Inspection on 16/10/06 for The Elms [Stonehouse]

This inspection was carried out on 16th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector 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 [Stonehouse] 08/09/08

The Elms [Stonehouse] 08/10/07

The Elms [Stonehouse] 27/02/06

The Elms [Stonehouse] 30/08/05

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 Elm Road Stonehouse Glos GL10 2NP Lead Inspector Mrs Ruth Wilcox Key Unannounced Inspection 16th October 2006 13:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Elms DS0000064620.V307548.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 DS0000064620.V307548.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms Address Elm Road Stonehouse Glos GL10 2NP 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) 01453 824477 01453 791813 manager.theelms@osjctglos.co.uk The Orders of St John Care Trust To be appointed Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. One named service user under 65 years old to be accommodated. This condition will be removed one the named service user reaches 65 years or no longer resides at the home. 27th February 2006 Date of last inspection Brief Description of the Service: The Elms is a purpose built care home, which provides personal and nursing care for 45 older people over the age of 65 years. The home also has two beds that are designated for respite care within that number. The home is situated in close proximity to the amenities of the local town, and is managed by The Orders of St John Care Trust. A Registered Nurse is on duty twenty-four hours each day, and there are waking night staff. For those residents receiving personal care only, nursing support is provided from community resources. The full range of health care services is available to all residents in the home, and people can register with the local GP of their choice. The accommodation is provided in single rooms, and is situated on two floors, which are accessible using a shaft lift or stairs. Two rooms have an en-suite facility, though all other rooms have a washbasin in situ, with a toilet in close proximity. Communal bathrooms are spacious and provide assisted bathing facilities. Communal space comprises of three lounges, a designated smoking lounge, and a large dining area. There is a small garden and enclosed courtyard at the home, which residents can use if they wish. Some information about the home is available in the Service User Guide, which is issued to prospective residents, and a copy of the most recent CSCI report is available in the home for anyone to read. The charges for The Elms range from £483 to £667 per week. Hairdressing, Chiropody, Newspapers, Toiletries are charged at individual extra costs. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. 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. One inspector carried out this inspection over two days in October 2006. A check was made against the requirements that were issued following the last inspection, in order to establish whether the home had ensured compliance in the relevant areas. Care records were inspected, with the care of four residents being closely looked at in particular. The management of residents’ medications was inspected. A number of residents and relatives were spoken to directly in order to gauge their views and experiences of the services and care provided at The Elms. Some of the staff were interviewed. Survey forms were also issued to a number of residents, visitors and staff to complete and return to the Commission for Social Care Inspection (CSCI) if they wished. 100 of residents’, 90 of relatives’ and 50 of staff surveys were returned. Some of their comments feature in this report. The quality and choice of meals was inspected, and the opportunities for residents to exercise choice and to maintain social contacts were considered. The systems for addressing complaints, monitoring the quality of the service and the policies for protecting the rights of vulnerable residents were inspected. The arrangements for the recruitment, training and provision of staff were inspected, as was the overall management of the home. A tour of the premises took place, with particular attention to health and safety issues, the maintenance and the cleanliness of the premises. What the service does well: The Elms provides a generally safe and, in the main, well maintained environment for those living here; there are some isolated areas that could be improved in terms of maintenance and these are being fully addressed as part of the ongoing programme. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 6 Each resident is admitted to the home on the basis of a full needs assessment, the results of which go on to form the plan of care for each individual. Care plans are generally well written, although certain isolated aspects of them could be improved by the addition of more detail. Care was observed to have been delivered in accordance with care plans, and staff were informed about individuals’ needs. Each resident is afforded good access to health care services, with appropriate medical interventions when required, to assist in meeting their health needs. Residents are supported to manage their own medications if they choose and are able, and with one exception where an improvement was required, medications are well managed. Residents spoke very positively about the staff generally, and about the way in which they were looked after. The majority of visitors surveyed or spoken to directly were also satisfied with the way in which their relative was cared for here. The home has an inclusive atmosphere for visitors, with relatives indicating that they feel welcome here, and that they are consulted and kept informed appropriately. The home offers a range of social opportunities, and residents confirmed that the staff are mindful of personal choices and preferences. Residents over all were satisfied with the quality of the food provided for them, although it was said that this could be variable. Residents and their families can be assured that the home has a robust approach to addressing any complaints or concerns, and that the standard