Care Home: Elm House

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What the care home does well Residents are fully assessed before they are admitted to the home so they know that their needs can be met. All residents have a care plan in place which contains adequate information so that staff know how to meet their needs. Medication management at the home is good so that residents receive their prescribed medications. Residents are offered choice in their daily lives and the standard of catering is good. Residents are treated as individuals and their privacy and dignity is respected. Recruitment procedures, staff training and staff supervision ensure that residents are protected from harm. Residents` financial interests are also safeguarded. The home is clean and comfortable with a warm and welcoming atmosphere. What has improved since the last inspection? Staff are now receiving regular formal supervision sessions six times a year to enable them to discuss care related issues and training needs with senior staff. What the care home could do better: The home should continue to maintain and improve the care and service given to people who live at the home. CARE HOMES FOR OLDER PEOPLE Elm House 76 Pillory Street Nantwich Cheshire CW5 5SS Lead Inspector Mrs Joan Adam Unannounced Inspection 28 February 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm House Address 76 Pillory Street Nantwich Cheshire CW5 5SS 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) 01270 624428 01270 510241 www.clsgroup.org.uk CLS Care Services Limited Jane Haines Care Home 37 Category(ies) of Old age, not falling within any other category registration, with number (37) of places Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 37 service users in the category OP (Old age, not falling within any other category) 9th May 2006 Date of last inspection Brief Description of the Service: Elm House provides care and accommodation for thirty-seven older people. Located in Nantwich it is close to the town centre and other local amenities such as shops, pub and train station. The lay out of the two-storey building is such that there are two passenger lifts to the separate first floors. There are a variety of aids and adaptations around the building to help those residents with mobility problems. The home has 35 single bedrooms and 1 room registered as a double room which is occupied by one resident at present. All bedrooms contain hand-washing facilities; one room has an en-suite toilet. Staff are on duty twenty-four hours a day to deliver care to the residents. The fees for the home are as follows: Cheshire County Council standard offer for residential residents £353.91 per week. Full cost charges for self-funding individuals £450/£465 per week, dependent on the size of the room. Elm House DS0000006502.V346781.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 the people who use this service experience good quality outcomes. The inspector visited without an appointment on 28th February 2008. The visit took six hours. The information reviewed included the previous inspection report, service history and other information received about the service. The findings were discussed with the manager on the day of the visit. Before the site visit the manager was asked to complete an Annual Quality Assurance Assessment to provide information as part of the inspection. The views of the people who live at the home and their relatives were also sought; their comments are incorporated into this report. During the site visit the inspector spoke to the manager, some staff members and people who live at the home. People’s records were looked at to check the care they receive. Policies, procedures and records of medication, care plans, staffing rotas and training records were also checked. What the service does well: Residents are fully assessed before they are admitted to the home so they know that their needs can be met. All residents have a care plan in place which contains adequate information so that staff know how to meet their needs. Medication management at the home is good so that residents receive their prescribed medications. Residents are offered choice in their daily lives and the standard of catering is good. Residents are treated as individuals and their privacy and dignity is respected. Recruitment procedures, staff training and staff supervision ensure that residents are protected from harm. Residents’ financial interests are also safeguarded. The home is clean and comfortable with a warm and welcoming atmosphere. Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3&6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A robust admissions procedure ensures that all prospective residents have their needs assessed, and are assured that the home has the capacity to meet their needs, prior to admission. EVIDENCE: The care plans looked at for two residents who had recently been admitted to the home showed that their needs had been assessed prior to admission. The manager said that she goes out to assess anyone interested in coming to live at Elm House, to find out whether their needs can be met at the home. The home does not provide intermediate care therefore standard 6 was not assessed. Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Individual plans of care ensure that residents’ health and personal care needs are met. Medications at the home are well managed to ensure that residents receive the correct prescribed medication at the right time. EVIDENCE: Each person who lives at the home has a care plan in place. Care plans were looked at for four people living at the home. These were comprehensive and contained health assessments, risk assessments, and records of visits by GP, physiotherapist and other health professionals. The plans were written in a person centred way “ I need help with washing myself” and gave a picture of the person. The care plans had been reviewed each month and any changes were highlighted so that staff could see what changes had taken place at a glance. Good daily entries were made to record care that had been given that day. Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 10 Risk assessments were completed in relation to pressure areas, moving and handling, nutrition, continence and falls. There was evidence that residents and relatives had been involved in the plan of care. Life histories had been completed by the residents, their families or the staff at the home. Medicines are well managed and good records are kept. All medicines items are checked in and signed for and a stock balance is kept for any items carried forward from one month to the next. Eye drops and other items with a limited shelf life had been dated when they were open. With regard to staff in general they were kind, courteous and friendly towards the residents. Staff were seen knocking on the doors of residents before entering and talking to the people who live in the home in a respectful manner. Surveys were returned by people who live at the home and comments such as: “All the staff are pleasant and caring”; “No one could care for me better”. Relatives’ surveys commented: “Pleasant and friendly environment”; “Staff give individual attention whilst building a strong community”; “ treat people as an individual”. Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The routines of daily living and activities available are flexible and varied to suit residents’ expectations, preferences and capacities. EVIDENCE: The home does not have an activities co-ordinator employed at present but staff are continuing with an activities programme, which is varied and suited to the needs of the people living at the home. During a recent residents’ meeting people who live at the home are in favour of the manager employing a new activities co-ordinator to enable more structured outings to take place. Raised beds have been created in the garden to enable people who live in the home to not only use the garden but to plant and weed if they wish to. People who live in the home were seen to go out in the community and visitors spoken with said they could visit any time. One visitor was organising a linedancing troupe to come to the home to entertain residents. A computer has been purchased for the people who live in the home to use and one resident takes and types the minutes of the residents meetings. Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 12 Other residents use the computer to communicate with their families and a web cam has been installed. Menus are in place and are varied to enable choice. Special dietary needs are catered for. One resident commented “Good home with good food”. Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Complaints and concerns are acted on to demonstrate they are taken seriously. An informed staff group and manager protect residents from abuse. EVIDENCE: There have been no complaints received at the home since the last inspection. The home has a satisfactory complaints procedure that was on display. The home has customer feedback forms, which are completed, and any negative comments are acted upon promptly. There are policies and procedures to guide staff on how to make sure that the people who live at the home are protected from harm or abuse. There is also a whistle blowing policy that tells staff how they can make any concerns known. Staff receive training regarding the safeguarding of adults on induction and the manager has a training video which all staff watch. The manager said that she was arranging for staff to access social service training regarding protection of vulnerable adults. Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a safe, comfortable and well-maintained environment, which is equipped to meet their needs EVIDENCE: The bedrooms looked at were nicely decorated, well personalised and adequately carpeted and furnished. Bedrooms are completely refurbished as they become vacant. The dining room floor has been replaced and new furniture has been purchased. The hall and corridor carpets on the ground floor have been replaced and some lounge chairs have been replaced. The garden has been improved with raised beds to enable residents who wish to plant to have more easy access and new garden furniture has been purchased. Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 15 The decoration of communal areas has been arranged for the near future. The home was clean and fresh on the day of the visit. The bedrooms looked at were nicely decorated, well personalised and adequately carpeted and furnished. Bedrooms are completely refurbished if required as they become vacant. The dining room floor has been replaced and new furniture has been purchased. The hall and corridor carpets on the ground floor have been replaced and some lounge chairs have been replaced. The garden has been improved with raised beds to enable residents who wish to plant to have more easy access and new garden furniture has been purchased. Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a good recruitment process and training programme in place to ensure that staff are suitable to work in the home and staffing levels ensure the needs of people living at the home are always met. EVIDENCE: The duty rotas were looked at and there are adequate staff on duty to meet the needs of the residents living at the home. Both the manager and the home services manager are supernumerary All staff have attended moving and handling training, fire safety training, infection control, and senior staff have attended a course on safe management of medicines, Of the thirty one staff employed at the home, only four have not acquired NVQ level 2 in care. Two staff are at present working toward the qualification. The personnel files of three newly employed staff members were seen during the visit. These showed that thorough recruitment procedures are in place including two references for each member of staff and a Criminal Record Bureau Check. Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 & 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents live in a well managed service providing them with safe financial procedures and equipment to meet their needs. Quality assurance systems are in place to ensure the views of residents, relatives and staff are sought and acted upon. EVIDENCE: The manager is experienced and has managed a number of care homes within CLS and has been registered with CSCI. She has qualifications, which include NVQ level 4, and Diploma in Management Studies. Surveys received said she was “approachable” and “supportive.” Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 18 A residents’ meeting held recently discussed current issues and residents were able to put forward their views. Residents’ personal allowances were safely secured and records for credits and debits maintained. Records showed that staff receive regular supervision. Fire records showed that fire detection equipment is tested by contractors regularly through the year and weekly alarm tests are carried out. There were good records of regular fire drills, including the names of the staff attending. Information provided by the manager prior to the inspection (Annual quality Assurance assessment) stated that all the required maintenance and health and safety checks of the building and equipment had been completed. Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 19 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Elm House DS0000006502.V346781.R01.S.doc Version 5.2 Page 21 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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