Inspection on 23/10/07 for The Royal Elms

This inspection was carried out on 23rd October 2007.

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

The inspector 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 Royal Elms 18/07/07

The Royal Elms 10/04/07

The Royal Elms 01/12/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE The Royal Elms The Royal Elms 23 Windsor Road Newton Heath Manchester M40 1QQ Lead Inspector Sue Jennings Unannounced Inspection 23rd October 2007 10:00 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 Royal Elms DS0000067697.V352224.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 Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Royal Elms Address The Royal Elms 23 Windsor Road Newton Heath Manchester M40 1QQ 0161 681 9173 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) Rajanikanth Selvanandan Care Home 26 Category(ies) of Old age, not falling within any other category registration, with number (26) of places The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home will only provide a service to a maximum of 26 people whose primary need for care arises from old age. The matters detailed in the attached schedule of requirements must be completed within the stated timescales. 18th July 2007 Date of last inspection Brief Description of the Service: The Royal Elms Care Home is a care home offering personal care for 26 older people. The home does not offer nursing care. The accommodation is provided on two floors in a Victorian style building, which is serviced by a passenger lift to all levels. The home has a modern extension that provides accommodation for five of the 26 residents accommodated at the home. The entrance to the home is at ground level and the garden area is accessible to all residents. There is a large garden to the rear of the property. It is set among similar sized well-established residential properties. There are three lounges; one of the lounges is the smoking area. There are two double rooms and twenty two single rooms; six of the single rooms provide en-suite facilities. There is an enclosed parking area to the front of the property offering off road parking for approximately eight vehicles. The home is situated in the Newton Heath area of Manchester close to good public transport links to Manchester City Centre and Oldham. Fees for the home are £373.54 per week with additional charges for hairdressing, chiropody and continence aids. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The visit was undertaken as part of a key inspection, which includes an analysis of any information received by the Commission for Social Care Inspection in relation to this home prior to the site visit. The visit was unannounced and took place over the course of 9.5 hours on 23rd October 2007. During the course of the site visit time was spent talking to the manager and the Responsible individual, 2 of the residents and 2 members of staff to find out their views of the home. A number of the Commission for Social Care Inspection’s survey forms were sent to relatives by the home. The survey forms received from residents gave positive feedback about the home, meals and level of care provided. Time was spent examining records, documents, the residents and staff files. A tour of the building was also conducted. What the service does well: What has improved since the last inspection? A new manager who has a long history of managing a care service had been appointed since the last inspection. Procedures for managing medication had been improved and a dedicated medication room had been provided. There have been a number of environmental improvements including redecoration and new carpets. Staff files have been audited and now contain the information required. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 6 New care plans had been introduced and these were being completed for all residents. 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 summary of this inspection report can be made available in other formats on request. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 7 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 Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 8 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 (Standard 6 is not applicable to the home) Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Enough information is made available about the home and assessments are completed before people move in to make sure that their individual needs can be met. EVIDENCE: A user guide is available which contains information about the service provided. The manager told us that this could be made available in large print or alternative languages if requested. We saw that there is an admissions procedure and that assessments are completed prior to anybody moving in. A care manager’s assessment of need was completed for those residents placed by the local authority. Once an individual comes to live there, a care plan is written based on these assessments. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 9 Residents spoken to said that either they or their relative had chosen the home. Intermediate care is not provided. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual needs are generally met well by the home. EVIDENCE: Residents spoken to all said that staff were polite and treated them with respect. Comments included “they are very good” and “all very polite and helpful”. We looked at the care plans for three people and the information provided covered areas such as mobility, diet and personal care. We saw that each resident had a care plan and that a new, more detailed care plan format had been introduced. The care plans were not fully completed and this presented the opportunity to make them more person-centred to address residents’ social and emotional needs. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 11 Recording in daily records has improved but further improvements could be made. Notes kept by staff need to contain good information which can then be used to evaluate and review the care being provided. Risk assessments are completed around areas such as falls, pressure areas and nutrition. We saw that these were generally well completed but more consistency is needed about when they are reviewed. Medication procedures had been improved and a medication room had been provided since the last inspection. They told us that they have had a series of meetings with the dispensing pharmacist. We saw that items were stored correctly and that records were generally kept well. A refrigerator was provided for items requiring cold storage and the temperature was being checked and recorded four times a day. Medication is dispensed in a blister pack monitored dosage system. The training matrix showed that eleven staff responsible for administering medication had received training in the safe administration of medication. Medication Administration Record sheets contained a photograph of the resident to reduce the risk of medication errors. A list of of names, signatures and initials of staff responsible for administering medication should be held with the MAR sheets. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home offers some activities. There is scope to improve this by making sure there is a full social care plan for each person and involving all staff in delivering this care. EVIDENCE: They told us that some activities were arranged including an outside entertainer and aromatherapy, however they did not have an activity programme. One resident said “there’s enough going on” and another person said “I’m not interested”. Both confirmed that where activities were arranged they were asked to join in. They told us that they are researching dementia care training courses so that all residents can be involved when planning activities. As stated previously we saw that care plans could be further improved by including more detailed information about each person’s social and emotional needs. It is recommended that all residents be consulted regarding what social activities they would like. This information could then be used to tailor The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 13 and further improve the activities on offer at the home. This is especially important for the residents who are more dependent on staff. They told us that individual restaurant style daily menus were being developed to put on each table at mealtimes. The menu is currently displayed in the dining room. Residents told us that staff always told them what was on the menu for the day. Residents told us that they enjoyed the food offered with comments including “the food is good”, “the cook is very good” and “quite tasty”. They showed us minutes of a recent residents’ meeting where menus had been discussed. There was an ongoing issue regarding the purchasing and quality of food. They told us that an account had been opened with a large catering supplier and that in future food would be ordered on a weekly basis. They told us it would be the responsibility of the cook to ensure the appropriate quantities were ordered based on the weekly menu. However, there were still instances where orders were not reaching the supplier on time. In order to ensure food stocks are sufficient a system of managing the ordering of food should be put into place. In survey forms residents commented on the poor quality of the bread provided for sandwiches. This was discussed with senior staff and they told us that the bread was now being purchased from a local supermarket in accordance with residents’ preferences. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 14 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 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individuals are aware of how to make a complaint. Policies and procedures are in place which support staff in protecting people living at the home. EVIDENCE: There are suitable procedures in place for dealing with complaints. Complaints were logged in a hard backed book. It was suggested that this be amended to show the complaint, details of the investigation and the outcomes. Records are kept of any concerns or complaints received. The complaints policy and procedure is displayed in the home and is part of the guide for the people living there. The service has internal policies and procedures for the Protection of Vulnerable Adults (POVA) and a copy of the local procedures was also seen to be available. There have been no recent allegations of abuse. They told us that only 7 of the 22 staff have received training in adult safeguarding awareness. The remaining staff including the deputy manager must receive awareness training in adult safeguarding policies and procedures. This is to enable care staff at the home to be able to recognise and report abuse. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 15 Staff spoken to were aware of Adult Protection procedures. One said ‘I would go and tell the manager, I would make sure the resident was OK first’. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 16 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, 21 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People living at the home generally enjoy a satisfactory and clean living environment. EVIDENCE: There is currently some building work going on at the home. A new medication room has been developed so that medication can be more safely stored. The carpets in the lounge and dining area have been replaced and new carpeting has been fitted to corridors. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 17 As a result of the new carpets some of the fire doors did not fit flush into the rebates. A requirement is made under Standard 38 that the fire doors must be refitted to ensure they meet the requirements of the local fire department. The fireplace in the second lounge has been removed and the walls plastered; this area will become a dining area. Residents told us they were happy with the environment. Comments from individuals included “I like my room”, “good” and “ok”. We saw that the home generally provides a pleasant and well-maintained place for people to live. Bedrooms were individualised to residents’ preferences and where residents have agreed to it a photograph is displayed on the outside of their bedroom door. Residents are able to bring personal items, including furniture, with them on admission and are able to have a private telephone line should they wish. We saw that the home was clean and when we asked residents if the home is always fresh and clean they told us “the home is very clean”, “usually” and “always”. A number of bedrooms on the first floor were designated smoking areas. A tour of the building was carried out and it was noted that the smell of smoke was evident throughout the first floor corridor area. It is strongly recommended that extractor fans be fitted to reduce the smell of smoke in the adjoining rooms and communal areas. They told us that a hairdresser visited the home and that one of the resident’s bedrooms was being used as a hairdressing room. A more appropriate area should be made available. A number of light bulbs were not working, making the rooms dark. It is recommended that a method of checking and replacing light bulbs is developed. They told us that one of the toilets on the ground floor had been out of action for a number of months. This toilet should be repaired to provide appropriate facilities for the residents in nearby bedrooms and prevent the risk of infection. Staff spoken to told us that although protective gloves were provided these were only provided in a large size. A selection of glove sizes should be provided to meet the individual requirements of the staff. Staff needing a small size would not be fully protected when wearing a large size glove and this could pose the risk of cross infection. It is recommended that protective gloves be provided in various sizes. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There are adequate numbers of staff on duty with the skills and knowledge to meet residents’ needs and residents are protected well by the recruitment procedures. EVIDENCE: We looked at the recruitment records for 5 members of staff. These had been audited since the last inspection and now contained all the necessary checks including references, Criminal Records Bureau (CRB) and Protection of Vulnerable Adults (POVA) checks. We saw that staff were very caring and spoke to individuals in a polite and respectful manner. Feedback about the way the staff carried out their duties was very positive. Residents told us “they are all very nice”, and “ the staff are good to me”. Staff spoken to told us that that they received the training they need to do their jobs. Staff are offered training in a number of topics such as First Aid, Manual Handling, Fire Safety, Medication administration and some staff had received training in the Protection of Vulnerable Adults. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 19 We saw a training matrix that showed that eight members of staff had received training in Basic Food Hygiene six members of staff had achieved NVQ level II. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 20 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 good. This judgement has been made using available evidence including a visit to this service. Residents live in a home that is safe, well managed and run in their best interests. EVIDENCE: A new manager had been appointed since the last inspection. The new manager has considerable knowledge and experience of running a care service for older people and this is evident in the improvements made to the service since the last inspection. Comments from staff about the management of the home included “good” and “they are approachable”. A requirement is made that the manager makes an application for registration with the CSCI. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 21 The minutes of a residents’ meeting were seen and issues discussed included catering and activities. Letters of compliment are displayed in the communal areas of the home and feedback from relatives and friends in completed surveys was all very positive about the home. There was evidence that staff were receiving supervision on a regular basis but this needs development to make sure that all full time staff receive this at least six times per year. There was an accident report book that met the requirements of the Data Protection Act 1998 and completed reports were filed appropriately. The Mental Capacity Act came into force in April 2007. It is recommended that a copy of the Codes of Practice for the Mental Capacity Act be kept in the office for staff to reference. It provides guidance and information for anyone who works with or cares for people who may lack capacity to make decisions. A quality assurance system has been introduced. People living at the home and their relatives or representatives were sent questionnaires as part of the quality assurance process. The most recent survey was in August 2007 and the results of this are filed and kept in the office. A copy of this survey and the analysis was also forwarded to the CSCI. All staff responsible for preparing or cooking food have received training in basic food hygiene to ensure that they have the necessary skills to undertake their role. Some fire doors did not fully close following the fitting of new carpets. The fire doors must be refitted to ensure they meet the requirements of the local fire department. A large amount of household rubbish such as old carpets and furniture was stored against the wall outside a resident’s bedroom. This was a fire hazard and must be removed. A stair gate was in use at the top and bottom of the middle staircase. This was removed by sliding it up and down vertical guide rails either side of the stairs. A resident was observed removing the gate to come downstairs. This posed a potential risk of falls downstairs to residents and an alternative method of securing this staircase must be found. The home manages the personal allowances for some resident’s records and receipts were kept for all transactions made. Two residents were appointed an advocate from the local authority. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 22 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 3 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 2 The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 23 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. 2. Standard OP31 OP38 Regulation 9 13 Requirement Timescale for action 18/12/07 Application must be made to register the manager with CSCI. The fire doors must be refitted to 18/11/07 ensure they meet the requirements of the local fire department. The style of stair gate used on the middle staircase poses a risk to residents and an alternative must be found. The household rubbish stored in the grounds poses a fire hazard and must be removed. 18/12/07 3. OP38 13 4. OP38 13 18/11/07 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 OP21 Good Practice Recommendations The broken toilet on the ground floor should be repaired to prevent the risk of infection. The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 24 2 3 OP26 OP7 It is recommended that protective gloves be provided in various sizes. It is recommended that daily records reflect the care provided based and links to the needs identified in the care plans. A list of of names, signatures and initials of staff responsible for administering medication should be held with the MAR sheets. It is recommended that all residents be consulted regarding what social activities they would like and that this information forms part of the care plan. It is recommended that the complaint log be amended to show the complaint, details of any investigation and the outcomes. It is recommended that a method of checking and replacing light bulbs is developed. It is strongly recommended that a more appropriate area be made available for hairdressing. It is strongly recommended that extractor fans be fitted to those rooms designated as smoking areas to reduce the smell of smoke in the adjoining rooms and communal areas. It is recommended that a copy of the Codes of Practice for the Mental Capacity Act be kept in the office for staff to reference. 4. OP9 5 OP12 6 OP16 7 8 9 OP19 OP19 OP19 10. OP38 The Royal Elms DS0000067697.V352224.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection Manchester Local Office 11th Floor West Point 501 Chester Road Manchester M16 9HU 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. 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