Care Home: Elgin House

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What the care home does well The overall care is planned in a responsible manner, and takes into account interests, preferences, needs and abilities of the people living at the home.The home allows people who live there freedom to experience every day life and be independent in what they do. The home was comfortable in appearance, was maintained to a good standard and set in pleasant surroundings. The home has a dedicated staff group who have been at the home for a long time and have a good understanding of the people who live at the home their needs and abilities. The home provides good training opportunities for staff. What has improved since the last inspection? There have been no major in the home since the last site visit. The home has computerised all its records, which makes it easier for people living at the home to access. The home continues with its plan of refurbishment improving the environment for people living there. What the care home could do better: There are no major areas requiring improvement although the home should address areas as detailed in this report. This is to maintain a safe and pleasant place for the people who live there CARE HOME ADULTS 18-65 Elgin House 89 St Lawrence Road North Wingfield Chesterfield Derbyshire S42 5LJ Lead Inspector Nancy Bradley Unannounced Inspection 21st April 2008 09:00 Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 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 Elgin House DS0000019978.V362631.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 Adults 18-65. 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. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elgin House Address 89 St Lawrence Road North Wingfield Chesterfield Derbyshire S42 5LJ (01246) 854486 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) renshaw-harris@supanet.com Mrs Christine Mary Renshaw Mr John Renshaw Helenor Renshaw-Harris Care Home 12 Category(ies) of Learning disability (12) registration, with number of places Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Plus One (1) Day Care Place Date of last inspection 11th December 2006 Brief Description of the Service: Elgin House is a converted detached house situated in North Wingfield, between Chesterfield and Clay Cross. The home is on a main bus route and close to local amenities. Accommodation is provided for 12 adults with learning disabilities requiring personal care and support. All the bedrooms are single and the home has several lounge areas. There are accessible gardens and sitting areas to the rear of the house. The home looks to enhance independence and develop learning skills. The use of community facilities is encouraged through the development of individual care plans and activity programmes. One-day care place is provided. Charges at the time of this visit are £367.45 per week, which includes the price of a week’s holiday. There are no ‘hidden extras’ that are charged for, although service users do contribute their mobility allowance to the running of the home’s minibus, which is accessed by everyone. Service users pay for services like hairdressing that are arranged outside the home, and towards some activities. The home currently has one vacancy. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This was an unannounced key inspection and took place over a total of five hours. We spoke with the registered manager, care staff and people living at the home. The inspection activity during this site visit was to assess the service against the key National Minimum Standards and these are identified through the report. We looked at all the information that we received or asked for, since. last key inspection. This included the following : The annual quality assurance assessment (AQAA) this was sent to us by the home. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives us some numerical infromation about the home. Additionally, time was spent in preparation for the visit, looking at the service history and the previous inspection report. Records were examined relating to the people living there and the general running of the home. There were ten people living at the home on the day of the visit, the home currently has one vacancy. We sent out twelve “Have Your Say” questionnaires and we received ten completed questionnaires, from people living there who confirmed they were very happy at the home and were looked after by the staff and could not wish to live anywhere else. We received seven completed questionnaires from both staff and relatives all were very positive about the home. We received a warm, friendly and enthusiastic welcome from the people living at the home. What the service does well: The overall care is planned in a responsible manner, and takes into account interests, preferences, needs and abilities of the people living at the home. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 6 The home allows people who live there freedom to experience every day life and be independent in what they do. The home was comfortable in appearance, was maintained to a good standard and set in pleasant surroundings. The home has a dedicated staff group who have been at the home for a long time and have a good understanding of the people who live at the home their needs and abilities. The home provides good training opportunities for staff. What has improved since the last inspection? 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. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 2 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to ensure that people who use the service have their needs fully assessed and met prior to admission. This ensures that people’s holistic needs are appropriately met. EVIDENCE: The majority of the people who are admitted to the home have their needs assessed by social workers or through the care management system. The single assessment then forms part of the planned care people receive. Also the home undertakes their own individual comprehensive needs assessments. This provides a person centred record of their individual needs, including identified strengths and needs, long-term goals, and evaluation. A life history is also included in the assessment. There was evidence on record to show that placing Authorises are not regularly reviewing the care needs assessment of people they place at the home. The registered manager agreed to look into this as a matter of urgency. The majority of the people have been living at the home for a long time, and there have been no new admissions since the last site visit. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 6,7 and 9. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a care planning and review system in place, which ensures that people’s individual needs are met. EVIDENCE: During the visit care plans of two people who live at the home were seen. The key worker for each person at the home had compiled the care plan and evidence was seen of care plans being reviewed on a regular basis. People living at the home who were case tracked had a comprehensive care plan, which was in accordance with their assessed need and formulated within a risk assessment. All care plans were very detailed and comprehensive including people’s individual lifestyle preferences and choices; the interventions prescribed by outside healthcare professionals were appropriate. Daily records are also maintained on each person who lives at the home. The home has moved to computer records and needs look how people who live at the home can sign their agreement and be kept informed about their care plan. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 10 There was evidence to show that care plans are being reviewed on a regular basis. The home currently compiles a two monthly summary and then formally reviews the care plan once every six months. People living at the home knew who their key worker was and told us how they help them on a daily basis. We discussed with the home about people who live there having access to the local Advocacy Services. Risk assessments were in place covering such issues as, people’s health and safety, physical health, nutrition, mobility, tissue viability, and risks associated with social activities. Risk assessments were are also monitored and updated as required. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 11 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13 15 16, and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There were arrangements in place to enable people to maintain and develop appropriate relationships, which enhances’ their independence. The home provides a well-balanced and nutritious diet to ensure that peoples dietary requirements are met EVIDENCE: The care records of two people from the home seen provided detailed needs assessment and care planning information regarding their social, recreational, educational and occupational activities both within the home and outside in the community. Several of the people from the home have been able to access IT and have attended classes locally. Discussion with people from the home during the visit confirmed they were very happy living at the home and they liked the activities offered. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 12 They told us they go on holiday to a caravan, narrow boat, Blackpool, and Butlins. Various photographs, which were around the home showed, people having a good time and enjoying themselves. The relationships observed between care staff and people who live at the home appeared open and good-humoured. People at the home told us they have a close relationship with the staff who play an important part in their lives. The staff encouraged the people living at the home to take pride in their appearance and their dress sense is respected The daily routines are flexible with every one being able to make their own decisions about how they spend the day. The majority of the people who live at the home are unable to work due to their level of disability, however some are able to attend the local day centre and adult education classes. Their personal goals, choices and preferences were identified and properly recorded risk assessments were in place for each person in relation to the activities they were engaged in. All activities available to people living at the home are shown on the homes’ information board. Information on peoples’ records indicated that contact with family and friends were appropriate. Any restrictions on contact are recorded in care plans. People at the home can speak with family and friends by telephone and will soon be able to have access and use e-mail. People at the home are encouraged to participate in the running of the home and were seen helping with daily household tasks. From examination of the menus the home is providing a healthy well-balanced and nutritious diet. People at the home made positive comments about the meals and said their likes and dislikes are taken in to account. During lunchtime every one was given a choice of menu. We had lunch with everyone at the home. The fridge and food temperatures were seen and these were within a safe range. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 13 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 18,19 and 20. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living at the home receive personal and health care support in a way, which promotes their independence and is in accordance with their preferences and wishes. EVIDENCE: From records seen and from discussions with staff, peoples’ health and personal needs were being met People living at the home were generally healthy and records showed that staff promptly contacted the appropriate medical services. People living at the home are registered and attended services within the community including doctor’s optician, podiatry, dentist, and audiologist. The people at the home said they have a choice of taking a shower or bath daily. A record is kept of people who are at risk of developing pressure sores and several of the people like to have their weight recorded. People at the home see this as part of maintaining a health life style. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 14 Most of the people at the home have some contact with learning difficulties service at Ashgreen. The home maintains records of all hospital and doctors visits. The home uses the NOMAD (monitored dosage) system for medication, which is stored securely in a locked cupboard. Senior care staff, which have undergone the relevant training to administer medication take the NOMAD cassettes to the people who able to self administer their medication. The medication is checked by the staff and person taking the medication then signs the medication administration chart along with the staff. Only one person at the home is not using the NOMAD system, and their medication is dispensed directly from the containers supplied from the pharmacy under staff supervision. However the home is not maintaining an audit trail for this medication or for non-prescribed medication. The home agreed to look into this and address the shortfall. The home has a good relationship with the local pharmacist and the registered manager confirmed they undertake a review of medication practice once every two months. There was a record of sample signatures belonging to both staff and people who live at the house. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 15 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Arrangements are in place to safeguard people’s welfare and ensure that their concerns are listened to and acted upon. EVIDENCE: The complaints policy was seen and included a timescale of 28 days for a response to complaints. The complaints procedure is included in the service user guide. The registered manager confirmed they had not received any complaints about their service neither have we the Commission. The home holds regular meetings with people from the home. Some of the minutes of these meetings were seen and demonstrated that issues raised, were dealt with promptly and appropriately. People living at the home indicated that any concerns could be discussed with the staff that were always very helpful and friendly. The adult protection policy was seen and as discussed with the registered manager needs to be revised and update to reflect the changes of emphasis to safeguarding adults. The home has a copy of Derbyshire County Councils Social Services Adult Protection policy however they do need to obtain update copy and information. Staff spoken to and from records seen indicated that staff have an awareness of adult protection issues. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 16 There has been no reported incident of Safeguarding of Adults since the last inspection. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 24 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is clean, well equipped and maintained, which prompts people’s independence EVIDENCE: We carried out a full tour of the home, accompanied by two of the people who live there. During the tour we were showed us the fire alarm system and told us what they do when it goes off. People living at the home commented that they like their bedrooms and the home asked them what they wanted in their bedroom. Several of the people were football supports and had furnishings showing this. . Bedrooms were inspected with consent and all rooms had been decorated and furnished to personal choice and were being personalised. All communal areas were inspected together with staff facilities. Communal areas were generally bright airy and well lit. Bathrooms were homely and comfortable. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 18 The Registered Manager stated that they had a rolling programme for refurbishment of the home and had identified areas that required attention. The home has a well-equipped laundry, and satisfactory hygiene procedures were in place. All areas of the home were clean and odour free on the day of the visit. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 32,34 and 35. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has recruitment and selection procedures in place to ensure that the appropriate staff are employed to care for vulnerable people. EVIDENCE: The home has a good percentage of staff who hold a NVQ level 2 or above. Staffing levels at the home were examined and remain satisfactory and meet the needs of the people who live there. There are currently no staff vacancies. The home has a recruitment procedure in place, which ensures that staff appointed are suitable to work with vulnerable people. Several staff personnel records were examined which confirmed that thorough employment checks were carried out. All new staff are required to provide two references, a full employment history, have a clear Criminal Records Bureau clearance and complete a probationary period. On checking personnel records we noticed that CRB clearance dates were over three years for several staff. As a sign of good practice the home may wish to consider undertaking new CRB clearance checks. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 20 The records seen at the visit indicated that all the required information has detailed in Schedule 2 of the National Minimum Standard is not being obtained by the home. The area of shortfall were discussed with the registered manager The staff personnel records were well presented Discussions with the registered manager confirmed that new recruitment procedures have been introduced, which involve the people who live there participating in the interview process. The home currently does not maintain records on interviews it holds. Records examined and discussions with the staff confirmed that the home has a formal structure for supervision of staff. Annual appraisals are undertaken. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 21 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 37 39 and 42. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Systems are in place to ensure that people living at the home have a voice and their views are listened to. EVIDENCE: The registered manager has a number of years experience in the care sector, and has gained a Recognised Manager’s Award. Discussion with the registered manager confirmed she has a good an awareness of her role and responsibilities. The manager and deputy manager both have the registered manager award at NVQ level 4. The Regulation 26 visits by the Registered Provider to the home include details of consultation with service users and staff. The home’s quality assurance exercise found that all the people who live there were happy with the way the home was run, they felt they were treated with Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 22 respect, were safe and comfortable. They felt they were supported in their relationships and were able to tell someone if they had any problems. They also have meeting every month, and minutes were seen. These indicated that they felt able to comment on the service provide. The people who live there made comments about the home that were positive indicating that they regarded the owners as being ‘excellent people’ and that ‘good homes should get more money’. Matters relating to health and safety, as well as administrative tasks, are dealt with by one of the proprietors. Accident records were seen and found to be appropriate. Several of the home’s policies and procedures have not been updated for some time. The registered manager agreed to address this area. The registered manager confirmed she had as yet to complete and return the Annual Quality Assurance Assessment questionnaire. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 X 2 3 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 X 28 X 29 X 30 3 STAFFING Standard No Score 31 x 32 3 33 X 34 3 35 3 36 X CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 3 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 3 X 3 X X 3 X Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 24 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 YA20 Regulation 13 Requirement The home must have suitable recording procedures in place for the handling,safekeeping and administration of all medication. This is to ensure that people living at the home are fully protected and there is a clear audit trail for medication. Timescale for action 30/04/08 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 YA2 YA6 YA23 Good Practice Recommendations The home should ensure that all referring agencies review peoples care needs assessments on a regular basis. The home should look at ways in which people living at the home can sign their care plan and are kept up to date on changes in their care. The home should obtain up to date information from the Social Services Department on Safeguarding Vulnerable Adults. This information should be included in their safeguarding Adults procedures. The home should maintain records of all interviews held at the home. DS0000019978.V362631.R01.S.doc Version 5.2 Page 25 4 YA34 Elgin House 5 6 7 YA34 YA34 YA40 The home should update Criminal Records Bureau clearance for staff that have been working at the home over three. The home should ensure they have full proof of identity for all care staff. All polices and procedures should be updated as required. Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Eastern Region Commission for Social Care Inspection Eastern Regional Contact Team CPC1, Capital Park Fulbourn Cambridge, CB21 5XE 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 Elgin House DS0000019978.V362631.R01.S.doc Version 5.2 Page 27 - 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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