Inspection on 07/04/05 for The Leonard Elms Care Home

This inspection was carried out on 7th April 2005.

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 16/01/07

The Leonard Elms Care Home 15/03/06

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 Home Brinsea Road Congresbury North Somerset BS49 5JH Lead Inspector Alison Murray Unannounced 7 April 2005 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 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 Home Version 1.10 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 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 622704 The Elms Nursing Home Mrs Helen Susan Enticott Care Home with Nursing 36 Category(ies) of Dementia over 65 (36) registration, with number of places The Wilfred Leonard Care Home Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 07/12/04 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 handbasin. 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. The Wilfred Leonard Care Home Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was a very positive unannounced inspection. Over 6 hours were spent in the home. Although five sets of care records were reviewed, the day to day care and experience of the residents was the main focus of the inspection. Many of the residents were not able to express an opinion, so time was spent sitting and chatting with them. During this time, it was possible to observe their body language, and the way staff and residents responded to each other. During the inspection, three relatives, and five staff members were consulted. Since the last inspection, one complaint has been sent to CSCI. This was passed to the home to investigate. Mr Bliss and Mrs Enticott carried out a full investigation into the allegations made. It was not possible to resolve the issues raised, as a significant time had elapsed between the incidents described, and the complaint being notified to CSCI. During this inspection, no evidence was found to substantiate the complaint. What the service does well: What has improved since the last inspection? Staff morale has improved significantly since the last inspection. There was a real sense of team work, and pride in the home. Staff said that they enjoyed their work, and were obviously fond of the residents. The recent appointment of a new deputy manager should have a positive effect on the continuity of care in the home. Relatives said that the health and general wellbeing of the residents had improved since their admission to the home. The Wilfred Leonard Care Home Version 1.10 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Wilfred Leonard Care Home Version 1.10 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 Standards Statutory Requirements Identified During the Inspection The Wilfred Leonard Care Home Version 1.10 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3, 4 and 5. The home does not provide intermediate care, so standard 6 is not applicable. Residents’ needs are thoroughly assessed before admission to the home. Family members are given good information about the home, and the services it offers. These services reflect current good practice in dementia care. EVIDENCE: Mrs Enticott said that she visits prospective residents, either at home, or in hospital to carry out an assessment of their needs. Records for two recently admitted residents showed that this is a comprehensive assessment. In both cases, a care management plan had been obtained from the placing social worker. Relatives said that Mrs Enticott had discussed care and social needs with them. They felt they were given very good information about the home, and the service it offers. The home offers a specialist dementia care service. The building was designed specifically for this client group. Written guidance for staff in the care plans was based on current good practice, and reflected the advice of the mental health team. Conversations with staff and observation during the inspection confirmed that care provided is in line with the written plan. The Wilfred Leonard Care Home Version 1.10 Page 9 One person was originally admitted for an emergency respite stay. Mrs Enticott had carried out an assessment visit at very short notice. Despite this his family felt that they were given all the information they needed to make a decision about the home. A relative said that she had been so happy with the standard of care that the placement was now permanent. The Wilfred Leonard Care Home Version 1.10 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 standard(s) 7, 8, 9 and 10 The health and personal care needs of residents are well met. There is a friendly, informal atmosphere in the home, with evidence of a good rapport between residents and staff. EVIDENCE: Care plans were written for each area of identified need. They provided staff with clear guidance to meet residents’ needs and had been regularly reviewed and updated. Staff demonstrated a good awareness of these needs. Relatives said that they were kept informed of any changes in the resident’s condition. The residents appeared very frail, and few were able to initiate a conversation. They looked relaxed in the home, and were happy to approach the inspector, or chat. All were neatly dressed, and attention had been paid to their hair and nail care. All the gentlemen were clean-shaven. One resident