Care Home: Elm House

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What the care home does well Elm House provides a homely environment for residents. The home is clean, well decorated and comfortably furnished. There are good standards of infection control in place that are well adhered to. Residents rooms are decorated to colours they have chosen and they are encouraged to bring in their own personal possessions and furniture. Equipment and aids for daily living are provided for them. Residents are fully involved in their care planning and are enabled choices about their daily activities and meals. There is full involvement in planning their meals, shopping for food and they are encouraged to eat healthily and are enabled choices. Staff facilitate family involvement by taking residents to visit and spend time with their relatives at home. Personal support and access to healthcare is good. Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Elm House provides residents with rehabilitation support in conjunction with Elm Park Hospital (an independent hospital belonging to the same organisation). Psychological support is also provided on an individual basis. What has improved since the last inspection? The general atmosphere of the home was more informal and relaxed. Staff and residents appeared to be happier, engaging in light and at times jovial conversation. Both the statement of purpose and service user guide had been reviewed and personalised to Elm House. The admission process had been reviewed and transitional visits extended to ensure residents’ needs could be met and they were able to fully experience life at the home. Care plans had improved and provided good detail for care staff. A daily diary plan had been developed, was discussed and agreed with residents and choices enabled. Monthly quality audits had been introduced for medication, health and safety, care planning etc. Residents’ activities had been increased and their independence encouraged. 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 was 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 were now enabled a choice of furnishings in their rooms and new garden furniture has been purchased to encourage them 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. What the care home could do better: The consent to administration for residents should be obtained. Photographs of residents need to be provided to ensure accurate identification. Staffing levels at night are of some concern as there is only one member of staff on duty. Back up is provided by an on call manager. However in the event of an emergency this may not be sufficient to ensure all residents are safe.Elm HouseDS0000017727.V376328.R01.S.doc Version 5.2 Systems need to be improved to ensure that names of attendees are recorded for fire safety. This will ensure that all staff including those who work during the night attend regularly. Some furniture needs replacement. There is no pandemic plan to be instigated in the event of a flu pandemic. The amount of training provided on one day raises concern that the content may be inadequate to ensure staff receive sufficient information and are competent. There is no designated first aider for the home. Key inspection report CARE HOME ADULTS 18-65 Elm House 192 Wivenhoe Road Alresford Colchester Essex CO7 8AH Lead Inspector Diana Green Key Unannounced Inspection 22nd June 2009 09:30 Elm House DS0000017727.V376328.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 House DS0000017727.V376328.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 House DS0000017727.V376328.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm House Address 192 Wivenhoe Road Alresford Colchester Essex CO7 8AH 01206 824443 01206 824443 jrassell@partnershipsincare.co.uk 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), Learning disability over registration, with number 65 years of age (1) of places Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home may accommodate 3 persons of either sex who fall within the category of learning disability The home may accommodate one named person, aged 65 years and over, falling within the category of learning disability The total number of service users accommodated in the home must not exceed 3 persons The home may provide assistance to one additional person during the day in order they may use the rehabilitation kitchen. The staff member assisting this person must be additional to staff provided in the home. 10th July 2008 Date of last inspection Brief Description of the Service: Elm House is a registered care home providing accommodation for three people under the age of 65 years who have an acquired brain injury. This is one of two homes in the area owned by Partnerships in Care. The registered manager has responsibility for managing both homes. 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 have behavioural problems, which can be managed within the home. Elm House is a detached house situated on the outskirts of the village of Alresford, approximately five miles from the town of Colchester. The home is within walking distance to the village amenities, which include a shop, pub and train station. Single room accommodation is provided, two of which have en suite facilities, one with a bath the other with a shower. The communal bathroom has a shower. The home has a comfortable, safe and fully accessible dining room, lounge and sitting room for shared activities or private use and a large back garden. Car parking for visitors is available at the front of the house. Previous inspection reports are available from the home and the Care Quality Commission website at www.cqc.org.uk. As at June 2009, the fees for accommodation were stated as ranging from £2166.15 to £2366.70 per week. Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 5 Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 6 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. Contact was made with representatives of service users to seek their views on the service. The manager and staff were welcoming and helpful throughout the inspection. What the service does well: Elm House provides a homely environment for residents. The home is clean, well decorated and comfortably furnished. There are good standards of infection control in place that are well adhered to. Residents rooms are decorated to colours they have chosen and they are encouraged to bring in their own personal possessions and furniture. Equipment and aids for daily living are provided for them. Residents are fully involved in their care planning and are enabled choices about their daily activities and meals. There is full involvement in planning their meals, shopping for food and they are encouraged to eat healthily and are enabled choices. Staff facilitate family involvement by taking residents to visit and spend time with their relatives at home. Personal support and access to healthcare is good. Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 7 Elm House provides residents with rehabilitation support in conjunction with Elm Park Hospital (an independent hospital belonging to the same organisation). Psychological support is also provided on an individual basis. What has improved since the last inspection? What they could do better: The consent to administration for residents should be obtained. Photographs of residents need to be provided to ensure accurate identification. Staffing levels at night are of some concern as there is only one member of staff on duty. Back up is provided by an on call manager. However in the event of an emergency this may not be sufficient to ensure all residents are safe. Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 8 Systems need to be improved to ensure that names of attendees are recorded for fire safety. This will ensure that all staff including those who work during the night attend regularly. Some furniture needs replacement. There is no pandemic plan to be instigated in the event of a flu pandemic. The amount of training provided on one day raises concern that the content may be inadequate to ensure staff receive sufficient information and are competent. There is no designated first aider for the home. 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 House DS0000017727.V376328.R01.S.doc Version 5.2 Page 9 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 House DS0000017727.V376328.R01.S.doc Version 5.2 Page 10 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 House 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 three residents at the home one of whom had been admitted since the previous key inspection. The admission processes were discussed with the manager of the home. The resident had received a pre-admission assessment by the manager of Elm Park, an independent hospital for people with brain injuries that is owned by the same provider. Transitional visits were arranged to Elm House. Initial visits lasted approximately two hours, gradually increasing to a whole day. This enabled the potential resident to experience life Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 11 at the home, to stay for a meal and to go on outings and to get to know the residents already living there. A pre-admission assessment was seen in the resident’s care file. 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. This was also confirmed from the care file viewed. 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 House DS0000017727.V376328.R01.S.doc Version 5.2 Page 12 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 House 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’ care plans had been updated with them to ensure they are focused on individuals’ goals and aspirations, as well as their rehabilitation needs and provided a more holistic and person centred approach to their care). 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 House DS0000017727.V376328.R01.S.doc Version 5.2 Page 13 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 and individual interests. Care plans for different elements of care were seen (personal hygiene, /bathing/showering were seen to provide good detail for staff giving them detailed guidance to enable them to provide appropriate care. Assessments were completed for independence, moving and handling, nutrition, continence. 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 individual risk assessments were recorded for example mobility, health, travel, in the bathroom, bedroom, kitchen, finances’ etc. Risk assessments were detailed and evidenced that risks were minimised as part of an independent lifestyle. A relative told us that their loved one was much more independent and that ‘the girls are fantastic. x is very happy and has changed completely’. 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 House DS0000017727.V376328.R01.S.doc Version 5.2 Page 14 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 House 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 House none had been able to take up any employment. The manager told us she had been investigating educational opportunities but due to the lack of insight no residents were interested. However one resident had expressed an interest in computing and the internet which she was pursuing. Each resident had a weekly planner that detailed the daily activities they had agreed with staff to take part in. A resident’s activity plan viewed detailed activities that included walks, going to the pub, listening to music, going Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 15 bowling and shopping trips to the supermarket to buy their food. Games sessions were also arranged and quiet time provided in the evening for hand massage, pedicure and craft sessions. During the visit to the service one resident had gone to a bouncability session which they said they enjoyed. Various trips were arranged to the pub, swimming, cinema, theatre, to the hairdressers, bowling, out for lunch and to various local places of interest (Colchester zoo, Beth Chattos’ Garden Centre, Tiptree jam factory, arts and Crafts centres etc). A DVD evening was arranged and also pampering sessions for those who enjoyed them. Residents spoke of their various outings and one confirmed that they had been to a ‘Motown Concert’. The AQAA informed us that residents are encouraged to maintain close links with family and friends and visiting was open access. A relative spoke very positively about Elm House and also told us that their loved one was brought home every two weeks to visit them and said ‘they bring x for the day, for a meal. X loves music and dancing. It is really lovely. X has changed completely’. The home’s daily routines were observed to be very relaxed. Residents were enabled a choice of time in getting up, going to bed, what to wear, going out and taking part in activities. The whole atmosphere was much more relaxed that observed at the previous key inspection. It was good to see and hear residents engaging in conversation with each other and staff and ‘sharing a joke’. The records confirmed that staff addressed residents by their preferred name and they were observed to engage with them in a friendly and respectful manner. The AQQA informed us that residents were encouraged to be involved in planning their meals and going to the supermarket to buy their own food. The home had a rehabilitation kitchen for residents’ use. One resident enjoyed baking and had baked a cake during the visit to the home. We were told that this was a regular event. Menus were seen on display together with information on healthy foods. 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. This enabled staff to monitor resident’s food and fluid intake and weight, to ensure they were receiving a nutritious diet and to take action if they were under or over weight. The lunchtime meal was observed. Two residents had chosen a pizza and salad and one had chosen to have chicken and vegetables which they clearly enjoyed. The well fitted main kitchen/diner was clean and well organised with dishwasher, fridge and freezer. Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 16 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 House 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 residents are involved in developing their own care plan and their personal preferences are included. There are no set times at Elm House for getting up, going to bed or having meals and residents are therefore able to do this at their own leisure. Observation during the visit to the service confirmed that residents were enabled a choice in time of getting up, what they wore, when and what they ate and how they spent their day. 