Inspection on 16/01/07 for The Leonard Elms Care Home

This inspection was carried out on 16th January 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 Leonard Elms Care Home 15/07/09

The Leonard Elms Care Home 15/03/06

The Leonard Elms Care Home 07/04/05

The Leonard Elms Care Home 07/12/04

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

CARE HOMES FOR OLDER PEOPLE The Wilfred Leonard Care Centre Brinsea Road Congresbury North Somerset BS49 5JH Lead Inspector Barbara Ludlow Unannounced Inspection 09:30 16 January 2007 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Wilfred Leonard Care Centre DS0000045770.V315696.R02.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 Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Wilfred Leonard Care Centre Address Brinsea Road Congresbury North Somerset BS49 5JH 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) 01934 853834 01934 852673 The Elms Nursing Home Mrs Helen Susan Enticott Care Home 36 Category(ies) of Dementia - over 65 years of age (36) registration, with number of places The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 03/08/06 Brief Description of the Service: The Wilfred Leonard Care Home is registered to provide dementia care, with nursing, for up to 36 older people. The home is in a rural setting on the edge of the village of Congresbury. Visitors to the home would require their own transport. There is a large car park. The Wilfred Leonard Care Home adjoins The Elms Nursing Home. Both homes are owned by Mr Bliss, but are registered separately. Mrs Helen Enticott is the registered manager of the Wilfred Leonard Care Home. The home is purpose built and opened in May 2004. It was designed with the needs of the client group in mind, using advice from dementia care specialists. Accommodation is provided on two floors. All of the bedrooms are for single occupancy, and have en suite toilet and wash hand basin. A passenger lift ensures easy access to all areas of the home. An enclosed courtyard in the centre of the property offers attractive, and secure outside space. Fees range from £545 to £600 per week. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This key standard unannounced inspection was undertaken by B.Ludlow for CSCI, the outcome of this inspection is excellent. Pre inspection information was prepared by the home manager and was sent to CSCI in advance the inspection. There was a registered nurse in charge of the home at the start of the inspection. The manager Mrs H Enticott and the home proprietor Mr P Bliss and Mrs P Martin, all came to the home during the inspection period to provide access to documentation and to assist with the inspection process. There were 34 service users in residence and all were seen during this inspection visit. Written responses to CSCI were made by 7 relatives and one G.P. Their comments are included in the text of the report. A random inspection visit of one hour was made on 3rd August 2006; medications management was examined and all was satisfactory. Time was spent at this inspection meeting with service users in their rooms and in the communal areas of the home. Methodology used included general observation of daily life for the service users and the case tracking the care of individuals. Observation was made of the service at lunchtime and of the refreshments offered during the day. The staff on duty were observed as they interacted and worked with the service users. Staff were spoken with during the day about their roles and training they have received. Visitors to the home were seen and their opinions were sought about the care and service at Wilfred Leonard Care Home. Records were sampled, these included care planning, complaints and maintenance checks. Staff files and training records were also sampled. Contractual arrangements with the service users were sampled in conjunction with the inspection of the sister home The Elms on 25th January 2007; these findings are included in this report. A tour of the premises was made. The home shares the catering facilities of the adjacent sister home, The Elms Nursing Home. The kitchen was seen and the chef was spoken with. All the management team remained at the home to receive feedback and the visit closed at 18.40hrs. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? What they could do better: There should continue to be close management attention paid to the catering provision for service users and the assessment of dietary needs until the catering service improvements are sustained. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 7 One new member of the catering assistant staff and one chef whose last food handling training was in 1999 were due to receive food hygiene training, this training had been arranged with a local college. The chef confirmed that new kitchen staff receive basic food hygiene training at their induction. Attention was drawn to the storage of open packets of dried foodstuffs and the cleaning of shelves in the kitchen storeroom. Fridge and freezer temperature records were up to date but there were no daily temperature records for the smallest fridge where the milk is stored. These matters were brought to the attention of and were discussed with the cook and the management team at the time of the inspection. The care plan examined for one diabetic did not have a completed nutritional assessment and the management of the condition was not separately care planned. This oversight was brought to the attention of the manager at this inspection. 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 Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 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 Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5 NMS 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Visits to the home are welcomed. There is a sufficient range of information for prospective service users and their families or representatives. Contracts are issued and contractual arrangements are clear. Pre admission assessments are made to ensure that care needs can be met on admission to the home. EVIDENCE: Case tracking was used to assess the care records held. Pre admission assessment had been made and fully recorded for prospective service users prior to their admission to the home. A dependency scoring tool is used to assess the level of care required. Copies of the community nurse assessment by the Primary Care Trust (PCT) for Registered Nurse Care Contribution (RNCC) for nursing care were seen on file. