CARE HOMES FOR OLDER PEOPLE
The Elms (Yeovil) Yeovil Marsh Yeovil Somerset BA21 3QG Lead Inspector
Ms Sue Hale Key Unannounced Inspection 09:30 6th June 2006 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.V293619.R01.S.doc Version 5.1 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.V293619.R01.S.doc Version 5.1 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.V293619.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 8th November 2005 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. The owner/manager lives on site and is closely involved in the day-to-day running of the home. All bedrooms offer single occupancy with en suite facilities. The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and undertaken by two inspectors, it took place over the course of one day in June 2006 (7 hours). There were 13 residents living in the home and two residents were in hospital. The home accepts 4 older people during the week for day care with a maximum of two on any day to minimise the impact on people who live in the home permanently. The inspection involved discussion with the people who lived and worked at the home, examination of records, policies and procedures and a tour of the building. The inspectors also spent time with the provider/manager Mrs Lee Osborne. As part of the inspection process the inspectors used ‘case tracking’ as a means of assessing some of the national minimum standards. This process allowed the inspectors to focus on a small group of people living in the home. All records relating to these people were inspected, along with the rooms they occupied in the home. Questionnaires were sent out to all residents, GPs, and all the professionals involved in residents care. The level of satisfaction from residents from both the returned questionnaires and on the day of the inspection was very high with a resident saying that ‘this is the third home I’ve been in, and this is the best, you couldn’t get any better’. The home has made very good efforts to address the requirements and recommendations made in the last inspection report and continues to offer a high standard of care. The current fees for the home range from £361 to £382 weekly. What the service does well:
The provider/manger, Mrs Osborne and her family live on the premises and The Elms is run very much as a family home with contact between residents and Mrs Osborne’s family and their pets, a dog, cat and tortoise a daily occurrence. The home considers carefully the needs assessment of each prospective resident before agreeing admission to the home. Prospective residents and their family, always have the opportunity to visit and spend time in the home The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 6 before agreeing admission. A variety of positive methods enable people to experience the home and what it has to offer. Staff are qualified and skilled to meet the needs of prospective residents. They are well briefed on how to make new residents feel welcome. Each care plan reflects the needs of the individual taking into account their cultural, religious and social preferences. The need to respect residents of privacy and dignity is a key principle of the homes aims and objectives. Residents to remain at the home with medical and health care support if necessary until the end of their life. The wishes of individual residents about their end of life and the arrangements they want after death are sensitively discussed as appropriate. The home provides very good, clear information for bereaved families and friends. The home has a medication policy which is accessible to staff, medication records are generally up-to-date for each resident and medicines received, administered and disposed of are recorded. Residents are encouraged to exercise choice and control over their lives and maintain close contact with their families, friends and the local community. They are able to enjoy activities and the home provides a stimulating atmosphere. The food served at the home is of a high standard and residents are very satisfied with the quality of variety of food available. The meals were described by residents as ‘very good’ and that there was ‘always a choice available’ The complaints procedure is up-to-date, clearly written and easy to understand. It is widely distributed and easily available for residents and visitors to the home. Residents understood how to make a complaint and were confident that they would be listened to and taken seriously. The policies and procedures regarding protection of residents are of good quality and are regularly reviewed and updated. They are clear when incidents need external input and who to refer the incident to. Systems are in place to ensure that residents’ rights are respected. From observation on the day of the inspection it was clear that staff treated residents with respect and that relationships were friendly and courteous but professional. The management and staff encourage residents to see the home as their own home. This was confirmed by a visitor to the home who described The Elms as having a ‘relaxed, open approach’. It provides a very well maintained, safe, comfortable, and very attractive home, which has all the specialist equipment and adaptations needed to meet individual residents needs. All residents are assessed for their need to have equipment or aids before they move into the
The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 7 home and as necessary thereafter. The home meets the changing needs of all residents promptly and the layout and design of the home is suitable to meet specific needs of the people who live there, for example residents who use wheelchairs or who have mobility problems. Staffing levels are good and the staff were qualified to provide a high level of care. There is no use of agency or temporary staff. Residents have confidence in the staff that care for them. All staff are clear regarding their role in what is expected of them. Staff are supervised and their practice monitored by the provider/manager. Staff were heard and seen to be engaging appropriately with residents and involving them and explaining their actions during care interventions. The manager has the required qualifications and experience and is competent to run the home. She works to continuously improve services and provide an increased quality of life for residents. There is a strong ethos of being open and transparent in all areas of running of the home. The home has sound policies and procedures that the manager effectively reviews and updates in line with changing legislation on good practice advice. Records are of a good standard and are routinely completed. One resident said that they had ‘nothing but praise’ to say about the staff and that they were ‘helpful and friendly’. The home has a good record of meeting relevant health and safety policies and staff are aware of safety arrangements. What has improved since the last inspection?