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 House DS0000017727.V376328.R01.S.doc Version 5.2 Page 17 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. 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. However on resident was self medicating but no risk assessment had been completed to demonstrate that risks had been considered and minimised. Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 18 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 House 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. 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, Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 19 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. However it was evident from discussion and previous knowledge that the registered manager would have no hesitation of making a referral if required. Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 20 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 House 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 electrics, 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.The unit car is available for sole use at Elm House and records confirmed that this is regularly serviced. The garden at the Elm House is not accessible for people with mobility problems and we were informed that a patio and ramp is 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. Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 21 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 and two rooms had en-suite facilities. All rooms were above average size with space for personal possessions (music system, TV’s etc) and other items of furniture. Locks had also been installed on residents’ bedroom doors to ensure their privacy. 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. There was one washing machine and two driers. 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). Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 22 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 House 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. The 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. 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 also on call, it does raise concerns that these levels could place residents in Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 23 danger should they need to be evacuated in an emergency. One staff member spoken with told us ‘they are going out to lunch and enjoying themselves’. The records confirmed that two staff had an NVQ level 2 qualification and that all staff had enrolled onto NVQ programmes. 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 brain and behaviour, mental health, disability etc) to enable them to understand residents needs and to be confidant when providing care. The staff records for four recently appointed staff were viewed. Two 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. Two had evidence of all checks with exception of CRB checks. This was followed up with the organisation’s human resources department who confirmed that details of CRBs are kept on a central database and evidence was received of disclosers having been received for both prior to their appointment. The AQAA informed us that all staff including new staff were undertaking induction to Common Induction Standards. This was also confirmed from the four staff files viewed. Training records were seen and confirmed that all new staff had received one weeks induction training which includes equality and diversity, health and safety, mental health act, brain and behaviour, manual handling, infection control, breakaway techniques, medication administration, confidentiality, food hygiene and PoVA. A training prospectus had been devised and monthly training held at Oaktree Manor. 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 the four staff files viewed. However one member of staff said they had not received supervision for several months. Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 24 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 House 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 House and Elm Cottage (another small care home Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 25 owned by the organisation), spending two days at each service. The duty rotas confirmed which home she was at on which day. The AQAA informed us that a new, more robust, quality assurance system has been implemented within the home to audit key areas on a monthly basis. A senior support worker carries out the monthly audits and reports any areas of concern to the manager. Evidence of audits undertaken were seen during the visit to the service. We were informed that residents are provided with a quastionaire at six monthly intervals to enable them to make comments. Any issues are identified for action and used to improve the service. Some of the policies and procedures within the home have 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. Records viewed at this inspection included: care plans, medication records, statement of purpose, service user guide, staff recruitment and training records, maintenance records and fire safety 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. 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 House DS0000017727.V376328.R01.S.doc Version 5.2 Page 26 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 3 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 3 34 3 35 3 36 2 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 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 X 3 3 3 3 3 Version 5.2 Page 27 Elm House DS0000017727.V376328.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 YA20 Regulation 13(4) Requirement To ensure safe storage of medication, residents who self medicate must have a lockable facility provided. To ensure the safety of residents and staff there must be a qualified first aider employed. Timescale for action 31/08/09 2. YA42 18(1) 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. Refer to Standard YA20 YA30 YA32 YA33 YA33 Good Practice Recommendations Residents who choose to self-medicate should have a risk assessment to demonstrate that risks have been minimised. 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 safely evacuated in the event of a fire, night staffing levels should be reviewed and advice sought from the fire service. To ensure residents can be safely evacuated in the event DS0000017727.V376328.R01.S.doc Version 5.2 Page 28 Elm House 5. 6. YA36 YA41 of a fire, and fire drills should be undertaken at night and the names of staff attending should be recorded. To ensure residents are cared for by well supervised staff supervision should be provided every two months. To ensure residents can be easily identified an up to date photograph should be available for each resident. Elm House DS0000017727.V376328.R01.S.doc Version 5.2 Page 29 Care Quality Commission Eastern Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@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). 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. 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