Care Home: Elm Lodge

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What the care home does well People feel that they receive good care from the staff. One person said, `staff are lovely, they can not do enough for you`. Another person said, `I am happy living here, I am treated very well`. The manager makes sure that a thorough assessment of the needs of the people who use the service is carried out. This means that people can be sure that the home will be able to meet their needs properly. One person said, `I was able to come and have a look around before I moved in and was given some information about the home`. This helps people to make their decision about whether they wish to move into the home. All the care plan information is now on an electronic system. This makes information easier to access for staff and provides good information about people`s individuality, their progress and any areas for concern. This helps in making sure that care is person centred and any issues can be identified and acted on promptly. Staff have a very good understanding of the care needs of people who live at the home and work well with health care specialists if there are any concerns about people`s health. A health professional who was visiting the home said, ``the home is good at keeping us informed about any issues. Whenever I visit staff always know the reasons why I am here and have a very good knowledge of people`s needs`. One person living at the home said, `the care is very good. Nothing is too much trouble for the staff`. This enables people to receive the right kind of support promptly in order to have their needs met. People feel that their concerns are listened to and know how to make a complaint. This helps in encouraging people to raise any concerns and have confidence that any issues will be addressed properly. There is a warm, friendly and welcoming atmosphere in the home. A relative said, `the home is first class, it is always welcoming and friendly`. A health professional who was visiting the home said, `there is always a good atmosphere when I visit`. The staff team are committed to providing good standards of care so that people`s quality of life is maintained and their needs are met. The management are supportive to people who use the service and the staff team. One person who uses the service said, ``the owners are lovely, they can not do enough for you`. A staff member said, `the management are unbelievable, they always put people who are living here first and will do whatever they can to make sure they have a good quality of life`. A health professional visiting the home said, `this is an exceptional home and you can`t fault it`. What has improved since the last inspection? People now receive a copy of the home`s terms and conditions when they move into the home. This enables people to receive written information about the service they will be provided with and their rights. Meetings are held on a more regular basis with people at the home and their relatives to discuss the care and services. This helps people who use the service and their relatives to be more involved in care planning and means that care is more person centred to suit people`s individual needs. A dentist carries out six-monthly checks so that people`s oral hygiene can be maintained. There has been an improvement in the way that medication is recorded. This helps in making sure that people receive the medicine they need. Additional areas of the home have been made available to enable people to watch alternative television channels. The home has had new furnishings and changes to the layout to improve the pleasantness of the environment for people. There are new tables and chairs in the dining room and some flooring has been fitted in a downstairs bathroom to maintain people`s safety. A new call system has been installed so that people access staff more easily if needing assistance. What the care home could do better: Arrangements could be put in place so that senior staff are more involved in putting care plan information onto the new electronic system. This will help in developing their knowledge and skills in planning and evaluating the care that people need. Medication refrigerator temperatures could be checked every day to make sure medication is being stored at the correct temperatures. Consideration could be given to looking at more ways to enable people who wish to spend time out of the home to be able to do so in order to meet their social needs. One person said, all the days can seem the same, it can be a bit boring`. Two surveys received from staff members said, `there could be more activities and outings`. Staff could receive formal supervision more regularly to make sure they are receiving the support they need to meet people`s needs and to address any management issues.As part of the home`s quality assurance system, the views of professionals who have involvement with the service could be sought to inform the home about what it is doing well and any areas for improvement. Better arrangements could be put in place so that people have access to their personal monies at all times. CARE HOMES FOR OLDER PEOPLE Elm Lodge Cluntergate Horbury Wakefield West Yorks WF4 5DB Lead Inspector David White Key Unannounced Inspection 3rd June 2008 08:30 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 Lodge DS0000062249.V365383.