of care, services and facilities is regularly reviewed as part of good quality monitoring systems. The home has policies and procedures for the protection of vulnerable residents, and staff have attended adult protection training. The home offers a safe and transparent system for safeguarding personal monies or valuables for those residents wanting such a service. Staff have access to training opportunities, and are making very good progress with the National Vocational Qualification (NVQ) training programme. New staff are inducted to the home, working under supervision during their induction period. What has improved since the last inspection? The most notable improvement for The Elms since the last inspection is that a permanent manager has been appointed. An application to register him with CSCI is currently being considered. The manager is experienced, and is endeavouring to prioritise and address many issues requiring attention in the home, particularly in relation to staff. The addition of an extra qualified nurse in the mornings has made a difference to the shift leaders in terms of addressing health needs of residents in a more The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 7 thorough and timely way; a second nurse does not yet work at weekends however. A new assisted bath and shower has been installed, and new low surface temperature radiators have been fitted throughout. A new dishwasher and a new central heating boiler have also been installed. What they could do better: The newly produced Service User Guide (information brochure) does not contain all that is actually necessary, and this now requires some information additions. The home is generally very clean, however transient unpleasant odours were detectable on occasions. The home has failed to comply with a requirement to replace a damaged window in a resident’s bedroom within the agreed timescale, however is intent on dealing with this soon, and a revised timescale has been given. Staffing numbers appear to be just adequate, however there are slight concerns expressed from some residents, relatives and staff that there could be more. Staff are busy and would seem to be short of time to spend with residents on occasions; there are a number of residents with a high level of dependency. The manager and senior staff are trying to implement alterations to work practices to address this; judging from staff surveys, some of the staff appear to have concerns about any changes being made in an attempt to effect improvements, and this is posing some difficulty. As reported above, everyone generally speaks well of staff, however one resident did say that some of them could be bossy towards the residents at times. Although the home has a robust recruitment procedure, there have been isolated failures to adhere to this consistently in recent months. There has been a high usage of agency staff here, and one of the manager’s areas for focus is on staff recruitment. Changes to the provision of cleaning staff on certain weekends, and to the catering team are anticipated to improve issues in these two areas in terms of continuity and consistency for the residents. Although health and safety issues are taken seriously in the home in the main, harmful substances, such as chemical cleansing agents were not stored securely in one particular area. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 9 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 DS0000064620.V307548.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1 & 3. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A thorough assessment process plus the provision of literature about the home, although now requiring some revision, enables prospective residents to make an informed decision regarding their admission and gives them assurance that their needs will be met. EVIDENCE: Each prospective resident is provided with information about the home, which has recently been updated by The Orders of St John Care Trust. Copies do not contain all the information that is required, with the following items not included: • Copy of the Terms and Conditions of the home • Copy of a standard contract • A summary of the Complaints Procedure • The contact details for the CSCI. Four written survey responses said that they did not have access to a copy of the CSCI report, when in fact this is displayed in the hall for anyone to read. A The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 11 copy of the report is not routinely included in the information brochure as it should be, and in view of this there should at least be a brochure insert, which informs the reader of how to access the most recent CSCI report. Pre-admission assessments are carried out on all prospective residents. Assessments are recorded, and go on to inform care planning for the resident when admitted to the home. Two of the most recently admitted residents’ assessments were seen, and these had been conducted in hospital before their admission to the home was agreed. Where applicable, copies of Local Authority assessments and care plans were obtained if the authority was involved in the placement. Copies of Registered Nurse Care Contributions assessments were also on file where relevant. The Elms does not provide intermediate care. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There is a satisfactory care planning system in place, which in the main adequately provides staff with the information they need to meet residents’ health and personal needs. The systems for managing medications are generally good, with one exception seen to the appropriate safeguards in place for residents. In most cases, care and support is offered in such a way as to promote the privacy and dignity of the residents. EVIDENCE: Each resident has their own personal plan of care, which is based on their assessed needs. Four care plans were selected as part of a case tracking exercise. A personal profile was recorded for each resident. Each had been regularly reviewed and updated as necessary. Generally plans were personalised, and were reflective of individuals’ choices, dignity and levels of independence, and in the main provided clear guidance for staff to follow. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 13 Manual handling risk assessments are contained within the care plans, and although the ‘history of falls’ section had not been completed, there was evidence that at least one of the four residents was at risk of falling; there was a falls risk assessment and associated care plan however. In one case there was a care plan for the management of a catheter; whilst case tracking this, it was clear that this was no longer the case, with a continence assessment leading to complete removal of the catheter, and the introduction of continence pads. On further scrutiny a review did confirm that this had in fact happened, however removal of this invalid care plan would have avoided any risk of confusion. In another case, the resident had evidently returned from a hospital stay with a superficial skin injury, which had steristrip closures, and some skin discoloration; there was no record of this in the person’s care records. In a third case a risk assessment had assessed the need for the use of a protector pad on the bed rail; during case tracking this had not been observed by staff when putting the resident in the bed. Care plans contained records of appropriate and timely access to a wide range of health care services. Records showed that medical interventions are sourced appropriately, with residents having access to all community health resources and support equipment to meet their needs. Residents are supported to manage their own medications if they wish and are able to, and this is done on the basis of a recorded risk assessment; there is no-one currently electing or able to do this. Medications were stored safely and securely. The majority of medications are dispensed in a Monitored Dosage System, although some are boxed and bottled; such items are dated on opening so that they are not used beyond their expiry date. Items requiring cold storage were held securely in a designated refrigerator, and temperatures in here were regularly checked and recorded. Scheduled drugs are stored securely, and the associated register properly recorded. An audit trail was conducted on two specific medications, and the results were accurate. The supplying pharmacist prints the medication administration charts; there were some examples of where the pharmacist’s hole punch had obliterated part of the printed instruction on the chart. The deputy manager resolved to address this with the pharmacy. Staff record the receipts of items on the charts, and a separate book of returned items is kept. The person responsible signs their hand written entries on medication administration charts, with a second signatory as witness. The route for administration of medicines in the case of a person who was nil by mouth was not correct on their chart; it identified an ‘oral route’, when in practice the medications were administered through the gastrostomy tube. Variable dosages were more accurately recorded on this occasion, with only one omission in this regard seen. The use of an external medicinal cream was clearly linked to a plan of care, ensuring instruction for its accurate usage. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 14 Residents themselves spoke very positively about how their care needs were met. Some said that ‘staff couldn’t do enough for them’, and that they were ‘most helpful’. However, one exception to this said that whilst most staff were very good, others had a ‘bossy’ attitude. Resident survey responses indicated that they receive good care and support, with one writing that ‘you couldn’t find better’. Some wrote that ‘the staff were very busy, and that they were short of time to help on occasions’. Visitor surveys were also positive about the standard of care, with some saying the home provided ‘good’ and ‘excellent’ care. Others expressed concerns about the levels of staffing in the home to meet needs, with just one expressing dissatisfaction with certain issues in the home. Many of the staff were observed interacting with residents in an informal, friendly but respectful manner, and appeared sensitive and aware of individuals’ needs. There was an isolated incident when certain staff seemed less mindful of the residents, whilst they were awaiting service of lunch however. Residents spoken to generally felt that staff observed their privacy, with one saying that they always knocked on her door before entering, and that her desire for independence was respected. One particular visitor said that ‘residents were treated with care and respect here’. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are able to keep close contact with their families and friends, and have the opportunity to make choices in their every day lives, and participate in a varied social activities programme. Their dietary needs are well catered for. EVIDENCE: There is a designated social activities coordinator, and there are good opportunities here for residents to participate in an optional and varied social activities programme. Information displayed showed different types of activity to meet a range of tastes and abilities, and also included trips out. Minutes of a residents’ meeting demonstrated that staff have consulted with them about their ideas for social activities, and comprehensive records were maintained regarding residents’ interests and ideas. The coordinator plans to increase the opportunity for more one to one based activity for those who are unable or do not wish to participate in group events. One resident said that her choice to participate or not, dependent on her taste, was respected; this person was also able to carry out her own ironing, as was her wish. Two people said that although they liked to join in with activities, they also enjoyed having the opportunity to pursue their own interests as well. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 16 Visitors are free to visit at any time of theirs or their relative’s choosing. Written survey responses from relatives confirmed that they feel welcome here, and that they are consulted about things appropriately. Visitors were observed coming and in and out of the home at various times, and relationships between staff and visitors appeared relaxed, welcoming and friendly. One relative spoken to directly, said that she stays all day long with her relative, and that the staff make her welcome, and that in her opinion all services at the home were excellent. Those residents who were able, were seen moving around the home, spending time where, how and with whom they chose. Some were spending time quietly, some reading, watching television or doing crosswords, and some were sitting in small groups, socialising independently. There was at least one resident who had elected to manage their own affairs independently; there are others who have the necessary arrangements in place to assist them with their affairs, as they require more support in this regard. One resident confirmed that she could ‘do what she liked, that there were no restrictions on her, and that she liked to do as much for herself as possible’. Another person said that ‘no-one interferes with me, and I can do what I like’. However, there was one resident who felt that some of the staff were bossy, and tried to tell them what to do. There were clearly personal influences in individual bedrooms, with individual preferences and choices evidently respected. Residents are also offered a good degree of choice over their meals. The service of breakfast, lunch and supper was seen during the two days of this visit. There was a choice of food at each meal, and if none of the choices were wanted, other alternatives were offered. Meals are generally served appropriately, although there was an agency cook on duty on the second day, and her unfamiliarity with the home had unfortunately led to a staggered and chaotic service for the residents. There has been a lack of continuity in the kitchen, but a new cook is now receiving extra support to achieve more consistent standards for the residents. Residents were generally very positive regarding the quality and choice of food, although one did say that the quality could be ‘a bit variable’. Special diets were observed, and staff were giving assistance where needed. Eating aids were provided as appropriate. The kitchen was organised and clean, although splash back tiles and grouting could be cleaned more thoroughly. Good catering records were maintained. Storage of food was appropriate. The Elms DS0000064620.V307548.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a good system for dealing with complaints, and, with minor exception, there is evidence that residents feel that any concerns they may have are listened to and acted upon. The home’s Adult Protection policies help to provide a safe environment for the residents. EVIDENCE: The written Complaints Procedure is displayed in the reception area. Resident and visitor written survey responses confirmed their awareness of how to make a complaint and of whom to speak to if they had any concerns; one visitor was less sure about the process. When spoken to, many said that they had had no cause to make any complaints, but that they had complete confidence in the staff to help them with any concerns they might have; isolated survey responses expressed a degree of reservation about this, indicating less confidence in the staff. The home has a system for keeping records in relation to any complaints received, with appropriate auditing arrangements in place; records pertaining to recent complaints were thorough and comprehensive, and demonstrated appropriate actions carried out by the home on the basis of concerns received, in the interests of ensuring protection for the residents. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 18 The home has written policies and procedures for the protection of vulnerable residents, and staff have received training in adult protection issues, including recognition of abuse and whistle blowing procedures. All staff surveyed confirmed their awareness of adult protection issues. In addition to this training, a dementia care training programme is being introduced, which also features recognition of what might constitute abusive practices and how to avoid or address them. Arrangements such as advocacy and powers of attorney are in place for more vulnerable residents where appropriate. One resident said that she felt ‘very safe’ at The Elms, and that she was ‘very comfortable’. The Elms DS0000064620.V307548.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The standard of the environment within this home is satisfactory, and provides residents with a comfortable and safe place to live. The home is generally clean, with appropriate and full observations regarding the control of infection. EVIDENCE: In general the home environment is well maintained and decorated, with attention to safety; records are kept of all maintenance carried out. The gardens are planted and adequately looked after. There is regular attention to cyclical and small maintenance issues, and the maintenance person was in the home carrying out his duties during this visit. External contractors address larger maintenance issues appropriately. There are some walls, particularly on the ground floor, which have patches of filler evident, and which appear unsightly as they await redecoration. The The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 20 corridor carpet on the ground floor is beginning to show signs of wear and tear. There have been a number of improvements since the last inspection, which include the provision of a new assisted bath and shower, new low surface temperature radiators, a new dishwasher and new central heating boiler. Although some windows have been replaced, there is one still outstanding at this time, which has damaged seals causing extreme condensation build up between the double glazed units; this has not been resolved within the agreed timescale, however there is a clear intention to address this. All areas of the home were clean, though there were some transient odours detected at various times throughout the visit. The laundry room was clean and organised, and laundry was being handled in accordance with good infection control practices. Some residents commented on the good laundry service provided. Gloves, aprons, liquid soap, sanitising hand gels and paper towels are provided for staff. Clinical waste is handled appropriately, with a contract in place to ensure it is collected and disposed of safely. The metal cupboards used to store some chemicals are rusted through prolonged usage. The Elms DS0000064620.V307548.