Care Home: Elm Cottage

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What the care home does well Elm Cottage is a small care home with a homely atmosphere. The environment is comfortably furnished, clean and well decorated. There are good standards of infection control in place and staff are supported by regularly updated policies and procedures that are well adhered to. Involvement of residents’ families and friends is encouraged and support is facilitated to also visit them at home. The care home provides rehabilitation through care that is regularly reviewed and supported by a multi-disciplinary team. There is good access to healthcare with support provided to attend outpatient appointments. A relative told us the care their loved one received was ‘par excellent’ and ‘x gets the best possible care we could have hoped for’. Residents are fully involved in planning and choosing their meals and shopping for food and they are encouraged to eat healthily.Elm CottageDS0000017739.V376331.R01.S.docVersion 5.2 What has improved since the last inspection? Both the statement of purpose and service user guide had been reviewed and personalised to Elm Cottage. The admission process had been reviewed and transitional visits extended to ensure that the needs of people planning to live at the home could be met and they were able to fully experience life at the home. Care plans had improved and provide good detail for care staff. A daily diary plan has been developed for residents. This was discussed and agreed with residents and choices enabled. The atmosphere was very informal and more relaxed than at the previous key inspection. Care staff were noted to engage with residents in light conversation. Residents’ lives appeared more fulfilled with an increased range and choice of activities provided, for example one resident attends a cross stitch club and a weight watchers class. Progress has been made to promote residents’ independence. Outings were arranged to visit families at home, for walks, lunches out and to various local places of interest. There was good access to healthcare, such as speech and language therapy and physiotherapy. Residents were encouraged to go to the hairdressers and have pampering sessions from staff such as foot massage. Menus had been reviewed in consultation with residents. Residents were supported to visit Tesco’s for food shopping where they were encouraged to eat healthily and also enabled a choice in the items purchased. The medication policies and procedures had been reviewed and were easily accessible for staff reference and guidance. A list of staff signature and initials were now in place. Secondary dispensing of medication had ceased and medication was provided in monitored dosage systems to minimise the risk of error. Instruction for application of creams was now included in the care plans. A new medicines cupboard that was suitable for controlled drugs (CD) had been provided and room temperature monitoring implemented to ensure medication was stored within safe recommended levels. Residents are enabled a choice of décor and furnishings rather than the corporate colours previously offered. Staff appeared more content and spoke positively of changes made. Recently employed staff said they felt supported by management and their individual needs were taken into account when determining their deployment in the organisation. New garden furniture has been purchased to encourage residents to spend time outside. All radiators have been covered and window restrictors fitted. The systems for managing residents’ personal monies had improved and were robust. Monthly quality audits had been introduced for medication, health and safety, care planning etc. What the care home could do better: There was no record of the resident having consented to have medication administered by staff. There is only one care worker on duty at night with a manager on call. This poses a risk in the event of having to evacuate residents.Elm CottageDS0000017739.V376331.R01.S.docVersion 5.2There have been no fire drills for night staff to ensure they are competent in the event of a fire. There is no list of staff attending fire drills to ensure all staff regularly attend. Some furniture needs replacement .There is no pandemic plan to be implemented in the event of a flu pandemic. Health and safety training training (first aid, fire safety, risk management, stress, acidents/incidents etc) is provided over three hours with manual handling training being provided over two hours approximately which is inadequate to provide information on legislation, theory and practical work. There was no designated trained first aider.There was no current photograph of one resident for identification purposes. Key inspection report CARE HOME ADULTS 18-65 Elm Cottage 7 Lucerne Road Elmstead Market Colchester Essex CO7 7YB Lead Inspector Diana Green Key Unannounced Inspection 24th June 2009 09:00 Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm Cottage Address 7 Lucerne Road Elmstead Market Colchester Essex CO7 7YB 01206 822794 F/P 01206 822794 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) Partnerships in Care Ltd Samantha Jayne Long Care Home 3 Category(ies) of Learning disability (3) registration, with number of places Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Persons of either sex, under the age of 65 years, who require by reason of a learning disability (not to exceed 3 persons) 17th July 2008 Date of last inspection Brief Description of the Service: Elm Cottage is a registered care home providing accommodation for three people under the age of 65 years who have an acquired brain injury. It is one of two homes in the area owned by