All residents had risk assessments in relation to pressure care, moving and handling, falls and nutrition in place; these are undertaken on admission and as necessary thereafter. All residents have a fully completed care plan and they are involved as far as practicable when it is drawn up. The care plans checked set out in detail the action needed to be taken by staff to ensure all aspects of residents care are met. The care planning and review documentation checked had been fully completed, dated and signed. The complaints policy and procedure has been revised to include the name, address and telephone number of the Commission for Social Care Inspection. It makes it clear that complainants are able to contact the Commission for Social Care Inspection at any stage of a complaint. Robust procedures for responding to suspicion or evidence of abuse or neglect specific to The Elms and reflecting guidance from the Department of Health document ‘No Secrets’ has been developed. A copy of the Department of Health guidance ‘No Secrets’ had been obtained and all staff have been made aware of the appropriate response should an allegation of abuse be made.
The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 8 The staff application form has been revised to include the Rehabilitation of Offenders Declaration and to make clear that applicants should put their last employer as a reference. All residents’ personal allowances are now audited by the provider/manager and kept individually. The supervision policy has been revised to ensure that supervision covers all topics detailed in the national minimum standards. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 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.V293619.R01.S.doc Version 5.1 Page 10 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2,3,4,5 Standard 6 is not applicable to the service The quality of this outcome group is excellent. The service considers carefully the needs assessment of each prospective resident before agreeing admission to the home. Prospective residents and their family, always have the opportunity to visit and spend time in the home before agreeing admission. A variety of positive methods enable people to experience the home and what it has to offer. Staff are qualified and skilled to meet the needs of prospective residents. They are well briefed on how to make new residents feel welcome. Each care plan reflects the needs of the individual taking into account their cultural, religious and social preferences. EVIDENCE: The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 11 All residents have a written terms and conditions of residency that includes all the topics recommended in the national minimum standards. The contract makes clear what is included in the homes fees and what is the residents responsibility i.e. hairdressing, newspapers and chiropody. The home produces a statement of purpose and service user guide that is written in plain English and printed on yellow paper to make it easier to read for residents with visual impairments. The documents emphasise that the homes ethos is to provide person centred care and to respect the rights and choices of individuals. The service user guide includes the contact details of local services such as Citizens Advice Bureau, advocacy services, Department of Work and Pensions, Social Services and professional bodies such as Age Concern and the Alzheimers Society. There have been no new residents admitted to the home since the last inspection. This standard was evidenced by examination of long-standing residents files, discussion with residents and the provider/manager. Mrs Osborne informed the inspectors that she visited prospective residents in their home or wherever they were staying to undertake a pre admission assessment to make sure that the home could meet their care needs. The pre admission assessment covers all the topics recommended in the national minimum standards and on files checked there was good detail to form the basis of the care plan. Residents are able to visit the home and spend time there before making a decision about residency. The inspectors spoke to several residents who confirmed that they had been able to meet Mrs Osborne and had looked around the home before they moved in. The home has a detailed admissions policy that includes specific instructions for staff on how to make new residents feel welcome and how their room should be prepared before they arrive to make sure that they are comfortable. The emergency admissions policy includes all the information recommended in the national minimum standards. Admissions to the home are on a trial basis and reviewed after a settling in period by the home and the funding authorities if appropriate. Mrs Osborne was aware that should residents physical or mental health needs change that this sometimes meant that a reassessment of their needs was required and this had taken place in relation to two residents who had been referred to the necessary health and social care professionals for advice and support. For residents referred through care management arrangements Mrs Osborne has obtained a copy of the funding authorities assessment and care plan and this information was also used to inform the care planning process. It was evident from observation and discussion with staff and residents that the staff team have the skills and experience to deliver a good standard of care and are able to meet the needs of residents living at the home. The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 The quality of this outcome group is good. Residents have a detailed care plan and appropriate risk assessments in place that have been agreed with them. Residents have right of access to health and medical services and the homes policies, procedures and practice strongly support this. The health care needs of residents too frail to leave the home are managed by visits from local health care services. The aims and objectives of the home reinforce the importance of treating residents with respect and dignity and these values are fundamental to the philosophy of care. Residents were supported to remain at the home if at all possible for the rest of their life. Their wishes and preferences are discussed sensitively with them and their family during the development of the care plan. The home has a medication policy which is accessible to staff, medication records are generally up-to-date for each resident and medicines received,
