Inspection on 08/10/07 for The Elms [Stonehouse]

This inspection was carried out on 8th October 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Elms [Stonehouse] 08/09/08

The Elms [Stonehouse] 16/10/06

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 08:45 8 & 9th October 2007 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 DS0000064620.V347837.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.V347837.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 Paul David Breen Care Home 45 Category(ies) of Old age, not falling within any other category registration, with number (45) of places The Elms DS0000064620.V347837.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. 13th February 2007 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. 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. 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 attached to the home’s Statement of Purpose, which is available in the home for anyone to read. The charges for The Elms range from £348.66 basic local authority rate, to £714.00 per week. Hairdressing, Chiropody, Newspapers, Toiletries are charged at individual extra costs. The Elms DS0000064620.V347837.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 unannounced inspection over two days in October 2007. 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 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 large number of residents and visitors to complete and return to CSCI if they wished; a number of responses were received, and some of their comments feature in this report. Only a very small number of the home’s staff responded to the survey forms that were issued to them. 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, provision and supervision 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. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 6 What the service does well: The Elms provides a safely maintained and clean environment for the residents to live in. It is managed by a committed and suitably qualified manager. The home has a relaxed and welcoming atmosphere for visitors, and residents’ families and friends are encouraged to join in the life of the home if they wish. Residents are admitted to the home on the basis of an assessment of their individual needs, although some assessment examples seen could have been recorded in better detail. Residents and their relatives were generally very satisfied with the way in which they are looked after here, although there were very isolated concerns raised regarding timeliness of certain aspects of care on occasions. The home works closely with all health care services in order to ensure that residents have their health needs well cared for. People also spoke very positively about the staff group here, with a small number commenting that, although most were very good, there were just a couple who were not so good. There were numerous examples witnessed of a number of the staff being kind, caring and sensitive towards residents. There is a good programme of social activities at The Elms, with consideration given towards residents’ choices and ideas. Independence is respected here, and there is a general philosophy regarding the pursuit of personal choice. Despite one very minor concern regarding one of the food options during this visit, residents’ satisfaction levels regarding the quality, quantity and choices of food were high. The home uses some good monitoring systems in order to assess and improve its services, and this includes seeking the views of the residents. People can be assured that the home takes any complaint seriously, and has a thorough approach to addressing any that are received; confidence in the manager among residents was high. There are policies and procedures in place for the protection of the vulnerable residents, which staff are familiar with, and the home offers a safe and transparent system for safeguarding personal monies or valuables for those residents wanting such a service. The home had responded well in relation to some concerns regarding certain vulnerabilities, and had ensured that the necessary safeguards had been implemented in each case. Staff are recruited in accordance with good recruitment procedures, with the necessary pre-employment checks taking place; however this could be further improved with the content of interviews carried out with prospective staff recorded in writing. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 7 The competence and skill of the staff group is developed through a structured induction-training programme, and through ongoing training in topics relevant to the needs of the residents. There is also a good focus on the National Vocation Training programme for care staff, with very good progress being made in this area. What has improved since the last inspection? What they could do better: The standard of care plan documentation requires some improvement, in order that all aspects are fully reflective of individuals’ needs, and are regularly reviewed so as to remain current and relevant. The Elms is a busy home, with many residents having high dependency needs; this would appear to have made staff very busy, creating an impact on the time available to some of the residents. There have been occasions when residents have not been attended to as promptly as they or the staff would ideally like, and this will remain an area for the home to consider and address. The systems for managing residents’ medications are satisfactory in many respects, however there were certain aspects of recording that require improvement, and more robust auditing arrangements are now needed. As reported above, staff were mainly very kind, caring and respectful towards residents, however two occasions were witnessed, involving two different carers, when the attitude of the carer was viewed as disrespectful and a compromise to the dignity of the resident. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 8 To date the home is failing to fully comply with the recently implemented Smoking Regulations such as they apply to care homes, and must take the necessary steps to ensure the proper measures are in place for their compliance and the necessary safeguards for the residents. The general standard of the laundry service is good, however there is a high incidence of missing or incorrectly returned items for residents. The manager has done well to bring about certain positive changes at The Elms, and is well regarded by the residents, however there must now be a much improved focus on the delivery of a formal staff supervision programme, as part of monitoring performance and standards in the home. Fire safety training for existing staff has not been regular throughout this year, however there are some very good plans in place to address and improve this for the future. 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 DS0000064620.V347837.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.V347837.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. 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. People living in this home have access to a good amount of information about it, and despite some minor exceptions, can be assured that the home will be able to meet their needs on the basis of a pre-admission assessment. EVIDENCE: The home has recently introduced a new and revised Statement of Purpose and Service User Guide, known as the Residents’ Handbook. The former is readily available in the entrance hall for anyone wanting to read it, and a copy of the latter, which contains all the information that is required, is issued to each prospective resident. The Statement of Purpose will now require a slight amendment to demonstrate the fact that the home is providing care and accommodation to a resident who is under 65 years of age. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 11 Care records belonging to two more recently admitted residents contained assessment forms that identified their care needs prior to admission to the home. One of the assessments in particular was only sparsely recorded, although associated documentation did indicate a satisfactory understanding of the needs of the individual, which had been relayed to staff. Assessments had been carried out at locations convenient to the prospective resident, and were supported by information provided by other health and social care professionals previously involved in the care of the individual. In the case of one particular resident, some mental health issues had arisen following admission that had not been identified by other health care professionals, and which had not manifested during the assessment process. All of the appropriate responses and actions were being taken to address these particular needs by the home. Prospective residents receive written confirmation of their placement in the home, as is required. The Elms does not provide intermediate care. The Elms DS0000064620.V347837.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. 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. People living in this home have their health and care needs met, although omissions in documented care planning and medication records could pose a small degree of risk in this regard. Dignity and privacy is largely observed, but attitudes of isolated carers could compromise this for some. EVIDENCE: Each resident has their own plan of care that has essentially been developed on the basis of an assessment of their health and care needs. Most aspects are regularly reviewed, but some gaps and omissions in this regard were identified. Four were selected as part of a case tracking exercise for closer scrutiny, as were three others during the inspection of their medication arrangements. Some included a personal profile for the person, which recorded their past life experiences and interests, which is helpful in appreciating the person as an The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 13 individual and understanding them better, but not all. Some indicated their chosen religion, but again not all. One had been recorded as observing two different religions, which was clearly an error. A general assessment of needs was recorded in each case, as was a risk assessment in relation to pressure sore vulnerability and manual handling. Appropriate support equipment was provided in each case to support the identified needs of the individual. In one case the resident was evidently at risk nutritionally, as she was losing weight, had very little appetite and was observed to receive little encouragement to eat her lunchtime meal, which had gone cold. There was no nutritional risk assessment in place, and neither was there an associated plan of care to address this particular area; this was addressed before the end of the inspection further to advice. In the same case, although there was a history of falls, there was no falls risk assessment in place, although care planning in relation to mobility did incorporate the risk the person was at to a degree. Despite this person suffering another fall in recent weeks, and sustaining a serious injury warranting hospital intervention, this care plan had not been reviewed and updated for three months, and was not reflective of the current circumstances. In a second case the resident had very specific needs regarding her posture and inability to support herself safely; there was no clear plan of care to address this, although when seen the resident was safely resting in bed, with appropriate safeguards in place to protect her whilst lying down. Despite a body chart indicating this person had a pressure sore on their sacrum, appropriate care was in place to reduce the risk of this occurring, and other care notes indicated that this was not the case; old charts such as this