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 Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm Lodge Address Cluntergate Horbury Wakefield West Yorks WF4 5DB 01924 262420 01924 262420 elmlodgecarehome@btinternet.com 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) Mrs Julie Mortimer Mr Philip Mortimer Mrs Lynne Harrison Care Home 17 Category(ies) of Dementia (17), Old age, not falling within any registration, with number other category (17), Physical disability (17) of places Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP, Physical disability - Code PD and Dementia - Code DE The maximum number of service users who can be accommodated is: 17 16th May 2007 2. Date of last inspection Brief Description of the Service: Elm Lodge Care Home is registered to provide care for 17 Older People. It is located close to the centre of Horbury, Wakefield. The home is on the local bus route and all the local amenities are easily accessible. The home is set back in its own grounds and has a large walled garden with a lawn to the front and car parking space to the rear. The home provides a large communal lounge a small quiet room with a telephone for people’s use and a dining room. The local Health Centres support the home and provide health care as required. As of 3 June 2008 fees at the home were £388 per week. People are responsible for paying for such things as hairdressing, chiropody, newspapers and selected social activities. The home has a service user guide that provides information about their service for current and prospective residents. A copy of this guide is provided to all prospective admissions to the home by the management of the home along with a copy of the most recent inspection report if requested. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means that people who use the service experience good quality outcomes. The Commission for Social Care Inspection inspects homes at a frequency determined by how the home has been risk assessed. The inspection process has now become a cycle of activity rather than a series of one-off events. Information is gathered from a variety of sources, one being a site visit. More information about the inspection process can be found on our website www.csci.org.uk We brought this site visit forward after receiving information from the care provider in their self-assessment that there had been a marked reduction in the number of referrals to the home that had impacted on occupancy levels. They also informed us that the previous manager had resigned. We went to the home without telling them that we were going to visit. This report follows the visit that took place on 3 June 2008. The visit lasted from 8.30am until 4.30pm. The purpose of the visit was to make sure that the home was operating and being managed in the best interests of people living there. Information has been used from different sources for this report. These sources include: • • • Reviewing information that has been received about the home since the last inspection. Information provided by the manager on an Annual Quality Assurance Assessment questionnaire. Surveys returned from eight people who use the service, four relatives of people who live at the home, five staff and two social care professionals. During the visit time was spent talking to people who live at the home, care staff, the housekeeper, a relative, a health professional who was visiting the home and the registered providers, one who is the manager of the home. We observed staff caring for people in communal rooms, looked at various records relating to care, staff, and maintenance, and looked at some parts of the building. The registered providers were available throughout the site visit and the findings were discussed with them at the end of the inspection. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 6 What the service does well: People feel that they receive good care from the staff. One person said, ’staff are lovely, they can not do enough for you’. Another person said, ‘I am happy living here, I am treated very well’. The manager makes sure that a thorough assessment of the needs of the people who use the service is carried out. This means that people can be sure that the home will be able to meet their needs properly. One person said, ‘I was able to come and have a look around before I moved in and was given some information about the home’. This helps people to make their decision about whether they wish to move into the home. All the care plan information is now on an electronic system. This makes information easier to access for staff and provides good information about people’s individuality, their progress and any areas for concern. This helps in making sure that care is person centred and any issues can be identified and acted on promptly. Staff have a very good understanding of the care needs of people who live at the home and work well with health care specialists if there are any concerns about people’s health. A health professional who was visiting the home said, ‘‘the home is good at keeping us informed about any issues. Whenever I visit staff always know the reasons why I am here and have a very good knowledge of people’s needs’. One person living at the home said, ‘the care is very good. Nothing is too much trouble for the staff’. This enables people to receive the right kind of support promptly in order to have their needs met. People feel that their concerns are listened to and know how to make a complaint. This helps in encouraging people to raise any concerns and have confidence that any issues will be addressed properly. There is a warm, friendly and welcoming atmosphere in the home. A relative said, ‘the home is first class, it is always welcoming and friendly’. A health professional who was visiting the home said, ‘there is always a good atmosphere when I visit’. The staff team are committed to providing good standards of care so that people’s quality of life is maintained and their needs are met. The management are supportive to people who use the service and the staff team. One person who uses the service said, ‘‘the owners are lovely, they can not do enough for you’. A staff member said, ‘the management are unbelievable, they always put people who are living here first and will do whatever they can to make sure they have a good quality of life’. A health professional visiting the home said, ‘this is an exceptional home and you can’t fault it’. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 7 What has improved since the last inspection? What they could do better: Arrangements could be put in place so that senior staff are more involved in putting care plan information onto the new electronic system. This will help in developing their knowledge and skills in planning and evaluating the care that people need. Medication refrigerator temperatures could be checked every day to make sure medication is being stored at the correct temperatures. Consideration could be given to looking at more ways to enable people who wish to spend time out of the home to be able to do so in order to meet their social needs. One person said, all the days can seem the same, it can be a bit boring’. Two surveys received from staff members said, ‘there could be more activities and outings’. Staff could receive formal supervision more regularly to make sure they are receiving the support they need to meet people’s needs and to address any management issues. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 8 As part of the home’s quality assurance system, the views of professionals who have involvement with the service could be sought to inform the home about what it is doing well and any areas for improvement. Better arrangements could be put in place so that people have access to their personal monies at all times. 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 Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 9 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 Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 10 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): 2, 3 and 6. People who use 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. Proper pre-admission procedures are followed to make sure that only suitable people are admitted into the home. EVIDENCE: A range of information is given to people who are thinking about moving into the home to help them with their decision-making. Once a decision has been agreed for a person to move into the home they receive a local authority contract. They now also receive a copy of the home’s terms and conditions so that they are aware of the care and services they will receive and their rights. Pre-admission procedures are in place to make sure that only suitable people are admitted into the home. Information about the person’s care needs is Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 11 collected from all available sources such as a community care assessment from the person’s social worker to support the home in their decision-making about whether they have the skills and resources to meet the person’s needs. The manager said she would then visit the person in their own home or in hospital to carry out an assessment of the person’s needs before deciding on the person’s suitability to live at the home. This information is then recorded onto an electronic system and a care plan is developed from this. People who are considering moving into the home and their relatives are invited for a visit before any decision is made about whether they move into the home on a permanent basis. One person said, ‘I was able to come and have a look around before I moved in and was given lots of information about the home’. A relative also said that they were invited to visit the home on behalf of their relative who because of their mental health problems is unable to make their own decisions. Staff said that they receive good information about people when they move into the home so that they are clear about their needs and how these are to be met. The care records of a newly admitted showed that pre-admission assessments are detailed and easy to follow. The home does not provide intermediate care. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 12 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 and 10 People who use 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’s personal and health care needs are well met by a respectful staff team who provide support in a private and dignified way. EVIDENCE: Each person has an individual plan of care detailing people’s individual needs and the actions that staff need to follow to meet these. All the assessment and care planning information is now stored on an electronic system. This made information easier to access and helped to ensure that information is kept up to date. The care plans were of a very good standard and were individualised and person centred. They took into consideration people’s likes and dislikes and social interests. A recently admitted person had told staff that they liked to sit Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 13 in a rocking chair at home. This had been recorded and staff had arranged to speak to a relative about this, to see if they could bring the chair to the home for the person to use. Staff had a very good understanding of people’s individual needs and said, ‘we regularly record information in daily records and have handover periods between shifts’. A health professional visiting the home said, ‘whenever I visit staff always know the reasons why I am here and have a very good knowledge of people’s needs’. One person living at the home said, ‘the care is very good. Nothing is too much trouble for the staff’. A relative survey told us ‘there is a genuine feel about the place’. The manager reviews the care plans on a monthly basis and outcomes from these reviews are recorded. As part of the electronic system, graphs are used to monitor progress in different aspects of people’s care so that improvements can be seen and any concerns can be easily identified and acted on. The manager did say that at the present time she is the only person who inputs the care plan information and reviews onto the new system although all staff use the system to record daily entries. This was discussed with the manager and it was agreed that she would look at developing the skills of other members of the staff team in using the new system to develop their skills and to involve them more in the care planning process. Regular meetings are also held with people and their families to discuss the care and services and to keep them informed and involved. Risk assessments are done in relation to falls, pressure ulcers, nutrition, moving and handling and the use of bedrails. Where necessary plans are in place to show how these risks will be managed. Risk assessments are reviewed regularly and graphs are used to easily identify any concerns at an early point so that referrals can be made to the appropriate specialist agency. People’s weights are monitored and referrals are made to a dietician as needed. Each person has a GP (General Practitioner) and access to chiropody services. A dentist visits the home every 6 months and an optician who is