchworth Care Group. The training matrix was examined and this shows when staff needs training and any gaps where must be addressed. Qualified nurses are able to undertake other training and this includes first aid and medication. The manager said she has been trained in male catheterisation and venepuncture. The other qualified nurses are undergoing training for venepuncture. From observations of the night staff it would appear that they require an update on infection control to ensure people who use the service are not put at risk of cross infection. And all staff would benefit from a moving and handling practical update to ensure they are moving people safely. This then may help reduce the risks of injury to people.Training records on Blanchworth Care computer systems were seen for the two recently appointed members of staff. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 23 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, 36 & 38 People who use the service experience good quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. A competent person supervises the management and administration of the home, and a quality assurance system is in place to obtain the views of people who use the service. EVIDENCE: Since the last inspection the home has had a change of manager. The new manager is in the process of being considered for registration by us. She is a qualified nurse and aware of the importance of keeping herself up to date. She has started the NVQ 4 training. Staff spoken with felt the new manager is approachable and they could go to her with any concerns. On the notice board in the main entrance are the results of surveys sent out to people who use the service and relatives from last year. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 24 Regulation 26 visits are taking place and some audits were seen that have taken place since July this year. These include controlled medication, care plans, kitchen, laundry and cleaning. An infection control audit had been started but not completed and it was not dated or signed. Minutes were seen of a staff meeting and staff confirmed they take place. A meeting for people who use the service and relatives took place in June this year. The home manages monies for a number of people and records and receipts are maintained. Evidence was seen of the staff checking the monies. A secure facility is provided. Records relating to staff supervision were seen along with the policy. Staff and the manager sign a record sheet following each session. The manager has undertaken supervision session with qualified staff in relation to care plans and the Nursing and Midwifery Councils code of practice. The homes Annual Quality Assurance Assessment (AQAA) lists dates of servicing certain equipment except there is no date for gas appliances. The home has had a recent visit by the Fire Service, which did identify areas that need improvement. No record was seen of fire training at this visit. Records of other fire equipment checks were seen. There appeared to be no records of maintenance wheelchairs. A requirement was issued at the last inspection for staff to clearly label chemicals that are decanted from their original containers, at this inspection a bottle of decanted chemical was found in the laundry room and it was not labelled clearly. Also chemicals are stored in a cupboard in the laundry that does not have a lock on it. And if the laundry is left unlocked it could potentially place people at risk. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 25 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 X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 1 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 1 1 X X X X X 2 1 STAFFING Standard No Score 27 3 28 2 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 3 X 2 The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 26 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 OP8 Regulation 12 1(a) Requirement When people are having their incontinence pads changed they must be washed and dried for their comfort and to preserve their skin integrity. When medication is administered to people who live in the home it must be clearly and accurately recorded and given in accordance with the doctor’s directions. This will help to make sure people receive the correct levels of medication. The registered person must ensure that entries on the Medication Administration Records are not ‘as directed’ and instructions are written on how and when the medication must be given. This will help to make sure people receive the correct levels of medication and at the correct time. The registered person must ensure that all staff respect the dignity and privacy of people who use the service. This relates to care staff providing personal care to people and leaving the DS0000062586.V350433.R01.S.doc Timescale for action 16/10/07 2. OP9 13(2) 16/10/07 3. OP9 13(2) 16/10/07 4. OP10 12(4a) 16/10/07 The Elms Version 5.2 Page 27 5. OP18 13(4c) 6. OP19 13(4a) 7. OP19 23(2b) 8. OP26 16(2K) 9. OP26 13(3) 10. OP29 19 11. OP38 13 (4) (c) door open and leaving people exposed when the bedding is removed. The home needs to identify why a number of people who use the service are found to have unexplained bruises and marks and look at ways of reducing risks to people. The registered person must review the use of the ‘star lock’ with the key left in it as this potentially places the person at risk as they could get locked in with no means of escape from the inside. The registered person must put the covers on the strip lights in the main entrance hall to reduce any risks to people who use the service. The home must make suitable arrangements for the appropriate disposal of clinical waste (this is with relation to the Lists of Waste Regulations 2005 and the European Waste Catalogue Codes). The registered person must ensure that people who use the service are not put at risk of cross infection due to the actions of the staff. The registered person must obtain a full employment history on all proposed staff with written explanation of any gaps in employment to ensure people who use the service are not put at risk. The registered person must ensure that unnecessary risks to the health and safety of service users are identified and so far as possible eliminated (This refers to cleaning materials that must be stored in adequately labelled containers in line with the DS0000062586.V350433.R01.S.doc 30/11/07 16/10/07 17/11/07 16/12/07 16/10/07 17/11/07 16/10/07 The Elms Version 5.2 Page 28 Control of Substances Hazardous to Health Regulations (COSHH) 1988). This requirement remains outstanding since the last inspection. 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. 5. Refer to Standard OP9 OP9 OP15 OP18 OP25 Good Practice Recommendations The home should obtain an up to date medication reference book. Handwritten entries on medicine charts should be signed and dated by the member of staff writing this with a second member of staff checking and signing as correct. The home should consider printing the menus in a larger font so people are able to read them easier. The staff in the home should consider attending the Protection Of Vulnerable Adults training provided by Gloucestershire County Council. The home should consider providing restrictors on their hot water taps to prevent any risk to people who use the service. The Elms DS0000062586.V350433.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection South West Regional Office 4th Floor Colston 33 33 Colston Avenue Bristol BS1 4UA 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 DS0000062586.V350433.R01.S.doc Version 5.2 Page 30 - 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!