The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 13 administered and disposed of are recorded. However, the current practice could be improved. EVIDENCE: The inspectors examined the personal files for three residents. All the files contained detailed care plans that covered all the social, health and physical needs of the residents. The plans contained detailed instructions for staff on how to meet identified needs and are well organised, fully completed, dated and signed. There was evidence from checking the files and talking to staff and residents that residents are involved in care planning and are asked to sign their agreement with the plans if they are able to do so. Care plans were reviewed monthly and any necessary changes noted and implemented by staff. All the files checked had up to date risk assessments in place in relation to the risk of falls, nutrition and pressure care and these had been reviewed and updated when residents’ needs had changed. Individual risk assessments were also in place in relation to using aids and adaptations, the administration of medication, and residents’ ability to manage their own denture care using steradent in their rooms. There were records of contact with GPs, district nurse and other healthcare professionals such as dentists, optician and chiropodist. There was good evidence on residents files checked that the home has good, effective relationships with other professionals and that referrals were made as appropriate for individuals. Pressure care assessments and equipment was provided as necessary on an individual basis. The home has a detailed policy, procedure and practice guidance to help staff when handling terminal care and death. Staff receive in-house training and practical advice in caring for residents at the end of their life and have access to support from Mrs Osborne to discuss any areas of anxiety and concern. Residents are supported by staff and medical and health care professionals to remain at the home if at all possible. The home has produced a very good leaflet for bereaved relatives and friends giving details of the procedures and practicalities that need to take place after someone has died. The leaflet includes the details of local register offices and the Department of Work and Pensions. Mrs Osborne told the inspectors that all staff that administer medication had undertaken appropriate training. Contained a photograph of residents with their date of birth, name of their GP and a record of any allergies known. Staff was observed to administer medication sensitively and discreetly. However, a
The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 14 number of issues of concern were noted during the inspection and these included gaps on the medical administration record (MAR), variable dosage recording varied, two signatures were not recorded for handwritten entries on the MAR sheets, some prescribed items were not labelled, items such as eye drops with limited expiry dates did not have the date of opening on them and it was unclear if six month medication reviews were undertaken by the GP. The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 15 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 The quality of this outcome group is excellent. Residents are encouraged to exercise choice and control over their lives and maintain close contact with their families, friends and the local community. The food served at the home is of a high standard and residents are very satisfied with the quality of variety of food available. Residents are able to enjoy activities and the home provides a stimulating atmosphere. EVIDENCE: Residents spoken to said that they enjoyed the food and that a choice was offered to them if they didnt want what was on the menu. Comments about food, included ‘very good’,’ always have a choice’,’ excellent’ and ‘they give us lovely meals’. The majority of residents had their breakfast in their room. Meals were seen to provide a wholesome balanced diet. The food served was fresh, of good
The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 16 quality and homemade. Mealtimes were seen to be unhurried, and support was available for residents requiring assistance. The menu was displayed in the dining room and whichever member of staff responsible for cooking saw all people living at the home individually, every day to find out their choices and preferences. The dining room tables were nicely laid with napkins and condiments available. Staff were available to offer assistance discreetly if required. Residents are actively encouraged to keep in contact with family and friends living in the community. Visitors are welcome at any time and facilities are available for them to have a drink of a meal with a resident. Residents can choose to entertain visitors in their room all one of the communal areas or in the garden. The routines of the home are as flexible as possible to suit the choices, preferences and needs of individual residents. All residents spoken to said that they were able to choose what time they rose and retired and that this was respected by staff this was observed by the inspectors during the visit. Activities are available and include trips out to places such as monkey world, Weymouth and walks locally and also activities within the home including bingo, quizzes and skittles which was taking place on the day of the visit. The inspectors observed that residents who were confused were supported to join in activities by staff and Mrs Osborne. Residents spoken to said that they enjoyed the activities available and they were encouraged and supported