experienced in testing people with dementia also visits the home. Referrals are made to specialist services as and when required and staff support people in attending appointments. One person with eye problems had been immediately referred to the GP and is now waiting to see a specialist at the local hospital. At the time of the site visit a District Nurse was attending to a person who had a pressure ulcer. Healthcare information is recorded in the care plans about why people are attending appointments and outcomes from these. This helps in making sure that everyone is aware of the person’s health needs and how these are to be met. A health care professional visiting the home said, ‘the home is good at communicating with us and keeping us informed about any issues’. The home uses a monitored dosage pre-packed system for medicines. Medication is administered by senior staff who have received the appropriate training to be able to do this. There are good ordering and checking systems in Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 14 place and all medication that is returned to the supplying chemist is recorded. The medication records were up to date and easy to read. Procedures for dealing with Controlled Drugs had been properly followed. The medication fridge temperatures were being checked weekly. Following discussion with the manager, this will now be done on a daily basis so that any irregularities can be more quickly identified and acted on. Staff were seen to be kind and respectful in the way they spoke to people and helped them with their care needs. People who need support with bathing said that this was always done in a sensitive way that maintained their privacy and dignity. One person said, ‘I can have a bath whenever I want and staff always help me with this’. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 15 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 and 15 People who use 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’s individuality is recognised and respected. They enjoy the activities that are on offer in the home although more consideration could be given to provide them with more opportunity to spend time out of the home. EVIDENCE: People’s social care needs and interests are included in the care planning information. Entertainers visit the home twice a week and offer activities such as quizzes, bingo and exercise classes. Information about the activity programme is displayed in the home. Additional areas of the home have been made available to enable people to watch alternative television channels. One person said, ‘I like attending the church services that are held in the home’. A survey returned by a relative commented ‘my mother has always been an active church member. The home is always obliging when her minister and friends come to administer Holy Communion’. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 16 Some people choose not to join in activities and are not pressurised to do so. One person liked to spend most of their time in their bedroom watching their own television and was able to do so. This person said, ‘staff regularly call in to check that I am OK’. The manager explained that outings had been arranged at Christmas and on another occasion and that some people enjoyed visits to the local pub. She did say that planning for outings could be difficult when people say they would like to go on them but then decide against this at the last minute. There were mixed comments from people living at the home about opportunities to go out. Whilst people said they would not want to go out, one person said, ‘I would like to go on more outings’ and another said ‘all the days can seem the same, it can be a bit boring’. Two surveys received from staff members said, ‘there could be more activities and outings’. People are able to see their family and friends whenever they want and in private if they choose. A relative said, ‘the home is first class and always welcoming and friendly. We are kept well informed and are invited to attend meetings about our relative’s care’. The employs usually employs two cooks to cater for people at the home. However one cook had recently left the home so one of the owners had taken over the cooking duties in the interim period until another cook is appointed. The providers said that they had received applications for this post and would be looking to appoint someone shortly once the necessary checks have been undertaken. The home has a four weekly menu. This is on display for people to see and is available in large print to help people with visual difficulties. People made positive comments about the quality of food. One person said, ‘the food is very good’. Another person said, ‘the food is really lovely and we can have something else if we do not like what is on the menu’. Staff have a very good understanding of what people enjoy eating and monitor food wastage to assess what meals people like or otherwise. Some people who live in the home require special diets. The cook was aware of this and there was lots of information in the kitchen area that provided advice and guidance about specific diets. The lunchtime meal looked appetising and people enjoyed it. The mealtime was relaxed and unhurried and support was given to people as needed in a dignified way. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 17 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 and 18 People who use 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’s concerns are listened to and acted on. Systems are in place to safeguard people from abuse EVIDENCE: The complaints procedure is on display in the home for people to look at. People living at the home knew who to speak to about any concerns and were fully confident that any matters would be dealt with properly. A relative said, ‘I have been told how to complain but have never needed to do so’. The home had received a verbal complaint about one aspect of a person’s care and this had been well recorded and the complainant was informed about the outcome. One complaint had been made direct to the Commission for Social Care Inspection since the last inspection. This was referred to the providers to investigate. The providers had responded to this within appropriate timescales. The issues were about staff training and staff having access to cleaning substances and protective clothing. These are commented on later on in the report within the sections ‘Environment’ and ‘Staffing’. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 18 Staff have received training on the protection of vulnerable adults. They were able to say what action they would take if they suspected abuse or had an allegation of abuse made to them. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 19 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 and 26 People who use 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. The home is homely, clean and safe for people who live there. EVIDENCE: The home has a warm, friendly atmosphere. A health professional and relative that visit the home both said, ‘we are always made to feel welcome and the atmosphere is always good’. The accommodation is situated over two floors that can be accessed by stair lifts. There is also level access to the home so it is suitable for people with mobility problems. A survey returned by a relative commented ‘the home could be improved by having a passenger lift’. There is a garden area where people Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 20 can sit out if they choose to do so. Most of the bedrooms are single. In shared bedrooms screens were being used to maintain people’s privacy and dignity. There are lockable communal bathroom and toilet facilities on both floors. Bedrooms were personalised and people said that they thought the standard of the accommodation is good. Communal and personal areas are fitted with appropriate aids and adaptations to meet the needs of the people in the home. This included hoisting equipment, bath seats and handrails. A new call bell system is in place and this has enabled people particularly in lounge areas to access staff more easily when needing assistance. Some people also have call bell pendants to alert staff if they need support. The home has had new furnishings and changes to the layout to improve the pleasantness of the environment for people. There are new tables and chairs in the dining room and some flooring has been fitted in a downstairs bathroom to maintain people’s safety. The flooring in the laundry area has been damaged by problems with water leakage from the washing machine. The providers are in the process of replacing this flooring. People who live in the home do not have access to the laundry area so there are no possible risks to their safety. The home was clean and tidy throughout with no odours. There are adequate facilities to make sure that people’s clothing is properly laundered and there is a separate sluicing facility. The home had taken proper precautions and advice from the appropriate agencies in response to an outbreak of diarrhoea in November 2007. All staff receive infection control training and could be seen following procedures so that good hygiene practices are followed. A complaint made to the Commission since the previous inspection visit had alleged that protective gloves, aprons and wipes were not available for staff to use. Staff spoken to, including the housekeeper, said that there are always plentiful supplies of these items and there was evidence of this during a look around the environment. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 21 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 and 30 People who use 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. Staff at the home are trained, skilled and employed in sufficient numbers to meet the needs of people who use the service. EVIDENCE: People who live at the home said that staff were always available when they needed them and responded promptly to call bell requests. Despite lower bed occupancy levels, the staffing levels remain good at all times. In addition to care staff there is a housekeeper and a cook who help to maintain good food and hygiene standards. The providers are based at the home throughout the week and are on-call at all other times. The home does not use agency staff. A member of staff said, ‘there are high standards of staffing levels and fantastic staff morale’. Another said, ‘it is a good place to work. We have 100 confidence in the management and all staff pull together’. ‘ It was clearly evident that staff had a very good knowledge and understanding of people’s individual needs. Nearly half of the staff have completed the NVQ (National Vocational Qualification) programme and others are currently doing Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 22 it. This helps to ensure that people are receiving care from staff with the right skills and knowledge. The home follows good recruitment procedures. Interviews are held, references are obtained and CRB (Criminal Record Bureau) and POVA (Protection of Vulnerable Adults) First checks had been completed to make sure that people were protected from unsuitable workers. Three staff recruitment files were looked at and confirmed that proper checks had been completed before new staff started working at the home. A complaint made to the Commission since the previous inspection visit had alleged that staff did not have first aid or moving and handling training before they started providing care to people. All the training records seen had evidence that a range of training is given to people during their induction period to make sure they have the right skills and knowledge to care for people properly. A new member of staff said, ‘I gained a number of certificates to show I was competent in different aspects of care before I started caring for people’. Training is provided on safe working practices such as moving and handling and fire safety as well as on more specialist subjects such as dementia care and equality and diversity. This training is updated on a regular basis. One staff survey commented ‘courses are open to us if we wish to participate in any extra training regarding all aspects of care’. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 23 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, and 38 People who use 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. Overall the home is managed in the best interests of people who live at the home and proper attention is given to maintaining their health and safety. EVIDENCE: The home does not currently have a registered manager following the previous manager’s resignation in January 2008. The registration certificate still had the name of the previous manager on it. This was pointed out to the providers who immediately made arrangements for the certificate to be amended with the correct information. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 24 The registered providers are currently managing the service between them and are based at the home on a daily basis. Both Mr and Mrs Mortimer have NVQ level 4 in social care. Mr Mortimer generally deals mainly with the administration of the home and maintenance of the premises. Mrs Mortimer who manages the care aspect of the home is about to start the Registered Manager’s Award in order to obtain a management qualification. She will also be applying to register with the commission as the manager of the home. At the present time, as well as her management responsibilities, Mrs Mortimer is also carrying out some cooking duties that are mainly on a weekend. This matter was discussed with the providers who said that this was only a shortterm measure until a new cook is appointed. People who use the service, staff, a relative and a health professional who was visiting the home were full of praise about the way the home is managed. One person who lives at the home said, ‘the owners are lovely, they can not do enough for you’. A staff member said, ‘the management are unbelievable, they always put people who are living here first and will do whatever they can to make sure they have a good quality of life’. A health professional said, ‘in my opinion this is an exceptional home and you can’t fault it’. A survey returned by a staff member said, ‘the proprietors are the best I have ever worked for’. The providers are based at the home throughout the week and are on-call at all other times so they are able to closely monitor the standard of care and services on offer. Audits are carried out in areas such as medication and the environment and records are kept of these and any actions to be taken. As part of the home’s Annual Internal Quality Assurance Assessment, questionnaires are sent out to people who use the service and their relatives so that the home knows what it is doing well and where it can improve. It was suggested to the providers that the views of professionals who visit the home should also be included as part of the quality assurance process. The providers have set up more regular meetings with people who live at the home and their relatives to involve them more in discussions about care and the service that is offered. Staff said that they attend regular staff meetings to discuss their views and any concerns. There are supervision arrangements in place to support staff in their job role and to address any management issues. However, staff said that supervision did not take place regularly and the providers said they were aware of this and would be addressing this matter. People are supported to maintain their own finances through the risk assessment process. The home does hold some personal monies on behalf of people and records are well maintained so that incoming and outgoing monies can easily be accounted for. Staff can access monies from the safe when the providers are in the home. However they are unable to do this when the providers are not there as staff do not have access to the safe as it is located in an office used to store confidential information. The providers said that if money was needed at these times then staff would contact them and they Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 25 would go to the home to arrange this. These arrangements could potentially limit people having access to their monies at all times if the providers were not available for some reason. In their (AQAA) Annual Quality Assurance Assessment, the manager said that all the health and safety checks were up to date and a random check of some health and safety records had evidence to support this. All the recommendations from a recent visit from environmental health had been met. Fire safety equipment and checks are carried out when needed although another fire drill is now due. All the staff receive health and safety training and this is updated as needed to make sure that are following safe working practices. Elm Lodge DS0000062249.V365383.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 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 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 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 2 2 X 3 Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 27 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. 1. 2. Refer to Standard OP7 OP9 Good Practice Recommendations Arrangements should be put in place to enable senior staff to develop and evaluate care plans on the new electronic system. To improve medication practices for people living in the home, medication refrigerator temperatures should be checked and recorded daily to ensure medications are being stored at the correct temperatures. More consideration could be given as to ways in which people may have more opportunity to spend time out of the home in order to meet their social needs. When assessing the quality of service that people get, the views of visiting professionals should also be asked for. This will give them the opportunity to comment on the service that is offered and where it can be made better. Arrangements should be put in place to enable people at all times to have access to their personal monies that are held on their behalf by the home. DS0000062249.V365383.R01.S.doc Version 5.2 Page 28 3. 4. OP12 OP33 5. OP35 Elm Lodge 6. OP36 Staff should receive formal supervision on a more regular basis to make sure they receive the necessary support to meet people’s needs. Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elm Lodge DS0000062249.V365383.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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