CARE HOMES FOR OLDER PEOPLE
The Elms (Yeovil) Yeovil Marsh Yeovil Somerset BA21 3QG Lead Inspector
Ms Sue Hale Unannounced Inspection 8th November 2005 09:30 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.V264708.R01.S.doc Version 5.0 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.V264708.R01.S.doc Version 5.0 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 415098 Mrs Lee Teresa Osborne MR JASON 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.V264708.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 5th July 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.V264708.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over the course of one day in November 2005 (4.5 hours). There were 15 residents in the home. 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 inspector spoke to 6 residents during the inspection. As part of the inspection process the inspector used ‘case tracking ‘as a means of assessing some of the National Minimum Standards. This process allowed the inspector to focus on a small group of people living at the home. All records relating to these people were inspected, along with the rooms they occupied in the home. As a result of this inspection 7 requirements were identified and 7 recommendations were made. What the service does well:
Residents live in a safe, clean, comfortable and homely environment. The furnishings, fittings and decoration in the home are all of a very high standard. All residents spoken to were very satisfied with their standard of living and the way in which their private room is looked after by staff. Residents have access to an attractive area outside. All accommodation is on the ground floor and accessible for residents with mobility problems and those who use wheelchairs. All residents spoken to were happy to live at The Elms, and several residents described the home as ‘a lovely place’. Residents have access to medical and health care professionals. Residents spoken to liked the staff and felt that they looked after them with staff working hard to ensure that people living at the home were treated with respect and supported them to maintain as much independence as possible. Staff were familiar with the preferences and individual needs of people living at the home. The standard of meals served at the home was high and residents were very satisfied. Comments included that the food was ‘really very good’ and ‘excellent’. All residents spoken to were confident that any problems or concerns would be listened to and taken seriously by the staff and provider/manager.
The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 6 Residents have contact with the owner/managers, cat, dog and children, and this makes them feel involved, and part of a large family. The staff team have been stable since the last inspection. Staff are supported and encouraged to attend training so that the homes staff team have the skills and experience to provide a high standard of care for residents. Staff are formally supervised to ensure that their practice is appropriate and to a good standard. The home is staffed above the minimum required to ensure that residents health, social and care needs are met. What has improved since the last inspection? What they could do better:
All care plans and risk assessments must be fully completed on admission and regularly thereafter. Reviews of care plans should be undertaken monthly. Residents and/or their relatives must be involved in these processes and be asked to sign that they are in agreement with the care provided. The complaints and adult protection policies and procedures must be updated to meet the national minimum standards and staff made aware of the changes. The owner/manager and all staff must be aware of the correct procedure to follow should an allegation of abuse be made or received. Residents’ personal allowances must be kept individually and records audited by the owner/manager. The staff application form must be revised to strengthen the recruitment and selection procedure to ensure the safety of residents. Staff supervision should be recorded separately on each occasion. The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 7 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.V264708.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Pre admission procedures are robust to ensure, that the home can meet residents needs before they are admitted to the home. EVIDENCE: The inspector checked the files of two residents who had recently been admitted to the home. The provider/manager had met both residents to carry out an assessment to determine if the home was able to meet their needs. The owner/managers said that prospective residents and their families are fully involved in this process. The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 10 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. Care plans did not contain sufficient information for staff to meet residents assess needs. Risk assessments to ensure the health, safety and well being of residents had not been undertaken. Medication is administered and stored in the correct manner. EVIDENCE: The inspector checked selected residents care files. The owner/manager explained that the care planning system was new and that staff were still getting used to the new way in which information is recorded. The assessments and care plans were not fully completed and did not contain detailed instructions for staff on how residents, health, social and care needs are to be met. Risk assessments in relation to reducing the risk of falls, nutrition and pressure sores had not been completed on files checked. The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 11 There was no evidence on files checked that residents and all their relatives had been involved in the care planning process. Care plans had not been reviewed to ensure that they were current and met the residents assessed needs. Residents had access to medical and healthcare professionals as and when necessary. The medication standard was not fully assessed but a check was undertaken in relation to the administration and storage of controlled drugs, which was found to be correct. Several members of staff including the owner/manager are currently undertaking training via distance learning on the safe handling of medicines. The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 12 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): 15. All the residents were very satisfied with the high quality of food served at the home. 