to participate if they wanted to put that they could choose not to join in as well. The inspectors observed that residents were given the opportunity to go out with staff for short walks, including those residents using a wheelchair. Residents are encouraged to be responsible for their own money for as long as they wish and/or supported by staff to maintain their independence as long as they are able. The homes policies, procedure guidance and quality assurance systems ensure that residents are protected from financial abuse. The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 17 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,17 & 18 The quality of this outcome group is good. The complaints procedure is up-to-date, clearly written and easy to understand. It is widely distributed and easily available for residents and visitors to the home. Residents understood how to make a complaint and were confident that they would be listened to and taken seriously. The policies and procedures regarding protection of residents of good quality and are regularly reviewed and updated. They are clear when incidents need external input and who to refer the incident to. Systems are in place to ensure that residents’ rights are respected. EVIDENCE: The home has not received any complains since the last inspection. The home has an up to date complaints policy and procedure that is included in the statement of purpose and service user guide. It has been revised in 2006 and meets the requirements and recommendations of the national minimum standards. A suggestion box was displayed so that residents and their relatives/visitors could comment anonymously if they chose about the home and the services it provides. The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 18 All residents spoken to were clear about who they would speak to if they had any problems or concerns and were confident that these will be listened to and taken seriously. All residents are registered to vote and their legal rights protected by the homes values, policies and procedures. Information about local advocacy services is available and on display and also included in the service user guide. The home has an adult abuse policy and procedure that had been reviewed and updated to reflect guidance published by the Department of Health in the ‘No Secrets’ document. The revised policy gives clear instructions to staff about the correct procedure to follow should an allegation of abuse be received. Staff spoken to were clear about what constituted abuse and how any such allegations would be dealt with. The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 19 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 & 26. The quality outcome for this group is excellent. The management and staff encourage residents to see the home as their own home. It provides a very well maintained, safe, comfortable, and very attractive home, which has all the specialist equipment and adaptations needed to meet individual residents needs. All residents are assessed for their need to have equipment or aids before they move into the home and as necessary thereafter. The home meets the changing needs of all residents promptly and the layout and design of the home is suitable to meet specific needs of the people who live there, for example residents who use wheelchairs or who have mobility problems. EVIDENCE: The home was very clean, tidy and odour free on the day of the inspection. The furnishings, decoration and fittings of a high standard and residents are
The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 20 able to bring in items of their own furniture by agreement with the home and to personalise their rooms in line with their choices and preferences. All residents spoken to said that staff kept their room clean and tidy. There is a selection of communal areas, according to the numbers of residents, this means that residents and their visitors have a choice of place to sit quietly, meet with family and friends will be actively engage with other residents. The home has seating available in the front and rear gardens and these are very well maintained and fully accessible for those residents with mobility problems or who use wheelchairs. The bathrooms are clean and tidy, offered variety of opportunities i.e., baths or showers and provided the aids and adaptations required by residents with varying needs. There are a number of toilets strategically placed around the home. Call bells are left within reach of residents and these are responded to promptly. The infection control guidelines in place were dated January 2005 and reflected current good practice. Further advice should be sought by Mrs Osborne in relation to regular checks to prevent the risk of Legionella. Good laundry facilities are provided and residents spoken to said that their clothes were always well laundered and returned to them promptly in good condition. The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 21 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29 & 30. The quality of this outcome group is good. Staffing levels are good and the staff were qualified to provide a high level of care. There is no use of agency or temporary staff. Residents have confidence in the staff that care for them. All staff are clear regarding their role in what is expected of them. EVIDENCE: At the time the inspection there were five care staff plus Mrs Osborne on duty. This exceeds the minimum number of staff required by the previous regulator. However, the home does not employ domestic or catering staff, and care staff undertake these roles in turn, hence one member of staff was cooking lunch from 9a.m. onwards. All care staff are aged 18 or over and all seniors are aged 21 or over. Night staff are employed in sufficient numbers to meet the needs of residents. There are currently 12 care staff, 6 of which are qualified to NVQ 2 above and a further 4 who are registered on NVQ courses so that the staff team have the skills and experience to provide a high standard of care.