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 10 At the inspection a copy of a blank service user contract was seen. The trial period is the first four weeks of residence. Contracts for the service users at the home were presented at the inspection of the sister home, The Elms. These records were sampled and were clear about the costs of the care service. One visitor commented that they were given information about the home and were pleased with their decision to make this choice with their relative. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10,11 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are treated respectfully. Care plans were person centred and there was recorded evidence of health monitoring and health promotion. Attention was seen to be given to pain control and good family contact where a service user was frail and unwell. EVIDENCE: The care plans for five service users were examined. Service users are assessed prior to admission to the home to ensure that their care needs can be met. Care plans were detailed and had photographic identification. Daily entries are made and personal care is recorded. A range of risk assessments are made, these included one for pressure sore risk, others for nutritional risk and the risk of falls. With the exception of one nutritional assessment for a diabetic these records were up to date and had been reviewed. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 12 Health promotion included weight monitoring and flu injections. Input by the local GP was recorded. CSCI received positive feedback about the home from a GP who regularly attends the home A little more social detail would enhance the lifestyle information held, for example the Christian names of spouse and children, if appropriate. This was discussed at the inspection. Medications storage, records, drug ordering and returns were examined; this was all carefully managed. Creams were labelled with opened on dates and stock was well managed. Random monthly checks are made by two staff and are recorded as a quality audit and control measure. Controlled medication was checked and was correctly stored and accounted for. The medications fridge temperature was monitored daily and was held within a safe range. Service users were observed throughout the inspection day, interactions with staff were polite and respectful at all times. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service users are treated with respect. Visitors are welcomed into the home. Service users who are able, mobilise freely around the home and can spend their time as they wish. The communal areas are well used and service users were kind and tolerant towards each other. The lunch was served hot and looked nourishing. Regular drinks are available. EVIDENCE: Time was spent in the communal areas of the home. There is a member of staff on duty in the lounge at all times when service users are present; this was seen to be effective. The music played in the lounge was changed periodically throughout the day. Staff explained that musical tastes were catered for and the service users seemed to enjoy this background music. Activities were offered, a seated hand ball game in the lounge, was enjoyed by those who chose to join in. Drinks were served in shatterproof glasses and hot drinks in cups with saucers. There were a high number of service users identified who required help with their food at lunchtime. This help was given discreetly. One relative The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 14 commented that food could go cold when service users were waiting for assistance with their meals. Lunch was served at midday in both the lounge and the dining room. Chicken pie with potatoes, broccoli and gravy was served with steaming gravy on hot plates. Pureed meals offered were chicken with potato and peas and gravy. Rice pudding with jam was served as a dessert. The meals were nicely presented and looked appetising. Birthdays are celebrated and cakes are made to celebrate the occasions. Cakes are made and are served with afternoon tea, which was quite a social occasion. Visitors are offered refreshments. The chef has audited the service users to assist with menu changes. The chef also stated that themed menus had been offered and this had been successful. He also stated that a cooked breakfast is offered and breakfasts are served in the service users own rooms. The kitchen staff are due to have food hygiene refresher training and this was confirmed as booked. A cupboard area needed to be cleaned and opened packets of dry foodstuffs were identified for sealed storage in the potentially steamy atmosphere of the kitchen. One fridge was identified for inclusion on the temperature and cleaning schedules. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a complaints procedure and complaints are dealt appropriately with by the management. Staff receive abuse awareness training. All staff had Criminal Record Bureau (CRB) checks and Protection of Vulnerable Adults (POVA) checks before commencing work at the home. EVIDENCE: The home had received a complaint about the quality of the food. This has been fully investigated and changes have been made to the catering processes at the home. The home’s management has since monitored catering at the home. Staff spoken with demonstrated their awareness of the risks to elderly people of abusive behaviour. Recruitment files were sampled and all newly recruited staff had CRB and POVA First checks before commencing work at the home. The pre inspection information indicated that all other staff at the home had undergone these checks. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.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): 19,20,21,22,23,24,25,26 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Wilfred Leonard Care Home has been commissioned and designed to a commendable standard. The layout and décor of the home reflects the advice of dementia care specialists and recent research. This attention to detail is most effective. The standard of housekeeping remains commendable. EVIDENCE: The accommodation is arranged around a square courtyard, which is accessible in warmer weather and has seating and a raised garden. The home’s design is easy for the service users to move around in freely and safely. There is level access around the home with a passenger lift between the ground and first floor. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 17 Bedrooms are personalised and very homely. The bathrooms and toilets are accessible, have assisted facilities and were clean and hygienic. The corridors have handrails for the service users to be safer when independently mobile around the home. The communal areas are well used. The lounge provides two distinct areas for sitting. Drinks were served and available in the lounge throughout the day. There is a staff presence in the communal lounge at all times when service users are present. The home was very clean and fresh smelling at this unannounced visit. Infection control practice is supported in this environment by a good level of staff hand washing facilities and good waste management practices. Service users and relatives spoken with confirmed that they are very happy with the environment, the cleanliness and the accommodation. One described their relative’s bedroom as ‘perfect’. Protective clothing such as gloves and aprons are available for all staff. The cleaner confirmed that there is safe storage for all cleaning chemicals in line with the COSHH guidance, in a locked cupboard. Laundry bags for soiled washing were seen in use. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.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 excellent. This judgement has been made using available evidence including a visit to this service. The home has an established staff team. There was a sufficient staff number on duty to meet the care needs of the service users. Staff are skill mixed and some have received specialist training to improve their awareness of needs in dementia care. Good evidence was seen for staff training and supervision. There was a good standard of staff recruitment. EVIDENCE: There is a registered nurse on duty at all times. The regular staff know the service users well. Staff received praise from families of service users, two relatives writing to CSCI remarked on how well their relatives are cared for by the staff at the home. The home had a sufficient number of staff on duty throughout the day. Agency staff are used to cover staff vacancies and absence. Regular staff are requested from the agencies used and are supplied where at all possible for the continuity of care. Agency staff on duty confirmed that they had been to the home before, one commented that they ‘enjoy’ coming to the home as there is always a ‘nice atmosphere’ and it is ‘safe’ and they also said it was enjoyable because it ‘ flows’. Five staff files were sampled, there was evidence of good recruitment procedure with CRB / POVA First checks made before the staff commenced The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 19 working at the home. Induction records were detailed and were in place. First appraisals had been carried out for new staff two months after commencing work at the home. The home has two maintenance staff with individual responsibilities for maintenance work and alarm and equipment testing at the home. The catering staff are shared with the adjacent sister home, The Elms. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.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): 31,32,33,34,35,36,37,38 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. The home is well managed. The service is run in the best interest of the service users in residence. Service users are protected by the home’s management systems and maintenance. EVIDENCE: The manager Mrs Enticott, has achieved her Registered Managers Award, and is a qualified registered nurse. Mrs Enticott provides sound leadership and manages in a clear and professional manner. There is management support from the proprietor Mr P Bliss and Mrs P Martin for the home. Administrative and the reception support are effective. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 21 The feedback from relatives and service users was strongly positive about the management of the service and the quality of the care and environment. The home has quality monitoring systems to assess the service from time to time. The results of this monitoring were shared with the inspector. Very positive feedback was given from families. The manager has commenced relatives and residents meetings since the last announced inspection visit. These were reported to have ‘taken off’ and are proving to be helpful with the quality monitoring of the service. Service records were sampled and all checks were up to date. The home’s two maintenance staff undertake the regular fire alarm and equipment tests, these were seen to be in order. The pre inspection questionnaire had been completed in August 2006 and reflected the up to date servicing of equipment such as the lift, fire alarm, emergency nurse call system, hoists and assisted baths and emergency lighting. Records were safely managed and stored and access was appropriately restricted. The grounds and environment are in good repair and are well and safely maintained. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.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 3 3 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 3 3 3 3 3 3 4 STAFFING Standard No Score 27 4 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 3 3 3 3 3 3 3 The Wilfred Leonard Care Centre DS0000045770.V315696.R02.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. Standard OP38 Regulation 13(4) (c) Requirement The registered person must ensure that catering standards at the home are safely maintained. Timescale for action 19/03/07 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 OP15 Good Practice Recommendations Care plans for special dietary needs should be completed and sufficiently detailed. The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Somerset Records Management Unit Ground Floor Riverside Chambers Castle Street Taunton TA1 4AL National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Wilfred Leonard Care Centre DS0000045770.V315696.R02.S.doc Version 5.2 Page 25 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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