was being nursed in bed. He looked peaceful and comfortable. A care chart confirmed that staff were regularly changing his position, and offering drinks. Visitors commented that the general health of their relative had improved since admission to the home. Staff said that they receive very good support from local GPs and the specialist mental health team. The medication administration records were well maintained, and drugs securely stored. The Wilfred Leonard Care Home Version 1.10 Page 11 There was a very good rapport between staff and residents. It was clear that staff were fond of the residents, and treated them with respect and dignity. One relative said ‘even though my mother is very confused, staff always knock on her bedroom door before entering’. During the inspection, several instances of potentially challenging behaviour were very effectively ‘de-fused’ by staff. Another relative commented that on occasion, he had found his wife wearing someone else’s clothes. He said that he had brought this to the attention of staff, and it had not happened since. Mrs Enticott plans to offer relatives the opportunity to order printed nametapes. She feels that this will make it far easier for staff to identify individual residents’ laundry. The Wilfred Leonard Care Home Version 1.10 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 standard(s) 12,13,14 and 15 Routines of daily living are sufficiently flexible to give residents choice in how to spend their day. Visitors are actively welcomed into the home. Opportunities for leisure and recreational activities would be enhanced by the appointment of a designated activities organiser. EVIDENCE: The inspection started at 10am. Staff said that most residents took breakfast in their room, before being assisted to wash and dress. It was clear that some residents had chosen to go back to bed after breakfast, whilst others were already washed and dressed. Residents were able to choose where to spend their time, moving freely around the home. Care records contained a brief summary of individual likes and dislikes. Despite advertising the post, the home has been unable to recruit an activities organiser. An outside company visit one afternoon a week, to provide musical entertainment. Staff were observed to spend time sitting with residents, chatting or looking at books and magazines. Visitors said that staff always made them feel welcome. One relative said that staff had encouraged her to telephone at any time, to check on her husband’s well being. She was very grateful for this opportunity, and found it reassuring. Regular visitors were greeted by name; others were assisted to find their way around the home. The Wilfred Leonard Care Home Version 1.10 Page 13 Most of the residents’ bedrooms were well personalised, with small items of furniture, pictures, and photographs. The home operates a 4-week rota. The menu is varied, and appears nutritionally sound. Although a choice is not documented on the printed menu, it was apparent that an alternative meal was available on request. The lunch served during the inspection looked and smelt appetising. The majority of residents took their meal in one of the communal dining areas. Tables were laid with attractive linen and crockery. Staff offered residents verbal prompts, and assistance where necessary. The mealtime looked relaxed and unhurried. One resident did not eat much lunch. Staff were observed to offer her a food supplement drink after the meal. Residents were offered drinks at regular intervals during the day. Jugs of squash and tumblers were provided in the communal areas. The Wilfred Leonard Care Home Version 1.10 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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 and 18 The complaint procedure in the home is satisfactory. Staff demonstrate a good awareness of adult protection issues. EVIDENCE: All of the visitors consulted during the inspection said that they would have no hesitation in raising concerns with Mrs Enticott. Communication sheets in the care records indicated that staff discuss any concerns raised informally in the first instance. They said that they were usually able to resolve any problems at this stage. Since the last inspection one complaint was sent directly to CSCI. This was passed to Mr Bliss and Mrs Enticott to investigate. They provided CSCI with a full report of their findings. The complaint was unresolved. A considerable period of time had elapsed between the alleged incidents and complainant raising concerns with CSCI. During the inspection, no evidence was found to substantiate the complaint. Staff consulted during the inspection demonstrated a good awareness of adult protection procedures. The Wilfred Leonard Care Home Version 1.10 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 standard(s) 19 ,20 ,21 ,22 , 23, 24, 25 and 26 The Wilfred Leonard Care Home has been commissioned and designed to a commendable standard. The layout and décor of the home reflect the advice of dementia care specialists and recent research. This attention to detail is most effective. The standard of housekeeping is commendable. EVIDENCE: The accommodation is arranged around a square courtyard. Residents are able to freely walk around the corridors and communal areas. Corridors are painted in contrasting bright colours. One lady, recently