should be removed or reviewed so as to ensure the current information. In consideration of the high dependency and vulnerability of this resident, it was reported that their care charts are shared and discussed with family each week. In another case the original assessment had been reviewed so many times, with amendments made, that it was becoming difficult to read clearly. Two particular needs identified on assessment had no associated plan of care to address them, although in practice the necessary care was being delivered. This person had specific dietary requirements for his health, and an associated care plan referred to a nutritional risk. This was disputed as being the case now, but evidently care plan reviews had not picked this up. The use of bed rails had received consent, and indicated a risk of falling out of bed; there was no specific risk assessment for this, and neither was there a plan of care that related to the person’s entirely dependent mobility needs. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 14 Regular wound management was taking place, and there were some clear records regarding this, with previous input from the Tissue Viability Nurse. Despite these shortfalls and omissions in recording the case tracking exercise did show that appropriate care was being delivered in the main. Residents had been reviewed medically whenever necessary, and had access to all community health care services to support their health needs. Residents themselves spoke very positively about their care and the way they were looked after by staff. Many spoke of good, caring staff, and comments were received such as ‘we have very good nurses’, ‘I get all I need day and night’. There were isolated comments such as ‘some staff are better than others’, and ‘staff can get very busy and get called away’. Relatives and visitors were also very complimentary in the main, and were largely happy with the care their relative was receiving. Comments were received such as ‘there is great care and compassion here’, ‘staff carry out duties with care and attention’, ‘excellent nursing’ and ‘it is reassuring to know my relative is so well cared for and is happy and contented’. One visitor said that his father’s health had ‘improved a lot since coming into the home’. Other less positive comments included, ‘my relative sometimes has to wait to be assisted to the toilet’ and ‘agency staff can be less aware of individuals’. This was also mentioned by an external social care professional, who had witnessed a resident becoming distressed at having to wait to use the toilet. One particular resident was assisted to the toilet very promptly when needed, whilst waiting for lunch. The manager said that staff do endeavour to assist in this regard, but accepted that there may be occasions, given the demands of a large number of residents on the staff numbers, when a resident may be kept waiting, which would not really be acceptable to the home. Residents are able to manage their own medications if they wish and are able, and this is done on the basis of a risk assessment protocol; there is no-one currently managing or wishing to do this. Nurses were witnessed carrying out the medication round at lunchtime, and were doing so in a safe and attentive manner. The nurse paid particular attention to the needs of frail people who may have required some pain relief. Medication administration charts were randomly selected for inspection. With oral preparations there was a good clear record of administrations. However, the use of external preparations is unclear in many cases, with no clear instructions for their usage recorded. The care plans contained no instruction for their usage either. Also there were no signatures on medication The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 15 administration charts to confirm that these preparations had been administered in accordance with the doctor’s instructions. A pot of medicinal cream was seen in one bedroom that was unlabelled and out of date, having been opened nearly one year ago; this did not appear to have been prescribed and was not an item that featured on the Home Remedy policy; staff were asked to dispose of this immediately. Most handwritten entries had been signed by the author, but some of the handwriting was not very clear, and would have benefited from being transcribed in capital letters. Variable dosages were identified. Medications were safely stored, with liquids and most external preparations dated on opening to ensure they were not used beyond their expiry date. Tablets were mostly dispensed in a monitored dosage system, and random audits were conducted on two boxed items. There were slight discrepancies in each box; one had mistakenly been used to medicate two people prescribed the same drug, whilst the other contained an extra three tablets above what there should have been considering the number of tablets signed out since the box had been opened. Storage and recording in relation to scheduled drugs was clear and safe. The home is about to take part in trials for a new and innovative medication system in conjunction with the supplying pharmacist; training and support was being provided for the staff. Some good examples were seen of staff being particularly sensitive, discreet and attentive towards residents, particularly those who were frail and vulnerable, of which there are many in this home. Residents themselves indicated that staff were generally very respectful towards them, although again ‘some were better than others’. One resident said that staff were respectful and mindful of her wish to pursue her life and time exactly as she wished, ensuring that her privacy and her level of independence was also respected. A relative said that staff ‘respected all and treated them with kindness’. However, two examples were seen whereby two carers adopted a less than respectful attitude, which impacted adversely on the dignity of the individual whilst in the dining room. Each of these cases was discussed at length with the manager. One relative also expressed concern about the attitude of some of the carers. The Elms DS0000064620.V347837.