Inspection on 18/02/08 for The Elms [Staunton]

This inspection was carried out on 18th February 2008.

CSCI found this care home to be providing an Adequate service.

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] 15/10/07

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 02:55 18 & 19th February 2008 th 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.V358869.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.V358869.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 Miss Venon Nkosi Care Home 31 Category(ies) of Old age, not falling within any other category registration, with number (31) of places The Elms DS0000062586.V358869.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. 15th October 2007 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 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 Funded Nurse Care Contribution Scheme (FNC). 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.V358869.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. Two Inspectors carried out this inspection over two days in February 2008. The judgements contained in this report have been made from evidence gathered during the inspection, which included a visit to the service and takes into account the views and experiences of people using the service. As part of this inspection anonymous concerns that we (The Commission) received via three letters were investigated. Concerns that related to ‘hear say’ where it would have been one person’s opinion against another were not investigated for that reason. The outcome to these concerns is detailed in the report. The Registered Manager was available during the inspection as were other members of the home’s staff team. A total of 25 standards were inspected. Where possible, people living at the home were spoken with to ascertain their views on the care and services provided and any visitors to the home. Staff were observed interacting with people who use the service. The comments received from speaking to people during the inspection have been used in the report. The staff spoken with throughout the inspection were helpful and co-operative. Two requirements have 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 Registered Manager is working hard to improve the home for people who use the service through quality assurance systems and staff supervision. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: It was found that in some cases not every person who uses the service had a care plans in place for each assessed need. Some entries made by staff were illegible so it was difficult to ascertain what they were writing in the care plans. Since the last inspection there has been a change of personnel in relation to the activities coordinator and they are now only working three day per week. This is a reduction in the number of hours. Care staff are meant to provide activities when the coordinator is not at work, however if they are busy then they will not place, especially as the number of people who use the service has increased. The home is monitoring the hot water temperatures on a monthly basis, however the temperatures are at times exceeding 60° C where the recommended safe limit is 43°C. A number of people who use the service have dementia and they are prone to wandering which places them at risk, as they will not remember that a member of staff needs to accompany them or be able to understand the warning signs in place. Therefore to protect people who use the service the home must restrict the temperature of the hot water. The home is still propping open some people’s doors with stools, which places them at risk if a fire was to happen. The home must in conjunction with the local fire service purchase an appropriate doorguard. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 7 The home must ensure that all staff receive training that is appropriate for their roles as it was found that one member of care staff has not had moving and handling training since 2005, which could potentially place people at risk who use the service. 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.V358869.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.V358869.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): 1, 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. The home has admission procedures in place that include an assessment of the prospective person’s needs to ensure they can be met by the home. EVIDENCE: Part of this inspection was to review the systems the home has in place to ensure that people who use the service that are funding their own nursing care and are in receipt of Funded Nursing Care Contribution (FNC) are aware of this and that the home is able to demonstrate how people receive this payment. At the time of the inspection the home did not have any people who are privately funding their own nursing care. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 10 A copy of the homes amended Statement of Purpose was obtained following a review of their of registration categories by us (The Commission). This guide states that the home does not have any person with dementia, however on reading a number of care recordings several people did in fact have a diagnosis of dementia. This must be amended to reflect the current situation in the home. The Registered Manager was confident that at the time of the inspection the home could meet the needs of people with diagnosis of dementia and is fully aware that the home is not registered for this category. However the Registered Manager said that if the condition of any of the people with dementia altered she would ensure that the a review of their care takes place and would contact the appropriate health care professional if deemed necessary. A pre admission assessment of a person who was recently admitted to the home was examined. The Registered Manager had completed the assessment prior to the person moving in and it contained detailed information about their needs. The Registered Manager said she visited this person where they were living prior to them moving into the home. This person said that their family had wanted them to move to a care home near to where they live so it is easier for them to maintain contact and to visit them on a regular basis. Their family had viewed the home prior to them moving in. The letter sent confirming the needs of people can be met is sent from the company’s head office and therefore was not examined at this inspection. Standard 6 does not apply to The Elms, as they do not provide intermediate care. The Elms DS0000062586.V358869.