Inspection on 18/11/08 for The Elms (Yeovil)

This inspection was carried out on 18th November 2008.

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

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 (Yeovil) 06/06/06

The Elms (Yeovil) 08/11/05

The Elms (Yeovil) 10/03/05

The Elms (Yeovil) 11/08/04

The Elms (Yeovil) 15/03/04

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 27/02/2009.

CARE HOMES FOR OLDER PEOPLE The Elms (Yeovil) Yeovil Marsh Yeovil Somerset BA21 3QG Lead Inspector Jon Clarke Unannounced Inspection 18th November 2008 11:30 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 (Yeovil) DS0000016083.V373397.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 (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms (Yeovil) Address Yeovil Marsh Yeovil Somerset BA21 3QG 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) 01935 425440 01935 471476 osbornetheelms@aol.com Mrs Lee Teresa Osborne Mrs Lee Teresa Osborne Care Home 16 Category(ies) of Old age, not falling within any other category registration, with number (16) of places The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 6th June 2006 Brief Description of the Service: The Elms is located at Yeovil Marsh, a small village 2 miles from the town of Yeovil. The village has a church and the facilities offered by Yeovil are a short car ride away. The home is an extended single storey building surrounded by gardens with views of the countryside beyond. The home provides residential care and support for up to 16 older people. The local authority has a block booking arrangement with the home for a number of beds. The home also offers day care to a small number of non-residents. All bedrooms offer single occupancy with en suite facilities. The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star. This means the people who use this service experience adequate quality outcomes. This was an unannounced visit to the home that took place over two days as part of an inspection. We looked at a number of records including preadmission assessments, care plans, staff (recruitment, training) and those relating to health and safety practice in the home. We also looked at the arrangements for management and administering of medication. There was an opportunity to discuss with individuals who live in the home their experience and views about the quality of care they receive. We also spoke to a number of staff about working in the home. As part of this inspection we received a number of Have Your Say questionnaires from individuals who live in the home and staff. The manager also completed an Annual Quality Assurance Assessment. We have used this information and comments we received to help us form a judgement about the quality of care provided at The Elms. Fees £390-445 A number of rooms are contracted to the local authority for those occupying these rooms the lower fee applies. What the service does well: There is clearly a committed group of staff who are valued by the individuals who live in the home as stated by one individual “they have my best wishes at heart” and another “you cannot fault the staff for what they do they try their best at all times”. The home makes a good effort to provide activities and has made changes to try and encourage more individuals to participate recognising that for some it remains their choice not to take part and respecting their right to choose. The home provides a warm, homely atmosphere with good facilities available to meet the needs of those living in the home. Despite the shortfalls identified in this report staff have a level of skills and training that clearly helps in their care of individuals in the home. Of note is the commitment from the owner and manager to staff achieving the NVQ professional qualification. The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 6 Comments received by the home from relatives illustrate the satisfaction of care provided in the home: “Staff worked with our relative with commitment and respect” “Thank you for the care and professionalism in all your dealings you treated our relative with tact and respect”. What has improved since the last inspection? What they could do better: This inspection identified a number of areas which the manager must address and put in place more robust procedure and practice to protect the health and welfare of individuals who live in the home. This inspection identified a number of areas that must be addressed to bring the quality of care provided at The Elms to the required level. On the day of our visit an immediate requirement were made in relation to the heating of the home. It is unacceptable that this had not been addressed and there was clear evidence that the lack of adequate heating specifically in a number of individual’s rooms was causing real discomfort and potentially harmful to those who were effected. Having adequate heating is in the inspector’s view one of the fundamentals that a care home must provide to those in their care who are frail and vulnerable. A further immediate requirement was made in relation to the locking of the front door this was to ensure as far as possible the safety of those that live and work in the home. Whilst it is recognised that the care planning practice of the home is of a good standard a significant gap and potentially placing individuals at risk is that of making sure that staff are fully aware of risks faced by individuals in relation to their daily care needs. It is not sufficient to identify a risk if there then is a failure to make sure that staff are not fully informed of how in their day-to-day practice these risks can be alleviated. Risk assessments must identify specific actions to be undertaken to address the risk and this may well include referrals to other health agencies for access to specialised equipment (such as pressure The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 7 relieving mattress). There was no evidence in the practice noted in this inspection i.e. that of pressure sore risk that such referrals had been made in an effort to alleviate or indeed confirm the risk level. A further area of real concern is that medication administering practice in the home and the lack of “accredited” training for all staff that have responsibilities in this area. It is not acceptable for staff to administer medication if training of a formal nature has not been provided. It is not purely