Partnership in Care. The home runs two programmes of care: one for community rehabilitation and the other being long term supported living assistance for service users requiring maintenance of their rehabilitative state, who may also present with behavioural problems, which can be managed within the home. Elm Cottage is a small, detached bungalow situated in a residential cul de sac in the village of Elmstead Market, approximately five miles from the town of Colchester. The home is within walking distance to local village amenities, which includes a shop, a pub and the local GP surgery. The village is on the main bus route to the town of Colchester and the seaside town of Clacton on Sea. Single accommodation is provided and a communal shower room. The home has a lounge and dining/sitting room for shared activities. Previous inspection reports are available from the home, Partnerships in Care. As at July 2009, the fees for accommodation were stated as ranging from £22166.15 to £2366.70 weekly. Elm Cottage DS0000017739.V376331.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 star. This means that people who use this service experience good quality outcomes. This unannounced inspection took place on 22nd June 2009. All of the Key National Minimum Standards (NMS) for Younger Adults, and the intended outcomes, were assessed in relation to this service during the inspection. This report has been written using accumulated evidence gathered prior to and during the site visit, including the homes Annual Quality Assurance Assessment (AQAA). The Annual Quality Assurance Assessment (AQAA), which is required by law to be completed by the service, is a self assessment that focuses on how well outcomes are being met for people using the service. This was completed by the registered provider and returned to us prior to the visit to the home. Information received in the AQAA provided us with some detail to assist us in understanding how the registered persons understand the services strengths and weaknesses and how they will address them. The inspection process included reviewing documents required under the Care Home Regulations. A number of records were looked at in relation to residents, staff recruitment and training, staff rotas and policies and procedures. Time was spent talking to staff, residents and the manager. The manager and staff were welcoming and helpful throughout the inspection. What the service does well: Elm Cottage is a small care home with a homely atmosphere. The environment is comfortably furnished, clean and well decorated. There are good standards of infection control in place and staff are supported by regularly updated policies and procedures that are well adhered to. Involvement of residents’ families and friends is encouraged and support is facilitated to also visit them at home. The care home provides rehabilitation through care that is regularly reviewed and supported by a multi-disciplinary team. There is good access to healthcare with support provided to attend outpatient appointments. A relative told us the care their loved one received was ‘par excellent’ and ‘x gets the best possible care we could have hoped for’. Residents are fully involved in planning and choosing their meals and shopping for food and they are encouraged to eat healthily. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: There was no record of the resident having consented to have medication administered by staff. There is only one care worker on duty at night with a manager on call. This poses a risk in the event of having to evacuate residents. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 7 There have been no fire drills for night staff to ensure they are competent in the event of a fire. There is no list of staff attending fire drills to ensure all staff regularly attend. Some furniture needs replacement .There is no pandemic plan to be implemented in the event of a flu pandemic. Health and safety training training (first aid, fire safety, risk management, stress, acidents/incidents etc) is provided over three hours with manual handling training being provided over two hours approximately which is inadequate to provide information on legislation, theory and practical work. There was no designated trained first aider.There was no current photograph of one resident for identification purposes. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 8 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 Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People planning to live at Elm Cottage can be assured their needs are assessed prior to admission to ensure the care home can meet their needs. EVIDENCE: The home had a Statement of Purpose and Service User Guide that were comprehensive documents. The Statement of Purpose had been reviewed and was seen to meet regulatory requirements. The Service User Guide was last reviewed during November 2008 and provided comprehensive information for residents in pictorial format to enable them to easily understand the information. There were two residents at the home both of whom were living at the home at the time of the previous key inspection. The admission processes were discussed with the manager of the home. One resident had a pre-admission assessment seen on their care file. Another person who had been a patient at Elm Park, an independent hospital for people with brain injuries owned by the same provider, for five years and was on a transitional visit to the home. We were informed that initial visits lasted approximately two hours, gradually Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 10 increasing to a whole day. This enabled the potential resident to experience life at the