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home have opportunities to remain as socially active as they are able and choose, and also have a nutritious diet that offers choice and variety. EVIDENCE: A varied social activity programme is planned for the residents, in which they can participate or not, according to their choices and preferences. They are consulted about their ideas, and records are maintained regarding their suggestions and interests, with the programme devised to accommodate these as much as possible. Programmes demonstrated a comprehensive range of internal and external activities, with regular outings organised. Personal interests are accommodated whenever possible, and several residents whose past interest included gardening have been able to take part in some planting for the home; many spoke very positively about this, saying they had enjoyed it enormously. The manager plans to have a greenhouse at the home in the near future, so that people’s love of gardening can be pursued further. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 17 Photographic evidence of activities and events is always on display in the home. Residents themselves were all very satisfied with the social opportunities in the home, as were most of their relatives. Many of these indicated that there were lots of activities and trips, and that there was a good social life with lots of choices. However, in contrast to this one relative felt there should be more therapeutic activity, to include music and art, whilst another felt that their relative needed more mental stimulation. The manager intends to try to improve the links within the local community. Interdenominational religious services are held in the home for those who want them, although ministers from different religions are contacted if particularly wanted by an individual. Visitors are free to visit their relative whenever they or their relative choose, and are openly welcomed into the life of the home; this was confirmed both by the residents themselves and some of their visitors. Nearly all visitors to the home who responded to surveys or were spoken to directly said that they were kept updated by staff and were well informed; there was one exception who said that this did not happen as much as they would like. The general philosophy of the home is to enable residents to spend their time where and how they choose. However many of the residents are highly dependent on the staff, and in the main staff were mindful of this and were observed remaining sensitive to ensuring options were available to them. In some circumstances of very high dependency, family input is very much welcomed regarding awareness of choices and preferences of the resident. Residents are supported to be as independent as they possibly can, and one particular resident was very appreciative of this, saying that this was very important to her, and that she managed all her own affairs. Some relatives commented that in their view the residents were supported to live their life how they chose, with one saying they had never witnessed any discrimination. Another said that the staff were usually very flexible to accommodate residents as much as possible. The service of lunch was observed in the dining room. Others had their meals taken to them on a tray, and a large number required help to eat. Special diets were catered for. The dining room was reasonably pleasant and organised, although the adopted practice of staff all standing and queuing at the servery for some considerable time was not judged to be the best use of their time, as residents were sitting waiting whilst largely unattended; there were some staff interacting with residents in a pleasant and sociable way whilst awaiting the meal, but the majority were not. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 18 There was a choice of food, one of which appeared wholesome, nutritious and appetising. The other choice did not appear so appetising, with long grain rice boiled to a thick and stodgy mass; many of the residents who had chosen this option appeared to struggle with it. Generally residents were very satisfied with the quality and quantity of food provided for them. They said that they had a good choice, with one saying that in their view ‘it was always well cooked and nicely presented’. One visitor said that they felt the choice of food was limited, however menus showed a good range of choices, with a well-balanced range of food on them. Some residents said that if they did not want what was on the menu that they could always have something else, and this was borne out for a small number during this visit. One resident admitted he did not have much of an appetite, but that staff tempted him with soups that he liked, and that he often enjoyed a boiled egg in the morning. However, there did seem to be a slight problem in this area on the first day of this visit, with at least three residents sending their choice of meal back, saying they had not wanted that. The exchanges between staff that arose as a consequence of this had a slightly disruptive effect on the otherwise calm atmosphere of the dining room. A new catering manual has been introduced, and this demonstrated that the appropriate catering records were being maintained. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 19 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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in this home are able to express their concerns, and can be reassured by the home’s complaints procedure and the policies regarding protecting their rights and the prevention of abuse. EVIDENCE: The home has a clearly written procedure for addressing complaints. This is made accessible to people in their information brochure, and is normally displayed in the entrance hall to the home, however it had to be retrieved for re-display, having fallen out of sight on this occasion. The home maintains a record of complaints and concerns received. There have been several complaints at The Elms that have been addressed by the manager himself, or The Orders of St John Care Trust, although the incidence has significantly reduced overtime. Residents and visitors all felt able to raise their concerns, and most spoke very positively about the manager being so approachable and easy to talk to in this regard. The manager was observed to be very approachable and interactive with residents and visitors throughout this visit, and demonstrated an eagerness to respond and help with any issues that might arise. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 20 One relative said that they thought more regular meetings might be helpful to families, and said ‘they would like to see more of officials’. Another said that ‘if they had ever had to make comments, then things had always improved’. The home has clear policies and procedures regarding the protection of vulnerable adults, that confirm that their philosophy is to uphold people’s rights, protect their wellbeing and not tolerate any kind of abusive practice. Staff spoken to directly or responses on surveys, showed that they were aware of these procedures, including the Whistleblowing procedure should they have concerns. Staff have been informed about the recent implementation of the Mental Capacity Act, and have access to an easy-read version. Adult protection training is delivered to staff during their induction period, and all NVQ (National Vocation Qualification) trainees receive instruction in this area during their course. There are currently approximately eight staff who have been at the home for some time, who have not had a recent update in this subject, and how best to access a training update is currently being considered by the manager. One resident spoke about ‘trusting the staff’ and ‘feeling safe here’. Another said that she ‘felt like she belonged to a family’. Staff in the home have identified some concerns in relation to three residents, which have prompted the necessary referrals to the local authority. The home has addressed these issues robustly and appropriately, instigating the necessary safeguards in these cases. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 21 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 & 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Despite some isolated concerns in this area, people living in this home are provided with comfortable and pleasant accommodation, which is suitable and safe to meet their needs. EVIDENCE: This home features as part of the redevelopment programme being carried out by The Orders of St John Care Trust. In the interim all efforts are being made to maintain the premises in a clean and safe condition, with ongoing attention to redecoration and necessary repairs. The rear garden has been fenced and made more secure, and some of the paving has been re-laid to ensure greater safety. Corridors and stairwells have been redecorated. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 22 There were isolated examples of bed sheets being very worn through prolonged usage or laundering, and would be best replaced. The home was not fully compliant with the Smoking Regulations, as the door to the designated smoking lounge was often left open, and was not a selfclosing door as is required, resulting in smoke pervading to the ground floor corridor. This must be rectified if the home is to be compliant under these regulations. The home was clean, and apart from transient unpleasant odours, was largely fresh and odour free. Carpets were being shampooed during this visit, and domestic staff were working throughout all areas of the home. Residents who responded to the survey said that they felt the home was kept very clean, with just one person who said that it was less so at weekends; rotas show that cleaning staff numbers are less during these times. One resident said that ‘the ladies kept her room spotless’. One visitor said that the home was clean, but that occasionally there were unpleasant odours. Another visitor said that their relative’s room was not always kept clean enough. A number of people also commented on the number and regularity of the laundry mistakes, resulting in clothing going missing or being incorrectly delivered to residents after laundering. The laundry itself provides good facilities, and generally it is well operated by a long serving and experienced assistant. Never the less, there are occasions when care staff also assist with the return of items during the afternoons, and it is not clear when and how errors are arising, which is something that the home must continue to find ways to resolve. Clinical waste is correctly managed, and sluice rooms were clean and orderly. There were copious supplies of the necessary protective equipment for staff use as part of infection control procedures, and this included liquid soaps and sanitising hand gels, paper towels, gloves and aprons. The Elms DS0000064620.V347837.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. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Despite isolated concerns regarding some staff, people living in this home receive care from a generally competent workforce, and can be reassured by the rigorous pre-employment checks carried out on new staff. EVIDENCE: Retention of staff at The Elms has gradually improved, albeit with very slow progress, and although regular use of agency staff continues this has significantly reduced. Residents were mostly complimentary about the staff group, with most indicating that there were ‘one or two carers who were not so good’ or ‘nice’. Those spoken to or surveyed confirmed that staff were available to them, although one person said that ‘staff get so busy, and can get called away’. Comments from visitors to the home included ‘staff carry out their duties with great care and attention, and nothing is too much trouble’. Another said that staff were ‘truly caring, and provided good human contact’, whilst another observed that staff were ‘often happy and cheerful’. The Elms accommodates many residents who have high dependency needs, and as such is a busy home. The manager has done well to implement revised The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 24 working practices to benefit residents, although further work is ongoing in this area. There were reports of isolated members of the care staff being resistive to the changes in the home, which has not been helpful in terms of its development. Concerns in relation to two carers are also reported under standard 10. Some people said that the home needed more staff in their opinion, as the home appeared short staffed at times; one relative said that this was particularly the case between 6pm and 8pm in the evening. The rotas demonstrate that there are two qualified nurses on duty on most mornings, with at least one on day and night. There are nine, six and three carers on duty during the morning, afternoon/evening and overnight respectively. Whilst discussing the staff numbers with the manager it was acknowledged that 6pm to 8pm is a particularly busy time for the staff, with many residents needing help and care at similar times, and that it could quite possibly appear as though there were insufficient staff on duty to a visitor, as most would be engaged with residents. The home was well organised during this unannounced visit, and residents were being cared for in a timely way, with call bells not sounding for too long a period before they were answered. An ancillary team of cleaning, catering, maintenance, administration and laundry staff supports the care and nursing team, and the manager works in a supernumerary capacity. The home is making excellent progress with the NVQ training programme for care staff. There are fifteen care staff qualified to at least level 2 at this time, with a further eight already working towards the award, and five of these near to completing it. Personnel files relating to two members of staff who had been recruited in recent months were inspected. In each instance, the prospective employee had completed an application form providing details of their employment history. One of these contained some gaps in their history, and in the absence of proper interview notes it was not possible to confirm that these gaps had been explored as would have been required; the manager was able to say that he had posed the question during an interview, but accepted it had not been recorded. Two written references had been provided in each case, including one from the last employer. Correct POVA (Protection of Vulnerable Adults) and CRB (Criminal Record Bureau) screening had been completed for each person. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 25 The General Social Care Council Code of Conduct for care workers had been issued to each member of the care staff. New members of staff had received structured induction training, and had worked in a supervised capacity for that period; one of these staff confirmed that they had felt very well supported during their induction period, and had not worked alone. An electronic induction-learning package is also in use in the home for new care workers, and this incorporates the National Common Induction Standards for Care Workers. There is a designated training coordinator for the home, and full records of all training planned or delivered are maintained. There is a range of mandatory and optional training available to staff, all of which is entirely relevant to the role they perform and the needs of the residents. Nurses have recently undergone training in their ethical and legal responsibilities, and in the regulatory framework within which they work. Staff receive certificated evidence of the training they have undergone, and each is encouraged to develop and maintain their own professional portfolio. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 26 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The people living in this home benefit from open and respectful management, in which the manager strives to monitor and maintain standards, although the implementation of a formal staff supervision programme would help with this. EVIDENCE: The manager of The Elms is a level one qualified nurse who has been registered with CSCI for his position. Although experienced in a management role, he has yet to undertake and achieve the necessary formal management qualification, having decided that the training course he was previously on was not the best option for his needs; he is currently considering other options to fulfil this responsibility. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 27 Throughout this inspection the manager was observed to be very approachable to residents and visitors, consistently adopting a polite and respectful attitude. Residents themselves spoke very positively about him, and evidently appreciated his efforts. There are a number of quality monitoring approaches adopted in this home, some of which consult and incorporate residents’ views and opinions. The home redevelopment plans are readily available to residents and their families, and there has been information sharing and consultations with them about this. Residents have recently taken part in the home’s annual satisfaction questionnaire, the results of which are currently being analysed and reported upon in readiness for an action plan to address the points of weakness and strength. Residents and their families can also attend meetings during which they are consulted and encouraged to express their views and opinions. Feedback and suggestion forms are available in the hallway for anyone to use if they wish. Some other quality monitoring tools available to the home have not been fully implemented as routine here. The home is due to be re-audited for the quality standard award ISO 9002. A number of the clinical policies and procedures are under review, and some new ones are to be introduced as well. A large number of residents have placed personal money and valuables in the home’s main safe for safekeeping. Clear and transparent records for each person are kept, and these include transaction details, running totals, and receipts. A regular audit is carried out on these arrangements, and residents and their representatives can have access to the records for signing and scrutiny whenever they wish. All staff have received an annual appraisal as part of the home’s policy regarding staff supervision. However other than that the policy has not been adhered to, with formal staff supervision not taking place. A new member of staff said that she had received good support and supervision when she started work, and one other member of staff said that they felt well supported in the home; at least two others said that they never received any formal supervision, and the manager acknowledged that this was an area that he had to address. A number of systems are in place to promote the health and safety of the residents and staff, with health and safety training provided for staff. Maintenance records showed that regular checks are carried out on the fire safety systems, and the policy regarding fire safety training and evacuation The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 28 procedures is currently under complete review, further to the home’s Fire Safety risk assessment. It is planned that an external training provider will provide Fire Marshall training for the manager, which will include evacuation and necessary safety procedures, as for a number of other key staff. All other staff will undergo an annual training session with the training provider, and receive six monthly refresher training from the home’s designated Fire Marshall. However, at this point fire safety training has only recently been given to new starters, with nothing since February of this year for existing staff; full and complete records of that particular training session could not be located for inspection purposes. There is first aid equipment in the home, and basic first aid training has been provided to ten care staff and the maintenance person; qualified nurses are in addition to these numbers, as previously reported. Hot water temperatures are regularly checked for safe levels, and regular Legionella checks on the water supply have also been carried out, with the appropriate control measures in place. All the necessary safety checks and maintenance of utilities and equipment are undertaken in a timely fashion, and the associated records are kept in these areas. The building was secure, with coded door entries in a number of locations. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 29 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 2 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 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 30 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(1) (2b) Requirement Timescale for action 30/11/07 2 OP7 13(4c) 3 OP9 13(2) 4 OP9 13(2) Care plans must be more comprehensively prepared on the basis of assessments of need, so as to show how residents’ entire needs are to be met in respect of their health and welfare, and be regularly reviewed so as to be up to date and accurate. A suitable risk assessment tool in 30/11/07 relation to the risk of falls must be implemented and documented in residents’ care records. A full audit of all medications 30/11/07 prescribed for use externally must be carried out, in order that clear and precise details for their usage are ascertained and recorded on medication administration charts, and can be directly linked to a plan of care; there must be a clear record of administration. This is to ensure that residents receive their external medications as prescribed. An audit and investigation must 31/12/07 be carried out regarding the DS0000064620.V347837.R01.S.doc Version 5.2 The Elms Page 31 5 OP10 12 (4.a) 6 OP19 23(5) 7 OP36 18(2) medication stocks and the manner in which they have been administered by staff, in an effort to establish reasons for the stock discrepancy identified. The registered manager must 30/11/07 ensure that all staff members conduct themselves in a way that is respectful towards the privacy and dignity of residents. Through consultation with the 31/12/07 authority for environmental health the registered manager must ensure that the home is fully compliant in relation to the Smoking Regulations in Care Homes. The registered manager must 31/01/08 ensure that staff working in the home receive regular and formal supervision. 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 OP9 OP29 OP36 Good Practice Recommendations Staff should make a record of all residents’ choices regarding their religious and spiritual needs in their care plan. The use of external medicinal preparations should be linked to an associated plan of care. The registered manager should maintain a written record of interviews conducted with prospective staff. Staff should receive formal supervision at least six times in a twelve-month period. The Elms DS0000064620.V347837.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Gloucester Office Unit 1210 Lansdowne Court Gloucester Business Park Brockworth Gloucester, GL3 4AB 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 DS0000064620.V347837.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. 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