about (as witnessed by the inspector and reported by staff member) staff being shown what to do they must have a real understanding and knowledge of the use and effects of medication on older people. This acts as a safeguard to protect the health of the individual. There were also shortfalls in the administering practice that place individuals at risk or potentially can lead to abuse of medication where there is no instruction as to the use of medication i.e. as in this instance use of medication which has a sedative effect. The staffing arrangements raised issues from individuals who live in the home and staff as to the impact of no domestic or kitchen staff being employed. There was clear evidence from comments made to the inspector that this is not a satisfactory arrangement. It has led to individuals feeling that staff do not have time to do their work namely providing care not just of a practical nature but also just as valued and important the time to sit and spend time which is not about focusing on a task. Whilst it is acknowledged that staff clearly are making a real effort to support and assist individuals this is under the pressure of having to meet the domestic and kitchen needs of the home. This can but not have an effect on the care tasks being provided. This in the view of the inspector places them under continual stress and pressure that is not of their making or indeed should be considered in the inspector’s view part of their role or responsibility. It devalues the skills of care staff and is not an efficient use of their time and expertise. This pressure was clearly evident during the afternoon when the two care staff on duty were having to prepare tea and at the same time support and assist individuals. The training of staff needs to be addressed to make sure that all staff have undertaken what is considered “mandatory” namely moving and handling and Safeguarding. The manager must make sure there are always staff on duty that have received first aid training and with regard to night staff where there is as in this instance only one waking member of staff all night staff should complete this training. Please contact the provider for advice of actions taken in response to this The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 8 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 (Yeovil) DS0000016083.V373397.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 (Yeovil) DS0000016083.V373397.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): 3 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home undertakes full and comprehensive assessment of prospective residents so that they are able to make an informed decision about the capacity of the home to meet health and social care needs of the individual. Individuals are given the opportunity through the admission assessment; preadmission visit and trail period to make an informed decision that the home is suitable and can meet their needs. EVIDENCE: We looked at two pre-admission assessments they were detailed in giving information about the care needs of the individual, medical and physical health. The manager visits perspective residents and one individual we spoke with said they had had the opportunity to visit the home before they moved in. The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 11 Where individuals are known to social services a copy of their assessment is obtained. The Elms (Yeovil) DS0000016083.V373397.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. Care Planning and arrangements for meeting health care are generally good providing staffs with the necessary information so that the health and social care needs of residents are met. However there are significant gaps in relation to risk assessments and ensuring clear tasks and instructions are given where risks to health and welfare are identified. Arrangements for managing resident’s medication do not make sure that resident’s health needs are fully protected. The practice of staff and policies of the home help to make sure that residents are treated with respect and their dignity is upheld. EVIDENCE: We looked at a number of care plans (4). There was good detail about the individuals care need: Washing and dressing, Toileting with associated task. Moving and handling assessments had been completed and reviews held The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 13 monthly. There was detail about personal preferences in one instance about the clothes the individual liked to wear however there was little information about the personal circumstances and history of the individual. There was evidence of involvement of the individual and signatures. Risk assessments had been completed for falls, skin integrity, nutrition. In two instances where the skin risk assessment had been completed and indicated high risk there was no information as to actions to take by care staff to reduce the level of risk and impact on the care provided to the individual. We spoke to a member of staff about individuals who were at high risk of pressure sores and they said, “There are none”. In another instance where the individual had angina there was no written instruction or guidance to staff as to how to respond to angina attacks. This same individual had on two occasions been given Gaviscon which had not been prescribed to her there was no evidence of follow-up to these instances or whether this had been the appropriate response given their history of angina. Records showed that access to health professionals such as chiropody, community nurses is available and these services received by individuals in the home. Individuals who live in the home and responded to the questionnaire said that they “Always” 9 “usually” 1 receive the medical support they need. One individual commented, “There is good communication between the home and my doctor’s surgery”. A health professional said “Staff always listen to my advice and the home contacts me if there is a problem with a resident” and “home always provides me with a private room to treat patients”. We looked at the medication administering records for period of 4 weeks and found that they had been completed as required. Member of staff had signed changes to MARS records. One individual receives medication “as required” one or two. There was no guidance as to the circumstances of when this drug should be given and level of dose. Homely remedies are