home, to stay for a meal and to go on outings and to get to know the residents already living there. The completed Annual Quality Assurance Assessment (AQAA) informed us that during the transitional phase prospective service users are supported to complete paperwork regarding their likes and dislikes, and their goals and aspirations. The AQAA informed us that the pre-placement document has been revised and updated to assess the needs of potential service users and now covered the service users history, their medical history, their skills and knowledge, personal beliefs and preferences and their independence. All residents had access to independent advocacy services. The service user guide had been updated to provide information of the independent advocacy service through an organisation named ‘RETHINK’, representatives of which visits the service monthly. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Elm Cottage can expect to have control of their lives and to be fully involved in planning their care and independent lifestyle. EVIDENCE: The AQAA informed us that all residents’ plans had been updated with the individual, to ensure they are focused on the their goals and aspirations, as well as their rehabilitation needs. Occupational therapists and speech and language therapists are also consulted where required, and assessments carried out as necessary. A new key worker system has been put into place to ensure residents received more consistent support and to provide them with a choice of individual. Residents’ relatives are consulted where residents do not have the capacity. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 12 Two support (care) plans were viewed during the visit to the care home. Both included a pen picture of the resident, demonstrating that staff were aware of their history, preferences and individual interests. Care plans for different elements of care were seen, such as personal hygiene, toileting, household tasks, speech and language therapy, health and safety, eating and drinking, meal planning and preparation, in-house activities and physiotherapy. These were seen to provide good detail for staff giving them detailed guidance to enable them to provide appropriate care. Support plans had been signed by the key worker and resident and had been reviewed monthly during regular meetings which enabled them to voice any concerns. The AQAA informed us that the Care Programme Approach (CPA) meetings are held every 6 months and all professionals involved in the service users are invited, which includes physiotherapists, speech and language therapists, occupational therapists and neuropsychiatrists. This was also confirmed from the two records that were viewed. The care records viewed confirmed that a basic practical independent assessment was recorded for individual needs and activities undertaken, for example in the bedroom, bathroom, dealing with clothes and laundry, in the kitchen, money and finances, health, mobility, and health and safety. Risk assessments were detailed and evidenced that risks were minimised as part of an independent lifestyle. Policies and procedures in place demonstrated the home’s commitment to minimising identified risks and hazards and promoting the health and safety of residents. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 13 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): This is what people staying in this care home experience: People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service . People living at Elm Cottage can expect to have opportunities to engage in activities that meet their social needs and enhance their lives. EVIDENCE: Due to the complex needs of people living at Elm Cottage none had been able to take up any employment. Both residents had a weekly planner that detailed the daily activities they had agreed with staff to take part in. For both residents this included going with staff for walks, for a drive, shopping, home visits and outings to places of local interest such as Manningtree, Brightlingsea, Clacton, Blake Craft Centre and Colchester. A resident’s activity plan viewed detailed activities that included physiotherapy, going to the gym, going for a walk, foot massage and seeing Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 14 the speech and language therapist. During the visit to the home residents were just returning from a walk with staff. We were informed that various trips were arranged to the pub, out for a meal, visits to swimming, cinema, theatre, to the hairdressers, bowling, out for lunch and to various local places of interest (Colchester zoo, Tescos, Brightlingsea, Colchester, Clacton, home visit, Elmstead Market for a walk and to the local Food Company etc). A relative told us ‘they get plenty of trips out’. Residents spoke of their various outings and one told us they enjoyed reading, watching television, playing cards and scrabble with staff and going to a stitch club each month and they were looking forward to going to a family graduation ceremony. They also told us ‘I get much better care than at X’. They said that since being at Elm Cottage they had stopped smoking, lost some weight and were able to wear contact lenses, showing they were encouraged to take control of their life which was good to hear. The AQAA informed us that residents are encouraged to maintain links with their families and friends and visiting was open access. One resident’s care plan stated that support is to be encouraged with family members and visits to a relative were to be facilitated. The atmosphere at Elm Cottage was very relaxed and one resident told us that they were enabled a choice of time in getting up, going to bed, what they did and how they spent their day and said ’they mostly let me do what I want’. The AQQA informed us that residents take part in household chores as part of their rehabilitation and are encouraged to be involved in planning their meals and going to the supermarket to buy their own food. One resident’s care plan included a care plan for meal planning and preparation. The two care records viewed included a nutritional assessment that had been completed on admission and a risk assessment of likes and dislikes, a menu planner and a weight chart. One resident told us they went to a weight watchers class and had lost some weight since receiving the support. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 15 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Elm Cottage can expect to have their personal and healthcare needs met and to be supported to have an independent lifestyle. EVIDENCE: The AQAA informed us that there are no set times at Elm Cottage for getting up, going to bed or having meals and activities are all done at resident’s leisure. A resident spoken with during the visit to the home confirmed that they choose what time to get up or go to bed and how they spent their day and said they could mostly do what they wanted. Since the previous key inspection a key worker system has been introduced to enable residents to have consistency in their care and support. This was also confirmed in discussion with a resident and from the records viewed. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 16 We were informed that all residents were registered with the local GP practice. Residents attended the practice where they were able and GPs also attended on request. There was evidence in the records viewed of residents being seen by opticians, dentists, and chiropodists. Access to occupational therapists, physiotherapists, speech and language therapists and a Consultant Neuropsychiatrist was arranged as part of their rehabilitation. A relative told us that access to physiotherapy had been limited but had recently improved. The records also provided evidence that a Mental Capacity Act assessment had been made by the consultant. The medication systems for the home were discussed with the manager. Since the previous key inspection the home’s policy and procedures had been reviewed and included a list of homely remedies that had been agreed with the GP. There was a list of staff signatures and initials of staff authorised to give medication to enable appropriate follow up in the event of an adverse incident. Medication was provided in monitored dosage systems and individual containers from the supplying pharmacy. There were appropriate procedures for the receipt and disposal of medication in place that were well adhered to. Medication was stored in a lockable metal medication storage cupboard that was secured to an external wall in the office and had been provided since the previous key inspection. Advice had been sought from the local pharmacist to ensure the cupboard was also suitable for storage of controlled drugs. Monitoring of room temperature storage was undertaken and recorded to ensure medication was stored within safe recommended temperatures (25°Centigrade). The home had a Controlled Drugs (CD) register available but no CD drugs were required and the register had therefore not yet been in use. The kitchen domestic type refrigerator was used for storage of medicines such as eye drops that required cold storage and temperatures were monitored to ensure this remained within recommended levels. Prescriptions were seen by the home for checking and were returned to the pharmacy for dispensing. Senior staff with appropriate training (confirmed from the training records) administered all medication. The medicines administration records and supplies for two residents were checked. Medication Administration Records (MAR) sheets were completed accurately and in full. All supplies were available as required. One resident was prescribed creams and this was detailed in the care plan ensuring that staff were aware and were able to confirm the cream had been applied as instructed. However there was no record of consent from the resident to medication being administered by care staff. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Elm Cottage can expect to have their concerns and complaints listened to and acted upon and to be protected by safeguarding adult procedures. EVIDENCE: The home had a complaints policy and procedures that included timescales for a response. However there were no details of the local authority included in the procedure for residents’ or their representatives’ information. A summary of the complaints procedure was displayed in the entrance hall of the home and a log for recording informal complaints was held which was checked regularly by staff. The manager stated that the procedure was available in written, oral, large print, widget and audio format. The AQAA informed us that all staff received training Brain and Behaviour which is carried out by the Neuropsychiatrist. This was also confirmed from the record of staff training provided during the visit to the service. This ensured staff understood residents’ behaviour and could therefore react appropriately. No complaints had been received by the home or the Commission since the previous key inspection. A relative spoken with told us ‘we have no concerns. We are very satisfied generally’. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 18 The home had a safeguarding adult’s policy, procedures and a whistle blowing policy in place to enable staff to raise concerns. Local procedures for Southend, Essex and Thurrock were available for staff guidance. Regular updated training was provided for all staff on safeguarding vulnerable adults and confirmed from the training records viewed. We were informed that representatives from Essex safeguarding adults held three monthly meetings at Elm Hospital that the manager also attended, ensuring she was up to date with current practice. The manager said that she was in the process of reviewing the safeguarding procedures for the home. There had been no safeguarding alerts made or received by the home. The procedures for handling residents’ monies were discussed with the manager. The system had been reviewed since the previous key inspection to ensure that only the shift leader has access and any transactions are countersigned by another staff member. Records are maintained and receipts held for any transactions. Neither the manager nor any staff are appointee for either resident living at Elm Cottage. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Elm Cottage can expect to live in a clean, comfortable well maintained home that respects their privacy and individual choices. EVIDENCE: The home was well decorated and well maintained and the records confirmed that regular safety checks had been carried out on the electricity, gas supply and other safety equipment. Internal weekly and monthly checks were also in place to to ensure the health and safety of staff and residents and confirmed from the records viewed. We were informed that the unit car is available for sole use at Elm Cottage and is regularly serviced and maintained. Since the previous key inspection the staff room had been refitted and reorganised and was pleasantly decorated. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 20 The garden at Elm Cottage is not suitable for residents with mobility problems and requires a patio and ramp to be installed.Since the previous key inspection shrubs had been planted and garden furniture provided to enable residents to sit outside when they choose. The records and staff practices confirmed that the building complied with the requirements of the local fire service and environmental health. The AQAA informed us that residents’ bedrooms are decorated in a colour they choose and they are encouraged to personalise their bedrooms as they choose with pictures and their own furniture. This was confirmed during a tour of the premises. All residents’ rooms were single. All rooms were above average size with space for personal possessions (music system, TV’s etc) and other items of furniture. Since the previous key inspection locks had also been installed on residents’ bedroom doors to ensure their privacy. We were informed that residents are now enabled a choice with regard to furnishings rather than the corporate colours previously provided for curtains etc. The premises were observed to be clean and free from odour. Staff hand washing facilities (liquid soap, paper towels and foot operated bins) were provided throughout all relevant areas. The laundry room was domestic in size, clean and well organised. Two industrial machines had been provided, one washing machine and one drier. Systems were in place to minimise risk of infection via the use of disposable gloves and alginate bags for any laundry soiled by body fluids, placed directly in the washing machines; washing machines had the capacity to carry out sluice wash cycles (i.e. wash at 65 degrees centigrade for a minimum 10minutes). Policies and procedures were in place for staff guidance in infection control. However there was no pandemic plan in place in the event of flu pandemic. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Elm Cottage can expect to be cared for by robustly recruited staff who are well trained and clear of their role and responsibilities but night staffing levels do not provide assurance that in the event of an emergency they will be safeguarded. EVIDENCE: We were informed that there had been a high turnover of staff since the previous key inspection and staffing was not yet at full establishment. Some staff worked at both Elm Cottage and Elm House. The staff rota pattern had been changed to allow for more activities to take place including evening activities. From observation staffing levels appeared appropriate and residents were well supervised and well cared for. A relative told us ‘there are more full time staff now…and the staff now are very good’. The duty rota was viewed and confirmed that staff were providing support during the day and evenings to enable activities and outings to take place. However night staffing levels comprised one staff member. Whilst we were informed that a manager was Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 22 also on call, it does raise concerns that these levels could place residents in danger should they need to be evacuated in an emergency. One staff member spoken with said they felt supported by management as their individual needs had been discussed and taken into account when arranging their depolyoment. There were no staff with an NVQ level 2 qualification. However the AQAA informed us that all staff are now enrolled on NVQ courses and the Senior Support Worker is undertaking NVQ Level 3. From discussion with the manager and staff and an inspection of records it was evident that care staff who had worked at the home for some time were skilled, experienced and competent to meet residents’ needs. New staff had received training, for example understanding brain injury, to enable them to understand residents’ needs and behaviours. The staff records for two recently appointed staff were viewed. Both of the staff records included evidence that the required checks (two satisfactory references, identification, full employment