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’,’ 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 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 the cook 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. The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 13 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. Residents were confident that they could raise complaints or problems with the owner/manager and that these would be listened to and taken seriously. . Residents’ legal and civil rights are protected by the homes of values, policies and procedures. The adult protection policy needed updating to reflect current guidance. EVIDENCE: The home had received one complaint since the last inspection, this concerned allegations about a member of staff by two residents, but it had been dealt with as a complaint rather than via the vulnerable adults procedure. The provider/manager had spoken to the member of staff concerned who had been sacked. Advice was given on the day of the inspection on how such allegations should have been managed. The home has a complaints policy and procedure that is included in the statement of purpose and service user guide. It needs minor revision, in order to meet the national minimum standards. A suggestion box was displayed so that residents and their relative/visitors could comment anonymously if they chose about the home and the services it provides. The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 14 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. The home had an adult abuse policy and procedure that must be reviewed and updated in line with guidance published by the Department of Health in the ‘No Secrets’ document. The provider/manager and staff spoken to were unclear about the correct procedure to follow should an allegation of abuse be received. Staff must be made aware of the revised procedure so that they would know how to respond appropriately to any allegations of abuse. The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 15 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26. The home provides a high standard of living and environment for residents. EVIDENCE: The home was clean, tidy and odour free on the day of the inspection. The furnishings, decoration and fittings of a high standard and residents are able to personalise their rooms in line with their choices and preferences. The infection control guidelines in place were dated January 2005 and reflected current good practice. The policy and procedure should be revised to reflect these. The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 16 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. The recruitment and selection process should be reviewed to safeguard residents. Staffing levels exceeded the minimum number required and the staff were qualified to provide a high level of care. EVIDENCE: All residents spoken to were very satisfied with the standard of care they receive from the staff team and comments included ‘rule I am very well looked after here’. Staff was observed to be relaxed, friendly, and were seen to treat residents with respect. At the time of the inspection there were four care staff plus the provider/manager 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 carer was cooking lunch from 9 am o’clock onwards. All care staff were aged 18 or over and all seniors were aged 21. Night staff was employed in sufficient numbers to meet the needs of residents. The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 17 No new staff have been employed at the home since the last inspection. The homes application form must be revised to ensure that applicants are aware that the Rehabilitation of Offenders Act does not apply and also that applicants are advised that they should provide a reference from their last employer. There are currently 16 care staff, nine of whom are qualified to NVQ 2 or above so that the staff team are qualified to provide a high standard of care. The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 18 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): 34, 35, 36. Staff are supervised and their practice monitored by the provider/manager. Appropriate financial accounting systems were in place. Residents’ individual finances were not safeguarded. EVIDENCE: Detailed individual records of monies held on behalf of residents are kept, but monies are pooled making auditing impossible. The provider/manager must keep monies individually, and audit the records regularly. Appropriate insurance cover is in place, and includes business interruption. An accountant audits the homes financial records yearly.
The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 19 All staff had received regular formal supervision that had been recorded on their personal staff file. The supervision policy should be further developed to ensure that supervision covers all the topics detailed in standard 36.3 of the National Minimum Standards. The provider/manager was advised to record supervision separately on each occasion to provide clear records. The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 20 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 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 3 18 2 4 X X X X X X 3 STAFFING Standard No Score 27 4 28 4 29 2 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X X 3 2 2 X X The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 21 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 Schedule 3 (1)(b) 13 (4)(b)(c) 15 Schedule 3 (1)(b) Requirement All residents must have a risk assessment in relation to falls undertaken on admission and as necessary thereafter. The provider/manager must ensure that all residents have a fully completed care plan and that they are involved as far as practicable when it is drawn up. If the resident cannot sign the care plan whenever possible a relative/representative should be asked to sign. It should set out in detail the action needed to be taken by staff to ensure all aspects of residents care are met. The provider/manager must ensure that the pressure sore risk assessment and moving and handling assessment is used on admission and undertaken regularly or as necessary thereafter. The complaints policy and procedure must include the name, address and telephone number of the Commission for
DS0000016083.V264708.R01.S.doc Timescale for action 01/12/05 2 OP7 01/12/05 3 OP8 13 (4)(c) 01/12/05 4 OP16 22 (7)(a) 31/12/05 The Elms (Yeovil) Version 5.0 Page 22 5 OP18 12 (1)(a) 13 (6) 6 OP29 Schedule 2 (7) 20 (1)(ab) 7 OP35 Social Care Inspection. 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’ must be developed. The staff application form must be revised to include the Rehabilitation of Offenders Declaration. All residents’ personal allowances must be kept individually and not pooled. 31/12/05 31/12/05 31/12/05 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 OP8 OP16 OP18 Good Practice Recommendations All documentation should be fully completed, dated and signed. The nutritional risk assessment tool should be completed on admission and regularly thereafter for all residents. The complaints policy and procedure should make clear that complainants are able to contact the Commission for Social Care Inspection at any stage of a complaint. The provider/manager should obtain a copy of the Department of Health guidance ‘No Secrets’. All staff must be made aware of the appropriate response should an allegation of abuse be made. The staff application form should make clear that applicants should put their last employer as a reference. The provider/manager should audit residents personal allowance records regularly. The supervision policy should be revised to ensure that supervision covers all topics detailed in standard 36.3. Staff supervision should be recorded separately on each occasion. 5 6 7 OP29 OP35 OP36 The Elms (Yeovil) DS0000016083.V264708.R01.S.doc Version 5.0 Page 23 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.V264708.R01.S.doc Version 5.0 Page 24 - 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!