used in the home and recorded in dairy and on MARS record as required. Controlled drugs are prescribed to one individual and record is kept with two staff signatures however this is not in controlled drug register. Storage of drugs is satisfactory and secure with separate Controlled Drug storage. Eye ointment was in use for 3 individuals there was no date recorded when this was opened in that this ointment has limited life span once opened. The inspector noted that there were staff administering medication who had not received formal training in this area and this was confirmed by staff members. In talking with individuals who live in the home they spoke of staff as being “all very good” “treat me well”. When asked if they felt staff treated them with respect all those we spoke with said “yes”. Individuals said that they “could do as we please” “its up to us what we do”. When asked about privacy individuals The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 14 said that staff always knock on their room door before entering and felt their privacy was respected. Staff were observed throughout our visit speaking with individuals and assisting in a respectful and sensitive manner. The Elms (Yeovil) DS0000016083.V373397.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. 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. The arrangements for meeting the social and recreational needs of residents are good and there are opportunities for residents to maintain links with family, friends and the local community. The home’s practice and routines are flexible and enable residents to exercise choice and have control over their lives. The home provides meals, which are balanced and meet the dietary needs of individuals in the home however improvement could be made to provide better choice of meals particularly at teatimes so that there is a more varied diet. EVIDENCE: We spoke with individuals who live in the home about the activities provided. There was mixed response from “there’s always something going on” to “there’s not enough”. Staff said they try and do something most days. Activities included board games, crafts, quizzes, exercise and outside entertainers. A trip was being planned to the Xmas pantomime. Respondents to the questionnaire said that there are “always” 6 “usually” 4 Activities arranged by the home that you can take part in. One individual commented The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 16 “there are usually things going on. Sometimes I join in sometimes I prefer to stay in my room”. On the day of our visit there was a volunteer who visits the home to provide activities on a fortnightly basis. There were a small number of individuals playing carpet bowls. When asking staff about the time they spend with individuals they spoke of “this is difficult” “we would have more time to sit and chat if dedicated domestic and kitchen staff” “would be better if kitchen person would have more time (to have conversation with individuals)”. A staff comment received was that there should be “allocated time to each resident as at times it is difficult for staff to spend time with residents. Sometimes a chat is all that is required to make the resident feel comfortable and cared for and well liked.” Individuals who live in the home said that at times staff were “very quick” don’t have time to talk” “always so busy”. Individuals we spoke with said they could have visitors “at any time really”. One individual said they felt the home and staff were “always” welcoming to their visitors. We spoke to one relative and a friend who was visiting the home. They said they found staff friendly though one said they could be “more welcoming”. The relative said they always felt they were kept informed about their relative and also on one occasion having rang the home about a problem found that the home was very responsive “and done something about it”. We spoke to individuals about the menu and food provided. There were positive comments “always give me something I like” “always a choice” “quite satisfactory”. On the day of one of our visits the meal was well presented and looked appetising though it was noted that fresh vegetables are not served every day. The menus were looked at and showed a good variation of meals being provided in the home. Tea menu whilst offering choice was noted to be mainly cheese and pickle or beetroot and in the inspector’s view very limiting in choice. The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 17 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has complaints procedure in place so that individuals who live in the home can register any concerns or dissatisfaction with the service they receive. The home has the necessary Safeguarding policies and procedures in place. However the home fails too fully protect the welfare of individuals who live in the home because staff have not received the necessary training to provide them with the knowledge and skills in identifying and responding to abuse. EVIDENCE: We spoke to a number of individuals who live in the home about what they would do if they had any worries or wished to make a complaint. All were aware they could make a complaint and also felt able to speak to the manager or staff. One individual said they had never had to make a complaint but “knew something would be done if I was unhappy about anything” another said “staff listen to us and would do something”. All respondents to the questionnaire said they knew how to make a complaint. There has been one complaint made to the home since our last inspection. This related to staff practice and was responded to professionally with the necessary action taken to address the issue of complaint and improve practice. The home has Safeguarding policy and procedure that reflects the guidance issued by the Department of Health in the ‘ No Secrets’ document. We looked at training records for 6 members of staff of these 4 had not undertaken The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 18 Safeguarding training. We also spoke to a group of staff about Adult Abuse whilst they were able to identify what could be considered as abuse they failed to illustrate knowledge of how to respond if an individual who lives in the home made an allegation of abuse. The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home provides a well maintained environment but fails to make sure that all areas of the