The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 22 Selected staff files were checked and it was noted that the application form had been revised to make clear that new applicants must put forward their last or most recent employee as a reference and also now includes the rehabilitation of offenders’ declaration. All files checked contained two written references and evidence of proof of identity. The files were generally well kept but it was unclear in some cases when criminal record bureau checks had been returned and seen by Mrs Osborne. The homes recruitment policies include information on equal opportunities, staff code of conduct and a copy of the General Social Care Code of Conduct. Residents spoken to were very complimentary about staff and they were described as ‘very helpful and friendly’. The home provided information on the pre inspection questionnaire about the training that staff had been doing recently and this included positive dementia care, and safe handling of medicines. Staff spoken to confirmed that they were supported and encouraged by Mrs Osborne to attend training to obtain skills and qualifications relevant to their role. The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36 & 38. The quality of this outcome group is good. Staff are supervised and their practice monitored by the provider/manager. The manager has the required qualifications and experience and is competent to run the home. She works to continuously improve services and provide an increased quality of life for residents. There is a strong ethos of being open and transparent in all areas of running of the home. The home has sound policies and procedures that the manager effectively reviews and updates in line with changing legislation on good practice advice. Records are of a good standard and are routinely completed. The home has a good record of meeting relevant health and safety policies and staff are aware of safety arrangements. The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 24 EVIDENCE: Mrs Osborne is skilled and experienced and qualified to manage the home and staff and residents spoken to had confidence in her ability to do so. Staff spoken to said that the ‘staff team work very well together’ and that support was always available from Mrs Osborne and other staff. The homes policies and procedures safeguard resident’s finances. Detailed individual records of monies held on behalf of residents are kept, and monies are now kept separately as required in the last inspection report. Mrs Osborne audits the financial records. Records checked were all found to be correct. Appropriate insurance cover is in place, and includes business interruption. An accountant audits the homes financial records yearly. The home has a commitment to quality assurance policy and this was evidenced by discussion with Mrs Osborne and by checking he records of staff and residents meetings. The home produces a newsletter that is posted to all families and visitors to the home as well as being given to individual residents. The newsletter was informative and included invitations to visitors to attend activities and events at the home such as cream teas for Mothers day and the forthcoming summer fete. Mrs Osborne had undertaken a full internal audit of the home in October 2005. Surveys of stakeholders had been done in 2005 and the results collated. The home has appropriate policies and procedures in place and these are available to staff and updated and revised regularly by Mrs Osborne. Information is available in the office for staff to use for reference purposes. Records examined were well kept, fully completed, dated and signed. The supervision policy has been revised to ensure that supervision covers all topics detailed in the national minimum standards. The policy makes clear that staff are paid for at least three training days per year and that staff are supported and encouraged to access appropriate training. The policy states that staff are supervised daily on an ad hoc basis as required and this was observed during the inspection. Further efforts need to be made to ensure that the target of six supervisions a year is achieved and inspectors discussed with Mrs Osborne the possible delegation of this task to senior staff. Staff supervision should be recorded separately on each occasion. The inspectors saw evidence that the fabric of the building and the equipment used such as bath hoists, electrical equipment, fire extinguishers, was regularly checked and serviced. Records were seen that temperatures checks were made of fridge and freezers. Food was seen to be stored correctly. Please refer to standard 25 in relation to legionella checks. The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 25 All staff had undertaken mandatory training courses including movement handling and fire safety. The majority of staff has completed training in first aid and food hygiene. The fire precautions in the home were up to date, detailed and readily available for staff. The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 26 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 4 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 4 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 3 18 3 4 3 3 3 3 3 3 3 STAFFING Standard No Score 27 4 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 2 X 3 The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 27 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 OP9 Regulation 13(2) Requirement The registered person must ensure the administration medicines procedure is followed at all times by staff. This must include: *all medication administered must be signed for on the MAR sheet *all prescribed medication such as Movicol must be labelled and residents must only be given medication prescribed for them. *the registered person must ensure that residents on 4 or more medicines have a medication review at least six monthly. The registered person must ensure that appropriate monitoring measures to prevent the risk of legionella is in place. Timescale for action 31/07/06 2 OP38 23(1)(a) 30/08/06 The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 28 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 OP9 Good Practice Recommendations The registered person should ensure the administration medicines procedure is followed at all times by staff. This must include: *a record of two signatures for at all handwritten entries on medical administration (MAR) sheets *variable dosage recordings need to be improved *medication due to be returned to the pharmacist should be more clearly defined and kept separately from currently used items *items such as eye drops with a limited time use should have the date of opening recorded The staff file checklist should be revised to include the date of CRB check is returned and who has validated that it is satisfactory. All staff should be formally supervised at least six times per year. 2 3 OP29 OP36 The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 29 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
© This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Elms (Yeovil) DS0000016083.V293619.R01.S.doc Version 5.1 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