history, Criminal Records Bureau Disclosure (CRB) and POVA first check) had been obtained prior to appointment. The AQAA informed us that all staff including new staff were undertaking induction to Common Induction Standards. This was also confirmed from the two staff files viewed. Training records were seen and confirmed that all new staff had received one weeks induction training which includes equality and diversity, confidentiality, manual handling, health and safety, mental health act, food hygiene awareness, adults safeguarding and complaints management and management of violence and agression. However the health and safety training (first aid, fire safety, risk management, stress, acidents/incidents etc) is provided over three hours with manual handling training being provided over two hours approximately which is inadequate to provide information on legislation, theory and practical work. There was no designated trained first aider. Handover sessions were provided between shifts to ensure that staff were made aware of residents’ changing needs. Evidence of supervisions being undertaken was seen in one of the two staff files viewed. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 23 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living at Elm Cottage can expect the home to be well managed with good standards of health and safety that protects them and staff. EVIDENCE: The registered manager was appointed in July 2008, had completed NVQ level 4 in Care and had recently completed the Registered Manager Award which is currently being externally verified by the college. The manager had experience in care of people with learning disabilities and from discussion appeared a competent and skilled manager. The manager has responsibility for covering the management of Elm Cottage and Elm House (another small care home Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 24 owned by the organisation), spending two days at each service. The duty rotas confirmed which home she was at on which day. A relative told us the manager is ‘absolutely fantastic. She has pulled together so much. There is nothing you cannot discuss with her’. The AQAA informed us that as part of the new Quality Assurance Programme that had been put in place at Elm Cottage, residents are given questionaires to complete every six months. Any areas of concern raised are discussed either at residents’ meetings or with key workers and action taken to used to improve the service. Evidence of audits undertaken were seen during the visit to the service. Some of the policies and procedures within the home had been reviewed and updated, following a timetable of review. Records held on behalf of residents were kept up to date and stored safely in secure facilities in a locked office in accordance with the Data Protection Act 1998. However there was no current photograph of one resident for identification purposes. Records viewed at this inspection included: the statement of purpose, service user guide, care plans, medication records, staff recruitment and training records, policies and procedures, fire safety and maintenance records. The home had a health and safety policy and procedures for staff guidance. The records viewed confirmed that new staff received health and safety training and regular updated training was provided. Evidence of a sample of records viewed showed that there were systems in place to ensure the servicing of equipment and utilities (e.g. gas, electricity certificates, annual PAT testing etc.), and there was evidence of appropriate weekly and monthly internal checks being carried out (e.g. checks on fire equipment, fire alarms and emergency lighting, hot tap water temperatures, etc.). All radiators had been covered since the previous key inspection and window restrictors fitted. Regular checks are also carried out by the health and safety manager and maintenance team to ensure the health and safety of service users and staff. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 25 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 3 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 3 30 3 STAFFING Standard No Score 31 X 32 2 33 2 34 3 35 2 36 3 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 X 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 3 3 3 x Version 5.2 Page 26 Elm Cottage DS0000017739.V376331.R01.S.doc 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 YA42 Regulation 18(1) Requirement To ensure the safety of residents and staff there must be a qualified first aider employed. Timescale for action 30/09/09 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. Refer to Standard YA30 YA32 YA41 YA42 YA42 YA42 Good Practice Recommendations To ensure staff have appropriate guidance a flu pandemic plan should be developed. To ensure that care staff are skilled and competent 50 should have an NVQ level 2 qualification. To ensure residents can be easily identified an up to date photograph should be available for each resident. To ensure residents can be safely evacuated in the event of a fire, night staffing levels should be reviewed and advice sought from the fire service. To ensure staff are competent to safely evacuate residents in the event of a fire, fire drills should be undertaken at night and the names of staff attending should be recorded. To ensure the health and safety of residents and staff the content and length of health and safety training including manual handling should be reviewed. Elm Cottage DS0000017739.V376331.R01.S.doc Version 5.2 Page 27 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries.eastern@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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