home are adequately heated and that all reasonable steps are taken so that the safety of all those that live and work in the home is protected. The home provides a hygienic and generally clean environment. EVIDENCE: In walking around the home it was evident that there is a high standard of decoration and appears well maintained. All areas of the home are comfortably furnished and well equipped. Whilst there was no direct evidence of cleaning not being to the required standard there were comments made by individuals who live in the home and a member of staff regarding the standard of cleaning. One individual said that they had never seen furniture moved to clean behind and a staff member said that cleaning in the kitchen was not as The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 20 through as it should be. It was noted that there was no cleaning schedule for the kitchen though visually looked clean. It was clearly evident that a number of rooms were not at a sufficient heat and comments were made by individuals who live in the home about the heating “it’s freezing” “heating is not proper”. A staff member also commented that the home was not as warm as it should be affecting residents. A relative had also raised this issue at a meeting two months previous to our visit. The manager was aware of the difficulties relating to position of thermostats and this had been evident for two months. However they had not taken any action to improve the heating by providing additional heating that would have resolved the problem in the short term or taken any other action to resolve the issue on a permanent basis. Concerns were expressed by a member of staff as to the locking of the front door at night. At the time of our visit the practice was to lock the door at 9:30pm. The concern was about visitors to the home entering the building and staff not being aware where they were in the home because of not getting to front door to see who was visiting. It is noted that outside doors are alarmed at night. The home has infection control guidelines in place and staff are provided with protective clothing where this is required. Water testing has taken place with regard to Legionella since the last inspection. The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 21 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staffing arrangements in the home are generally satisfactory however the lack of domestic and kitchen staff affects the level of care being provided to individuals who live in the home. The recruitment and selection of staff is undertaken to make sure that as far as possible the health and welfare of resident is protected. The training of staff must be improved so that all staff complete the required “mandatory” training and to make sure that staff have the necessary skills to fully protect the health and welfare of those that live and work in the home. EVIDENCE: There is generally 5 care staff on duty am (3 from 7am, 2 from 8am) 3 pm (2 from 4:30-9:30) with one waking staff and sleep-in. This is with the current occupancy of 12 residents. There is no kitchen or domestic staff employed care staff undertaking these duties. Hence during mornings once individuals are up one care staff works in the kitchen and others undertake domestic tasks. In talking with individuals about the staff in the home there were very positive comments about their response to call bells “come when I call” “always come as quick as they can”. Other comments were “help me do anything I ask them” The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 22 “very good and helpful”. There were however comments that “staff very busy” “can be very quick” “don’t have time to have conversation”. Respondents to the Have Your Say questionnaire said that they “always” 6 “usually” 3 receive the care and support they need. To Are staff available when you need them? Respondents said “Always” 4 “Usually” 5. Comments made “at busy times especially in the mornings they may not always be available straight away.” “The staff always have my best interests at heart, they are very caring, without hurrying me”. In discussion with staff they were asked if improvements could be made and there was consensus that “we would have more time if there was dedicated domestic and kitchen staff” “would be better if had kitchen person would have more time (to care for residents). We also received comments from staff members “I think at times staff do to much cleaning and not enough caring. As our concern is the residents and their needs.” “No time with residents, not getting care they should be getting, in mornings all have to help cleaning and in the kitchen”. The home has over 50 of staff trained at NVQ level 2 or 3 with other staff being registered to undertake this professional qualification. We looked at recruitment and selection records for 4 members of staff. All applicants had completed detailed application forms, two references had been obtained and Criminal Record Bureau (CRB) check undertaken. In one instance it was not clear whether references were from previous employer as required. It was also noted that 3 staff had started without CRB though had POVA1st checks. Training records for 6 staff members showed that 4 had not undertaken Safeguarding training, one had no moving and handling and one who was night staff member had no first aid. Others all had the required “mandatory” training moving and handling, Safeguarding, health and safety (fire), food hygiene. Other training undertaken included Dementia, Infection Control. The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Quality in this outcome area is adquate. This judgement has been made using available evidence including a visit to this service. There are good opportunities for individuals who live in the home and others to express their views about the service they receive. The practices of the home help to make sure that the health, safety and welfare of residents and staff is protected. EVIDENCE: Since the last inspection a manager was appointed but has recently left and the owner Mrs Osborne who was previously the manager has resumed this position. Mrs Osborne has extensive experience and is qualified to manage the home. Individuals we spoke with spoke of her, as “someone we can talk to” “would talk to her if I had a problem and she would help”. The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 24 We received some