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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. The health and personal care that people receive is based on their individual needs. The principles of respect, dignity and privacy are not always put into practice by all staff. EVIDENCE: Three people who use the service were randomly selected during the inspection to have their care examined in detail. This included reading care records, speaking to that person where able and a member of staff. Staff were observed interacting with these people and others during the inspection. The care plans of a number of other people who use the service were also examined. One person was a recent admission to the home and the other two people had been at the home for a period of time. All three people who had their care examined in detail all had care plans in place for the majority of their identified needs. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 12 However two people need to have a care plan formulated for their medical conditions to ensure staff know how to manage their specific needs. The vast majority of care plans contained individual information about the needs of people and how they needs are to be met. However it was difficult to read some care plans and entries to these, as the writing was illegible. The Registered Manager said she is aware of this and is working with the staff to ensure all entries can be read. The qualified nurses at the home must be reminded of the Nursing Midwifery Councils policy about record keeping. One person had a care plan in place, which was very detailed and had a ‘holistic’ approach to the management of their care. This is considered good practice. Reviews were seen of each care plan examined. One person had a care plan detailing concerns about their weight and dietary intake and mentions monitoring monthly weights. On speaking to this person it was found that their dentures did not fit properly and it was difficult for them to communicate. This was not documented in their care plan as this could have problems for them when eating. One of the concerns we received mentioned that one person who uses the service had a specialist scan that required precautions to be in place on their return to the home. The concern alleged that staff were not informed about this. We found that this was not the case as handover records clearly documented the precautions required and a care plan had been devised but was not dated. One member of care staff said that she remembers being informed of the precautions by a qualified nurse. Risk assessments were in place for all three people who had their care examined in detail in both a handwritten format and the set format used by the Registered Provider. On the whole the handwritten risk assessments contained detailed information about how the risk identified is managed. However one person’s risk assessment contradicted their care plan as it said this person was independent with personal care and the risk assessment said to observe this person when near the sink. Another person had a hand written risk assessment in place to manage the risk of scalds and to ensure signs are in place and observe when near sinks. We found this person has dementia and would not be able to necessarily understand the signs in place. In addition the person is prone to wandering so the staff may not be aware when this person is using a sink. Reviews were seen in place on mainly a monthly basis for risk assessments. One person was found to be losing weight since their admission in October 2007 and the home has monitoring systems in place for this. Records are maintained of health professional visits to include the GP and chiropodist. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 13 Another concern we followed up related to an accident/incident record not being written in relation to one person and an injury they received. No incident form was found relating to this specific date and injury. A record was made in the handover notes and in this persons care files therefore there is a record of injury and good practice would encourage an incident form to be completed. The majority of the concerns we received related to specific issues with medication and these were followed up at this inspection. Not all medication systems used were examined as these were fully examined at the last key inspection. All Medication Administration Records (MAR) were examined. There were a small number of gaps in the recording of medication and the majority of times a reason is given for the omission. On one MAR a member of staff had signed to say that a table was given then wrote ‘R’ for refused over the top. When staff are administering medication they must ensure that the medication is taken by the person before signing for it. Hand written entries we examined had been checked and signed by a second member of staff, which is good practice. Photographs of each person were seen with their MAR. One person was prescribed analgesia three times per day but no entries had been made to say why this was not being given. If this medication is ‘as and when’ required then this needs to be stated on the MAR as it looks like the staff are not administering it. One concern we received related to an entry made in the controlled drugs register (CD). It was alleged the staff member’s involved had not signed the record to state this medication was destroyed. The entry stated that the medication had been destroyed but the staff involved had not signed the record. Records were found in the returns medication book. Good practice guidelines encourage staff to sign the (CD) register when they are destroying this type of medication. The member of staff involved was spoken to and confirmed that only one qualified nurse with another member of staff would undertake this role and that they were aware they must sign in the book. The member of staff had put the medication in the denaturing kit but it had not been left in there for 24 hours as per the guidance. The Registered Manager said that at times the company they use to collect returns comes in the evening and they would have taken it away without realising it had to be left for the required time. Another concern was that a new person to the home brought in their temazepam medication and that it was not recorded in the CD register. From the records seen and from talking to the Registered Manager two bottles of this medication were brought in but only one was entered in the controlled drugs register as the qualified nurse did not realise there was two at first. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 14 When the second bottle was found these were put into the secure medication cupboard but were not recorded at that time. When they were later discovered they were entered in to the CD register. The Registered Manager said that the qualified nurse has been spoken to about this. No entries were found in this person’s care records listing the medication they brought in with them. On checking the MAR for this medication it was noticed that the night staff are administering two tablets of this medication and not one as directed on the Medication Administration Record. The Registered Manager said that the previous MAR had stated that one to two tablets could be administered but this had not been transferred on to the current MAR. The home must ensure that staff follow the directions stated on the Medication Administration Records. A further concern we received related to an entry in the returns medication book. It was recorded that medication was returned for two people because they had deceased, when in fact they were alive. The Registered Manager said that this was an error on her behalf and she had copied the information from the line above. The issue relating to the recording of the temazepam in the CD register and the issue with direction on the MAR sheet for this medication took place this year. The other concerns happened in 2006 and 2007. On checking the Medication Administration Records a hand written entry had been made for antibiotics, which was checked by a second member of staff. However the dose was written as 500mgs but the tablets received were 250mg. The staff administering the medication had not written how many tablets they administered for each dose whilst waiting for the 500mg tablets to arrive. This person had completed the prescribed course, however the records did not state what dose was given whilst using the 250mg tablets. The Registered Manager said that several qualified staff have recently undertaken training in medication practices or are due to attend this training. An audit of the medication systems had taken place in December 2007. In places the Registered Manager had written on the back of the MAR when she had found for example a gap in recording to ensure the staff complete them. During a tour of the lounge area a half digested tablet was found in one the armchairs. Staff that administer medication must ensure that the person has taken the medication before signing the MAR. One person who had their care examined in detail is self-medicating their morning medication. A lockable facility is provided for them to store it in and an assessment of their suitability is in place and reviews were seen of this. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 15 People who are receiving ‘as and when’ medication were found to have care plans in place informing staff on how to manage this. However one person had written in their care plan that ‘as and when’ medication is given regularly, if this is the case consideration must be given to the home asking the GP to review this to prescription. At the last inspection concerns were found with the way some members of staff were not maintaining people’s privacy and dignity whilst undertaking personal care. This was not followed up at this inspection as the Registered Manager has been doing ‘spot checks’ and is ensuring that staff are maintaining privacy and dignity. During the inspection it was noticed that staff were speaking to people in a respectful way, however two members of staff were observed hoisting a person in the communal lounge and they had exposed their underwear. The Registered Manager was informed and said that staff know they must cover people with blankets whilst hoisting them in communal areas and later in the inspection staff were observed covering people with blankets when they were being hoisted. Whilst observing staff assisting people to eat their meals, one member of staff touched the food and blew on it before administering it to the person. This is poor practice as it is an infection control risk and there is a dignity issue for the person having to eat food following this. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 16 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service can make choices about their daily life and an activities programme is available however at times there may be constraints on staffing levels and these may not always take place. EVIDENCE: Since the last inspection the home has had a change in activities coordinator. This person works three day a week. On one day of the inspection no planned activities were seen taking place. If care staff are meant to be providing activities when the activities coordinator is not at work this will not be able to take place when the care staff are busy. This is a change from the last inspection where the activities coordinator worked more hours. One person said they do join in the activities provided. Other people were seen spending time in their rooms and one visitor to the home said their relative normally prefers to stay in their room. One person said the hairdresser visits the home. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 17 The feedback received at the last inspection from visitors to the home was about the lack of outings for people. The Registered Manager said that due to the weather they had not yet been arranged but this is going to be looked at when the weather improves. Visiting to the home is not restricted and visitors were seen during the inspection. One person said they used to go out alone into the local community but have decided they do not wish to do this anymore. Part of the anonymous concern we received alleged that the Registered Manager had stopped a person who uses the service from smoking against their will. From discussion with the Registered Manager and from the care records’ relating to this person we found this was not the case. We found a discussion had taken place between the person, their family and the Registered Manager and it was agreed they would stop smoking. The Registered Manager said that the person using the service was not forced to stop smoking and they had requested assistance from the NHS but this person had refused. During a tour of the home a number of rooms belonging to people were seen and their belongings were on view. People spoken with said they are able to have choices about their daily lives. A mealtime was observed and staff as they arrived in the dining room all followed correct infection control procedures by washing their hand and wearing an apron. Staff were observed being very attentive towards the people in the dining room. One person was observed helping themselves from the serving dishes, which contained the vegetables, and they were observed helping other people on their table. The only concern raised about the staff is what has been previously mentioned in health and personal care. All people were seen being offered drinks with their meal. The cook was spoken with and they said they get a printout each week with particular diets on, however they are not keeping records of alternatives provided or sandwich fillings. The cook said they go and speak to one particular person who uses the service, as they do not eat red meat and they chat to them about the alternatives. Health and safety checks in the kitchen were not examined at this inspection as they had recently had an inspection from Environmental Health Department. One person said the food was quite good and a visitor said that their relative is a vegetarian and they are given meat and they also like pasta but do not get it very often. This was fed back to the Registered Manager for her to investigate, as on the records held in the kitchen said this person does not eat lamb or beef. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 18 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 adequate quality outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use the service and their relatives have access to a complaints procedure, however some people do not feel their complaints are acted upon. The home has systems in place to protect people from possible risk of abuse. EVIDENCE: From discussions with the Registered Manager and from records seen the home has not received any complaints since the last inspection. A copy of the homes complaints procedure is displayed in the main entrance to the home however there was no information to say whether this is available in other formats. We (The Commission) received three anonymous letters detailing concerns about some of the medication systems used and two concerns relating to the care of people who use the service. The outcome of the concerns relating to the care of people who use the service was incorrect. The appropriate records and information was available for staff to follow. The other concern relates to an incident form not being completed, which was the case, but there were records in this person care plans. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 19 Best practice guidelines would say that an incident form should have been completed. Some of the concerns about medication issues happened in 2006 and 2007 and they would not be classed as a breech in the Care Home Regulations. A visitor to the home said that they have complained in the past to the Registered Manager and to the Registered Provider but feels nothing has changed and the aspects of care they have complained about have not improved. Records seen and from discussions with the Registered Manager all but one member of ancillary staff has completed training in abuse and managing challenging behaviour in the last couple of years which is provided by the Registered Provider. Policies and procedures are available on the homes computer system. Consideration should be given to staff attending the ‘Alerters guide’ training provided by the local County Council. The home has not had any new staff since the last inspection and therefore POVA and Criminal Records Bureau Disclosures (CRB) reference numbers were not followed up at this inspection. At the last inspection concerns were raised about the number of unexplained marks and bruises found on people who use the service. The Registered Manager felt that this was because the staff were not following correct moving and handling procedures. At this inspection the number of incidents has reduced and it is clearly identified in peoples care records if they are at risk of falls and frequent monitoring of these people is highlighted in their care plans and on the information board in the staff office. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 20 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 parts of the environment are required as these potentially place people at risk. EVIDENCE: A tour of parts of the environment was undertaken with some rooms used by people seen. The issues identified at the last inspection in relation to the environment were followed up. The kitchenette area in the communal lounge/dining room was very dirty on the first day of the inspection and so was the fridge. The seal on the fridge was also damaged. The Registered Manager asked the domestics to make sure it was cleaned thoroughly and it was much improved on the second day. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 21 The ‘star lock’ is still in place on one person’s door but the key has been removed. One bathroom was identified at the last inspection as needing the flooring replaced as it was damaged. Part of the flooring has been replaced, however by the door and in between the bath and sink are also damaged but this has not been replaced. The bath is still stained. The toilet by room 4 was odorous. In one person’s room there is no top cover on the radiator guard and it is easy to get access to the top of the radiator, which felt very hot. This will need to be addressed. Also in this room no hot water was available, however a member of staff said that it was due to an issue with the boiler on that day and they were at the home to repair it. Other rooms that were checked did have hot water. This person’s armchair was stained and needs to be cleaned. The strip lights in the main entrance hall have not had the covers fitted and this remains outstanding since the last inspection. Work was underway on putting in a new fire escape route. Work has not as yet started on the sensory garden that the home has obtained funding for. The door to room three was propped open with a footstool. This is unsafe practice as this person has impairments with their sight and hearing and is unable to mobilise. The staff said this is done at the person’s request. However if a fire were to break out in the home they are putting this person at risk. If a person using the service requests their door kept open then the appropriate doorguard must be fitted in consultation with the local fire service. At the last inspection it was identified that the hot water temperatures in people’s rooms and communal bathrooms and toilets were above the recommended 43°C and in the majority of cases over 60°C. This is still the same at this inspection. As the home has a number of people with dementia that are prone to wandering this needs to be addressed as a matter of urgency. Some of the people using the service would not be able to understand the signage in place and staff are not able to constantly observe everyone in the home. Risk assessments are in place for all people for scalding but if the person is not able to understand the signage or know they have to have a member of staff with them because of a medical condition, the risk assessment is not relevant. Since the last inspection the home have put locks on the cupboards in the laundry where chemicals are stored and when decanting chemicals they are now clearly labelled. No soiled laundry was found on the floor in any rooms, which is good practice and helps prevent cross infection. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 22 No other concerns were found with the cleanliness of the home other than what is mentioned above and deep cleaning of a number of carpets was taking place during the inspection. At the last staff meeting the Registered Manager discussed the new cleaning schedule with the domestic staff to ensure good standards of cleanliness in the home. Staff were seen to be washing their hands and wearing protective aprons when required which is good practice and staff confirmed that specialist hand wash is available in the home. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 23 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 people feel that their needs are not always being met. Some staff still need training to ensure people who use the service at risk at not put at unnecessary risk. EVIDENCE: Since the last inspection the number of people who use the service has risen and the staffing levels have been increased. Ancillary staff are available to provide meals, cleaning, laundry and maintenance. The Registered Manager feels that the staffing levels in the home are meeting the needs of the people who use the service. The home is using agency staff to cover when they have gaps in their duty rotas. Following the last inspection we raised concerns about how certain members of staff undertook personal care. The Registered Provider and Registered Manager have now put in place extra supervision and made changes to the duty rotas to monitor care practice. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 24 The activities coordinator’s hours have changed since the last inspection, which will result in fewer activities for people who use the service. The care staff are meant to provide activities in their absence, however if they are busy this will not happen. One visitor to the home said that on the whole the staff are very good, however they did express one concern where staff from other countries are speaking in their native language whilst caring for their relative. They also said that their relative has had to wait long periods of time for staff to attend to them. During the inspection it was noticed that this person had to wait 1520 minutes after ringing their bell for two members of staff to arrive together. This is causing both the person who uses the service and their relative a lot of distress. This was relayed to the Registered Manager who said she would speak to staff about this. Staff spoken with felt that at certain times of the day they are busy and cannot always get to assist people immediately as they are helping other people. The number of staff with NVQ qualifications has not changed since the last inspection and the Registered Manager said they are looking to train staff to become in-house NVQ assessors and one qualified nurse is doing this at the time of the inspection. The home has not had any new staff since the last inspection; therefore the requirement issued to ensure that a full employment history is obtained could not be followed up. From discussion with the Registered Manager and from records seen relating to training a number of staff have not turned up to training sessions they are booked on. The Registered Manager and Registered Provider are looking at ways to address this. Records were seen where the Registered Manager has booked staff on courses and she is in the process of booking more staff on training. The training programme is provided by the Registered Provider and includes a number of different topics aimed at all disciplines of staff. The Registered Manager said she monitors the training needs of staff during supervision sessions. The training matrix showed that one member of care staff has not had moving and handling training since 19/1/05. This must be addressed as a matter of urgency as this could place people who use the service at risk. No staff were undertaking induction training at this inspection. At the last inspection the home has systems in place to ensure new staff receive a structured induction programme and booklet. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 25 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 monitor that the home is run in the best interests of the people who use the service. EVIDENCE: Since the last inspection the Manager of the home has been registered with us. She is a qualified nurse and undertakes the same training as the other staff in the home. The Registered Manager said that she is due to complete the management section in the NVQ 4 shortly. The Registered Manager was able to demonstrate through quality assurance and staff supervision ways that she is working hard to improve the home for people who use the service. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 26 Quality assurance audits were seen that the Registered Manager had undertaken in January this year and these included care plan, fire, infection control, kitchen, laundry, people’s rooms and the cleanliness of the home. Audits were also seen at the last inspection. No audits were in place for pressure sores and the Registered Manager said that this would be addressed shortly. Reports relating to Regulation 26 visits were seen but there was not a report for each month. The home must remember that copies of these reports must be sent to us. Minutes were seen of staff meetings. The home has staff meetings for each discipline and one meeting where all staff attend. The last general staff meeting was on the 30th January 2008 where staff were shown how to use the new evac chairs. The Registered Manager has done checks at night-time to follow up on the concerns we highlighted at the last inspection. She has still found concerns with infection control and is working with the staff involved to rectify the situation. The home is able to provide a safe and secure storage facility for people who use the service that wish to store their money with them. Several people’s monies were randomly selected and checked and these were all correct. Several people have money sent from the Registered Provider and records were seen of these being signed in. Record and receipts are kept, however it is recommended that money received from relatives is signed in on the records as well as providing them with a receipt for auditing and safety of the staff involved. Records relating to some randomly selected staff supervisions sessions were seen. The Registered Manager undertakes all staff supervision sessions. She has started to do staff appraisals and has a plan in place to finish these. One member of care staff was found not to have had a supervision session since August 2007 and the Registered Manager said she was not aware of the recommended six times per year for care staff. If an issue of competency is found with a member of staff extra supervision sessions are undertaken and records of these were seen. The home has had a recent Environmental Health visit where a number of issues were found with the kitchen. The Registered Manager said that these have now been addressed. The home still has not got a copy of their fire risk assessment or evacuation procedure but evac chairs are in place. A number of staff were asked if they could use these chairs and the agency staff had not been shown and another member of staff said they would need more practice. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 27 Two fire drills have taken place since the last inspection but not all staff have completed one, however the Registered Manager said she has plans in place to provide more drills. At the last inspection records relating to the maintenance of wheelchairs was not in place and no records were seen at this inspection. The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 28 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 2 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 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 X X X X X 1 2 STAFFING Standard No Score 27 2 28 2 29 X 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 2 The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 29 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 OP1 Regulation 6 Timescale for action The homes Statement of Purpose 20/04/08 must reflect the situation in the home. Therefore the home must amend the details where it says they do not have any people who use the service with dementia, as the home has several people with a diagnosis of dementia. Care plans must devised for each 30/04/08 assessed need so that staff have clear instruction to follow in meeting this need. 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. This requirement remains outstanding since the last inspection, timescale of the 16/10/07 not met. 30/04/08 Requirement 2. OP7 15 3. OP9 13(2) The Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 30 4. OP10 12(4a) 5. OP19 23(2b) 6. OP19 13(4a & c) 7. OP19 23(2b) 8. OP25 13(4a & c) 9. OP29 19 The registered person must ensure that all staff respects the dignity and privacy of people who use the service. This relates to care staff not touching or blowing on people’s food prior to administering it to them. 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. This requirement remains outstanding since the last inspection, timescale of the 17/11/07 not met. The door to room 3 must not be propped open with a footstool as this places this person at risk due to their condition. The home in consultation with the local fire service must obtain the appropriate doorguard to ensure the safety of this person. The bathroom identified in this standard must have the flooring in the bathroom repaired to reduce any risks to people who use the service. The hot water temperatures in the home exceed the recommended 43°C and places people at risk especially people who use the service that have dementia. The hot water temperatures must be restricted to prevent people from scalds. 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. This requirement could not be followed up at this inspection, as they have not appointed any new staff. DS0000062586.V358869.R01.S.doc 18/02/08 30/04/08 30/04/08 15/05/08 30/04/08 30/04/08 The Elms Version 5.2 Page 31 10. OP30 18(1ci) The one member of staff that has not received any moving and handling training since 19/1/05 must receive training to ensure they are not placing people who use the service at risk. 30/04/08 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. Refer to Standard OP15 OP18 Good Practice Recommendations 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 Elms DS0000062586.V358869.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection 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.V358869.R01.S.doc Version 5.2 Page 33 - 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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