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite some problems, staffing provision is just adequate to meet the needs of the residents currently living in the home. Robust recruitment procedures ensure that suitable staff are employed for the protection of residents, but failure to adhere to it consistently could pose some risk to residents. The arrangements for staff induction and training are satisfactory, with them being able to learn the skills necessary for their role. EVIDENCE: A staff rota is maintained, which allows for one registered nurse to be on duty at all times, with nine care staff in the morning, six in the afternoon and evening, and three overnight. On most mornings, there are two nurses on duty, and nurses spoken to said that this had made a big and positive difference to their work. The staff team is divided into four groups and areas for working, with one carer designated to assist those residents using the dining room in the morning, in an effort to ensure that there is an even distribution of staff at the busiest times. Some resident, visitor and staff surveys expressed concern about the levels of staffing in the home, saying that there was not enough. Many staff feel they are rushed in their very busy work; the home does have quite high dependency levels amongst the residents, with a number ill and nursed in bed. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 22 Some of the senior staff felt that any problems in the home in this regard were also associated with previously established work practices, which were considered no longer in the best interests of the home. Residents spoken to said that the staff were very kind and caring generally, but there were some comments about being kept waiting at times when the staff had other priorities. A visitor said that the staff were ‘excellent’. The manager has been helping to devise a new dependency tool as part of a ‘work party’ with other managers in the group, with the aim of devising a mechanism for identifying the necessary staff numbers to meet residents’ needs effectively. There has been a high use of agency staff, and one of the manager’s areas for focus is the recruitment and retention of staff. The manager works in a supernumerary capacity, and the deputy manager now has the advantage of having one day each fortnight on which she too can work supernumerary. An ancillary team of catering, cleaning, laundry, maintenance and administration staff supports the care and nursing team. Cleaning support had been lacking on some weekends, though recent changes should address this shortfall, with cleaning support more consistently available. Recent changes within the catering team have led to some lack of continuity, which the manager is endeavouring to address. The home is making very good progress with the National Vocational Qualification (NVQ) training programme for care staff. The home had not quite reached the target of 50 of care staff being qualified to NVQ level 2 standard, but there are currently eleven care staff who are qualified to at least this level, with eleven other carers currently undertaking their award. A selection of staff files was chosen for inspection, on the basis of their recruitment to the home since the last inspection. Each record contained application forms, including a full employment history. Criminal conviction declarations had not been sought in three of the four cases. Records of interviews were seen, with just one exception where it was not on the file. A statement of medical fitness had not been sought in one case. There was proof of identity with a recent photograph on file for one of them. Two written references, evidence of Criminal Records Bureau and Protection of Vulnerable Adults disclosures were in each file, with proof of qualifications declared obtained where applicable. A training programme shows a range of training opportunities, which are either mandatory or optional, based on the developmental needs of the staff. The home’s training coordinator has maintained meticulous records for each member of staff, and these show mandatory training such as First Aid, Fire The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 23 Safety, Infection Control, Dementia Care, Health and Safety, Manual Handling and Food Hygiene. New workers have a structured induction, which to date has included two days specific training away from the home, with an in-house induction programme specific to The Elms. This is about to change, with new staff having one day’s training at The Orders of St John Care Trust county office with the trust’s training manager, and a new electronic training package to be carried out over the first six weeks of employment in the home. This electronic package is innovative and very engaging, and ensures training in six modules, including Principles of Care, Roles and Organisation, Health and Safety, Communication, Abuse and Neglect, and Developing as a Worker. Each module has a list of topics under each to be covered. Candidates will be tested on their knowledge of each section, and their progress will be assessed by two verifiers in the home, and overseen by the training manager also. New workers work under supervision during their induction, and although not specifically recorded, supervisors are always one of the senior care leaders, the identity of whom can be ascertained from the rota. With some exceptions, written staff survey responses were positive about the training opportunities that were available to them. Staff spoken to during the visit confirmed good training opportunities. Staff are issued with the General Social Care Council Code of Conduct, and are issued with certificated evidence of their training and achievements. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite some previous lack of continuity in the management of this home, there are generally some good management systems in place to ensure that the interests, health and safety of the residents are safeguarded. EVIDENCE: The Elms has undergone a number of management changes in recent years, and this lack of continuity has had an unsettling effect on the home to a degree. There is now a new full time manager in post, who is a first level nurse, and who has had previous experience in similar registered settings. His application to register with the CSCI has been submitted to the Central Registration Team after a long and protracted period. He has commenced the Registered Manager’s Award with a local college. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 25 Residents spoke very well of the new manager, and where as some staff did too, some written staff surveys seemed to indicate a lack of support and some resistance to the changes being implemented by him. A range of quality monitoring is carried out in the home. This has included internal audits in areas such as accidents, social activities and complaints. Residents’ and relatives’ opinions have been sought as part of this process, and recently an annual quality assurance survey was distributed to them, so that they could provide feedback on their experience of the accommodation, facilities, catering, care, social activities and visiting arrangements. The manager had drawn up a report of the collated results, in order that strengths and weaknesses could be identified; this has been published to each resident. Comments and suggestions forms are available in the entrance hall, enabling anyone to offer their views of the service at any time if they wish. Meal monitoring forms have been regularly issued to residents, chosen on a random basis, so that they can give feedback on their experiences of the food and drink provided for them in the home. A residents’ meeting was held some months ago, and from recorded minutes it was clear that this too provided a forum for residents to have their say in how their home is run. The new manager demonstrated his awareness of the home’s priority areas for improvement, and his intention to drive such improvements here. Some residents have placed personal money and valuables with the home for safekeeping. Clear and transparent records for each person, which included transaction details, running totals, and receipts, were kept. Residents or their representative can sign to acknowledge transactions, but where this has not been possible in the majority of cases, two staff members have signed the record to witness on behalf of the resident. An audit trail on one such arrangement confirmed its accuracy. There was evidence that health and safety issues were addressed satisfactorily, with written policies, procedures and risk assessments and provision of necessary equipment. All necessary safety checks and maintenance of equipment was undertaken in a timely fashion, and servicing and safety certificates were seen. Hot water temperatures were monitored for safety, and Legionella risks were assessed; there was a water tank disinfection certificate on record. Staff have received training in fire safety, manual handling and first aid. A full fire safety risk assessment throughout the whole building has been undertaken by an external assessor, with due regard to revised fire safety regulations; there are issues to be addressed on the basis of this assessment. Chemicals are generally safely stored in designated COSHH (Control of Substances Hazardous to Health) store cupboards. However the sluice rooms were not secured and a key was left in the door of the chemical store cabinet The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 26 in the first floor sluice room; this had left the contents accessible on this occasion. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 27 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 3 9 2 10 3 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 3 1 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X X 2 The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 28 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 5(1) Requirement Timescale for action 31/12/06 2 OP7 17(1a) Schedule 3(k) 13(2) 3 OP9 The Registered Person must ensure that the following is included in the home’s information brochure: • A copy of a standard contract • The terms and conditions of the home, as detailed in this regulation’s amendments • A summary of the complaints procedure • The address and telephone number of the CSCI • A copy of the most recent CSCI report, or alternatively an insert that informs the reader of how to access a copy in the home. The Registered Person must 30/11/06 ensure that in relation to all residents: • A record of condition and of treatment is maintained. The Registered Person must 30/11/06 ensure that routes for administration of all medications are recorded clearly on medication administration DS0000064620.V307548.R01.S.doc Version 5.2 The Elms Page 29 4 OP19 23(2b) 5 OP29 19 (1b) Schedule 2 (1) (2) (8) 6 OP38 13(4a) charts. The Registered Person must ensure that the damaged double glazed unit seal in the identified bedroom is repaired. This requirement has been repeated from the last inspection. The Registered person must ensure that in relation to new workers the following is obtained: • A criminal convictions declaration by the worker • Proof of medical fitness. The Registered Person must ensure that chemicals or other harmful agents are securely stored. 31/12/06 30/11/06 30/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 4 Refer to Standard OP7 OP26 OP28 OP30 Good Practice Recommendations Staff should complete the ‘history of falls’ section on manual handling risk assessments. The home should consider replacing the damaged metal storage cabinets in the sluice rooms. At least 50 of the care staff (excluding registered nurses) should be trained to NVQ, level 2 in care, or equivalent. The name of all new staff’s supervisors should be recorded on personal files or on rotas. The Elms DS0000064620.V307548.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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