admitted to the home, remembered that her bedroom was on the ‘Barbie Pink’ corridor. The enclosed courtyard in the centre of the home provides attractive and safe outside space for the residents. The furniture and fittings are of a good standard, but some joins in the corridor carpet are fraying. These joins were all securely glued down, and did not pose a trip hazard. Mrs Enticott said that she and the maintenance person keep this under review. The Wilfred Leonard Care Home Version 1.10 Page 16 The standard of housekeeping was particularly good. The home was commendably clean, tidy and free from offensive odours. Regular visitors to the home were keen to praise the housekeeping staff. The Wilfred Leonard Care Home Version 1.10 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 and 30 The numbers of staff on duty are adequate to meet the needs of the resident. Despite strenuous efforts, problems in recruiting permanent staff with dementia care experience, to work in the home have affected the continuity of care. Staff receive induction and training to equip them to work in a dementia care setting. EVIDENCE: There were 31 residents in the home during the inspection. Conversations with staff and regular visitors indicated that staffing levels were appropriate to the needs of residents. Staff said that they were kept busy, but still had time to chat with the residents. Visitors said that they did not have a problem finding staff to speak to. Call bells were answered promptly during the inspection. Despite regular advertisements, the home has been unable to recruit a full team of nursing and care staff. Some care staff have been recruited from overseas. They have integrated well with the existing staff, and were seen to communicate effectively with the residents. Any shortfall in staffing numbers is made up by agency staff. Nursing staff said that this was not ideal. They commented that it was difficult to provide continuity of care. They were looking forward to a new deputy manager starting work the following week. Mrs Enticott said that she attempts to book staff who are used to the home and client group. Agency care assistants on duty during the inspection confirmed that they had worked in the home before. One was employed on a The Wilfred Leonard Care Home Version 1.10 Page 18 short-term contract with the agency. A trained nurse supplied by the agency had only worked in the home for one shift. None of the trained nurses currently employed are Registered Mental Nurses. In a specialist dementia care environment it would be good practice to employ both general and mental health trained nurses. Mrs Enticott said that there was an advertisement in the local press to try and address this situation. Staff on duty showed a good awareness of the emotional and mental health needs of the residents. They said that they had received training in dementia care. One of the staff on duty was recently appointed. He was shadowing another care assistant, as part of his induction to the home. An agency nurse said that she had received a good handover from the outgoing staff. They had ensured that she was familiar with the emergency routines. The Wilfred Leonard Care Home Version 1.10 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 32 Staff morale has improved significantly since the last inspection. The staff group are working together well, to meet the aims of the home. EVIDENCE: Staff said that they enjoyed their work. One person commented that the staff were ‘working like a team now...we’ve got a good core of people’ A staff meeting took place during the inspection. Both Mr Bliss and Mrs Enticott were in attendance at this meeting. Transport was provided to ensure that all staff were able to attend. The turnout was good. Staff had put forward items for discussion. They said that they felt comfortable raising issues about the day to day running of the home. Visitors to the home said that they appreciated Mrs Enticott’s visible presence in the home. One person commented that she knew ‘everybody and everything’. Another felt that her empathetic approach to residents and their families had a positive effect on the whole staff team. The Wilfred Leonard Care Home Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 4 3 3 4 3 3 3 4 STAFFING Standard No Score 27 2 28 x 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x 3 x x x x x x The Wilfred Leonard Care Home Version 1.10 Page 21 No Are there any outstanding requirements from the last inspection? 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 Regulation Requirement Timescale for action 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. Refer to Standard OP10 OP12 OP27 Good Practice Recommendations Staff should explore alternative ways of identifing individual residents clothing An activities organiser should be employed to work in the home. The home should continue in its attempts to recruit a permanent staff team. Priority should be given to employing trained nurses with mental health experience. The Wilfred Leonard Care Home Version 1.10 Page 22 Commission for Social Care Inspection Riverside Chambers Castle Street Tangier, 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 Wilfred Leonard Care Home Version 1.10 Page 23 - 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. 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