Care Home: Elm Tree Close

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What the care home does well Relatives told us that they were generally very happy with standards of care at Elm Tree Close. A relative said “I am very happy and satisfied with the care and attention they are getting, it couldn’t be better. They seem very happy to be there and it pleases me to know that they are receiving the care they need 24/7”. Residents told us they had no concerns about the care or services in the home. A resident said “I took to it straight away” when they first visited the home. Another resident told us “The staff are really good and kind, they can’t do enough for you”. One resident told us “they keep it very clean, wonderful cleaners, so thorough”. Residents told us that they enjoyed the garden and it was evident that staff encouraged and supported them to spend regular time outside. Staff considered that they gave a “good standard of care” and said that there was “good communication” within the home.Elm Tree CloseDS0000017811.V376836.R01.S.docVersion 5.2 What has improved since the last inspection? We noted that the atmosphere in the home had improved since the last inspection. Staff were observed to be very caring and welcoming to anyone visiting the home. The standard of care records had improved since the last inspection and were more personalised to the residents’ individual needs. There had been a significant reduction in the number of accidents in the home. The handling of concerns had improved considerably in the past year; prompt action was taken so that minor concerns did not turn into more major complaints. What the care home could do better: We became concerned during the inspection that a high number of residents in the home were losing weight (although some of the residents had underlying conditions or were in end stage dementia). Staff did not have a good understanding of the nutritional needs of residents with dementia or the actions to take to maintain or increase weight. One resident whose condition was of concern was not having their intake and output monitored accurately enough for the appropriate information to be given to their GP. We made a safeguarding referral following the inspection in relation to these issues and spoke with the community matron. The community matron told us that they would provide additional support and advice for staff at Elm Tree Close. The manager contacted the community dietician following the inspection and they agreed to visit the home and provide training. The pre-admission assessment needed to be expanded to include a section for assessing mental health in order for staff to be assured that they could meet the potential resident’s needs, particularly those with dementia. The storage of medicines needed to be improved. Residents felt that the standard of cooking was very variable. The manager told us that they were trying to recruit as they had a vacancy for a cook and different staff in the home had been covering the role. Infection control practices needed to be improved. Some staff were working long hours putting themselves at risk of becoming overtired and not able to sustain their best working practice for such long periods, putting residents at potential risk or at a disadvantage. Some training needs were identified.Elm Tree CloseDS0000017811.V376836.R01.S.docVersion 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Elm Tree Close Elm Tree Avenue Frinton On Sea Essex CO13 0AX Lead Inspector Francesca Halliday Key Unannounced Inspection 23rd July 2009 09:00 DS0000017811.V376836.R01.S.do c 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 homes for older people 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 Tree Close DS0000017811.V376836.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 Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm Tree Close Address Elm Tree Avenue Frinton On Sea Essex CO13 0AX 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) 01255 677747 01255 679926 Southend Care Limited Manager post vacant Care Home 40 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Persons of either sex, aged 65 years and over, who require care by reason of old age only Persons of either sex, aged 65 years and over, who require care by reason of dementia The total number of service users accommodated in the home must not exceed 40 persons 29th July 2008 Date of last inspection Brief Description of the Service: Elm Tree Close is a purpose built home for older people, situated in a residential area of Frinton on Sea, close to the town centre. Accommodation is all on one level. The home is divided into five separate units referred to as bungalows, which are joined by connecting corridors. Each bungalow has a lounge and dining area. All residents are accommodated in single bedrooms with en suite toilet and hand washbasin. The home also has two large communal areas. The home is registered to provide care and accommodation for up to forty older people and older people with dementia. The home has appropriate aids and equipment (e.g. mobile hoist, assisted bathing facilities, hand rails, etc.) available to assist residents with limited mobility. The home is owned and managed by Southend Care Ltd. The weekly fees at the time of inspection in July 2009 were £400 to £450 depending on the specific needs of the resident. There were additional charges for toiletries, hairdressing, newspapers, private chiropody and visits to the local day centre. Elm Tree Close DS0000017811.V376836.