comments from staff “I know I can contact the manager any time to discuss any aspect of my work that I am concerned about”, “I get good support from management”, “we have regular meetings to discuss anything that is needed by residents or staff. Worries etc are all aired any views considered and a plan of action implemented”. “My manager is very approachable”. One staff member said that morale had improved with the recruitment of new staff (3 in last month) this followed a number of staff leaving over a short period of time. The shortfalls identified in this report reflect in our view a failure from the manager to undertake robust procedures and ensure there are the required practices specifically around training, administering of medication. The deployment of staff is clearly an issue that the manager has failed to address and resolve satisfactory. The other failure was that of addressing the issue of the heating of the home where clearly this had been identified some time ago yet no action had been taken. Staff records (4) showed that staff receive regular supervision and staff told us there are monthly staff meetings. Resident’s surveys are undertaken and we looked at the results for one undertaken in April. This showed a good level of satisfaction with the care being provided in the home. Resident’s meetings are held and at the last meeting in October staffing was discussed, meals and activities. We looked at records relating to health and safety practice in the home. A fire safety audit had been completed by the Devon and Somerset Fire and Rescue service (10/09/08) this found “satisfactory standard of fire safety was evident”. Fire risk assessment had been completed with staff undergo fire Awareness training (11/06/08). Weekly fire alarms tests and monthly emergency lighting test. Equipment in the home is regularly serviced. Fire system serviced 22/09/08. There was an unannounced visit from the Food and Safety Unit on 3/09/08, which found the “premises satisfactory, clean, tidy well run with good management systems”. The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X 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 2 2 X X X X X 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 26 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 OP25 Regulation 23 (2) (P) Requirement Timescale for action 01/12/08 2 OP19 12 (1) The manager to make sure having regard to the number and needs of individuals living in the home that there is heating suitable for service users provided in all parts of the care home. This was subject of an immediate requirement to be met within 7 days. The managers to advise us by 24/12/08 what actions have been taken. This refers to the lack of adequate heating in parts of the home and also to ensure that adequate and satisfactory heating is available in all parts of the home. The manager to make sure that 25/11/08 the care home is conducted so as to promote and make proper provision for the health and welfare of individuals who live and work in the home. This was subject of immediate requirement to be met with immediate effect. This refers to making sure the security of the home is as required with regard to the DS0000016083.V373397.R01.S.doc Version 5.2 The Elms (Yeovil) Page 27 3 OP7 13 (4) © 4 OP9 13 (2) 5 OP30 18 (1) © locking of the front door. The manager shall make sure 31/01/09 that unnecessary risks to the health or safety of individuals who live in the home are identified and so far as possible eliminated. This is with reference to the need to identify actions to be taken by care staff in alleviating or eliminating risk of individuals developing pressure sores where there is a high risk identified by the risk assessment. The manager also to take the necessary action with regard to referral to other agencies for advice, support and assistance. The manager to shall make 31/01/09 arrangements for the recording, handling, safekeeping, safe administration of medication received in the home. This refers to the need to make sure that there is guidance and instructions as to the administering of medication where given “as required”. In addition the use of medication that has limited life should be recorded when opened so that it is clearly remains effective when used. The use of controlled drugs must be recorded in Controlled Drug Register. The manager shall make sure 28/02/09 that persons employed to work at the care home receive training appropriate to the work they are to perform. This refers to the need for all staff to undertake moving and handling, Safeguarding and where necessary First Aid training. In addition all staff that have responsibilities relating to the administering and management of medication in DS0000016083.V373397.R01.S.doc Version 5.2 Page 28 The Elms (Yeovil) 6 OP27 18 (1) (a) 7 OP9 13 (2) the home receive “accredited” training. With regard to staff administering insulin specific training must be given by community nurse to make sure all staff are competent to undertake this task. The manager shall having regard 31/01/09 to the size of the care home and the number and needs of individuals living in the home make sure that at all times suitably qualified, competent and experienced persons are working in the home in such numbers as are appropriate for the health and welfare of those that live in the home. This refers to the need to review the arrangements for staffing in the home specifically that of employment of domestic and kitchen staff. However it also relates to making sure there are adequate staff on duty at all time s to meet the health and social care needs of individuals. The manager to shall make 16/01/09 arrangements for the recording, handling, safekeeping, safe administration of medication received in the home. This requirement is specific to the administering of insulin by staff. Training must be provided by community nurses to ensure that staff are competent to perform this task. The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 29 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. Refer to Standard OP15 Good Practice Recommendations The manager to review the provision of meals in the home particularly around the use of fresh vegetables and the teatime menu. The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Elms (Yeovil) DS0000016083.V373397.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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