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 one star. This means that people who use this service experience adequate quality outcomes. This key inspection was carried out on 23rd July 2009. The term resident is used throughout this report to describe people living in the home and the term we refers to the Care Quality Commission (CQC). All the key national minimum standards (NMS) for older people were assessed during the inspection. The report was written using evidence accumulated since the last key inspection on 29th July 2008, as well as using evidence found during the site visit. This included looking at a variety of records and inspecting parts of the premises. The report was written using evidence provided by the manager and this included the annual quality assurance assessment (AQAA) sent to us prior to the inspection. The AQAA is a self assessment document required by law and it gave us information about how the service met the standards and data about the service. During the inspection we had chats of various lengths with six residents and four members of staff including the manager. We also spoke with a visiting member of the district nursing team. We sent out surveys prior to the inspection and we received four from relatives and eight from staff. Comments from the surveys and conversations have been included in the report where appropriate. What the service does well: Relatives told us that they were generally very happy with standards of care at Elm Tree Close. A relative said “I am very happy and satisfied with the care and attention they are getting, it couldn’t be better. They seem very happy to be there and it pleases me to know that they are receiving the care they need 24/7”. Residents told us they had no concerns about the care or services in the home. A resident said “I took to it straight away” when they first visited the home. Another resident told us “The staff are really good and kind, they can’t do enough for you”. One resident told us “they keep it very clean, wonderful cleaners, so thorough”. Residents told us that they enjoyed the garden and it was evident that staff encouraged and supported them to spend regular time outside. Staff considered that they gave a “good standard of care” and said that there was “good communication” within the home. Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: We became concerned during the inspection that a high number of residents in the home were losing weight (although some of the residents had underlying conditions or were in end stage dementia). Staff did not have a good understanding of the nutritional needs of residents with dementia or the actions to take to maintain or increase weight. One resident whose condition was of concern was not having their intake and output monitored accurately enough for the appropriate information to be given to their GP. We made a safeguarding referral following the inspection in relation to these issues and spoke with the community matron. The community matron told us that they would provide additional support and advice for staff at Elm Tree Close. The manager contacted the community dietician following the inspection and they agreed to visit the home and provide training. The pre-admission assessment needed to be expanded to include a section for assessing mental health in order for staff to be assured that they could meet the potential resident’s needs, particularly those with dementia. The storage of medicines needed to be improved. Residents felt that the standard of cooking was very variable. The manager told us that they were trying to recruit as they had a vacancy for a cook and different staff in the home had been covering the role. Infection control practices needed to be improved. Some staff were working long hours putting themselves at risk of becoming overtired and not able to sustain their best working practice for such long periods, putting residents at potential risk or at a disadvantage. Some training needs were identified. Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 7 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 Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 8 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 Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 9 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1, 3, 5 (standard 6 not applicable) 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. Potential residents with dementia cannot be assured that their mental health needs will be assessed prior to accepting a place at the home. EVIDENCE: The home had a range of information for prospective residents and their relatives or representatives. This included a statement of purpose and service user guide (also available in large print). The documents needed to be updated to reflect the changes of the regulator to the Care Quality Commission and to update the complaints section (see complaints section of this report). Residents and their relatives were invited to visit the home and to stay for a meal and part of a day in order to help them decide whether this was the right home for them. However, the manager said that it was not always possible for Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 10 potential residents to visit if they were being admitted from hospital. One resident told us that they had visited the home and said “It was my choice to come here”. Where possible a choice of room was offered. A review was usually held at the end of a four week trial period to ensure that the resident and relatives were happy that their care needs were being met and they wanted to make this a permanent placement. A resident told us that they had “not been very well” when they were first admitted but confirmed that they were now much improved. They told us “They (staff) helped me when I first came into the home”. The manager told us that they did not pre-book regular respite breaks but would offer a respite service if a bed was available. The manager usually carried out the pre-admission assessments. However, if they were not available one of the home’s senior staff or a member of the senior team at their nearby sister home carried out the assessment on their behalf. The manager confirmed that they would carry out another assessment before a resident was discharged if they had spent some time in hospital, to ensure that the home could still meet their needs. We sampled three preadmission assessments for residents admitted since the last inspection. They were of a good standard in relation to the potential residents’ physical needs and gave staff sufficient information to meet those needs on admission. However, despite the fact that the home mainly admitted people with dementia the pre-assessment document only contained a short section to test a potential resident’s memory and did not prompt the assessor to ask other questions in relation to their mental health needs. This could potentially result in people being admitted to the home inappropriately if staff were not aware of the psychological support and mental health input that they needed. This issue was highlighted at the last inspection but no action had been taken. Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 11 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, 10 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. Residents can expect a good standard of personal care but their nutritional needs are not always met. EVIDENCE: Relatives told us that they were generally very satisfied with the care provided by Elm Tree Close. Two relatives who responded to our survey said that staff “always” and two considered that staff “usually” met the residents’ needs and gave them the support and care that they expected. They said that they were “always” kept up to date with important issues affecting the resident they visited. Four staff considered that the way they shared information about residents “always” worked well and three staff felt that it “usually” worked well. One relative said “Staff are very friendly and helpful, whenever I ask for something they make sure it is done”. Another relative told us “Most carers do Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 12 care for the residents’ needs but some should check more often that residents are not having to sit in soiled clothing/chairs”. Residents told us that they were happy with the way that staff provided care and felt that staff respected their privacy. One resident said “The staff are very nice and helpful. I’m very happy indeed”. We observed staff interacting with residents in a very caring and respectful manner. We looked at the care records for four residents. The standard of the care documentation had improved since the last inspection. The care plans were more tailored to the individual resident and demonstrated that they, and their relatives where appropriate, had provided information about their preferences, interests and abilities. Staff had developed a system to carry out an overview of the residents’ condition but needed to tailor this to provide evidence that they were monitoring care and care needs on a monthly basis or when the residents’ condition changed. The majority of residents in the home had some form of dementia; however, none of the records we looked at had a care plan in relation to residents’ psychological needs. Staff did not provide evidence that they were systematically monitoring residents’ mental health, their responses to changes in medication or any periods of challenging behaviour. This was highlighted in the last inspection report but no action had been taken. The manager confirmed that a care plan in relation to psychological health was being introduced following the inspection. The daily records were of a variable standard and did not always give a clear description of residents’ mood, health care needs, care provided or how they had spent their day. On a some entries staff had written that a few residents had refused to allow staff to wash and dress them early in the morning, however, there was not always information about whether staff been able to assist them later in the day, or any indication that staff had tried to discover the reason that they did not want to get washed and dressed at a particular time. The manager told us that they were using the MUST nutritional screening tool to identify residents at nutritional risk but staff were not using the tool in a way that identified residents at risk of malnutrition and it was not prompting them to take appropriate action. We looked at the weight charts and were concerned to note how many residents in the home were losing weight (although some of the residents had underlying conditions or were in end stage dementia). Staff we spoke with did not have an understanding of the nutritional needs of residents with dementia and the actions to take if residents were losing weight. The nutritional content of food was not being enriched and there was no evidence from the food charts seen that residents were receiving any additional high calorie snacks even when they were losing weight. This was compounded by the fact that some local GPs were reluctant to prescribe food supplements. We contacted the community matron who said that they would visit the home and give staff some advice and support. Following the inspection the manager told us that he had arranged for the community Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 13 dietician to visit the home and provide training and advice. One resident who was catheterised had a low urine output that was of serious concern. However, staff were not recording their output accurately, for example estimates were recorded, so they would not have had the appropriate information to give to the GP. Residents we spoke with told us that they saw the GP when they needed to and that they had regular chiropody and had optical and dental checkups. One of the district nursing team told us that staff reported any health concerns to them promptly. They told us that staff followed the wound guidance and covered any wound appropriately and called the district nursing team. There was evidence that some residents had been rehabilitated and their condition improved sufficiently for them to be able to go home after a period of support at Elm Tree Close. The manager told us that they had advice from specialist nurses such as the Parkinson’s Disease nurse when appropriate. The manager said that residents in the home had not developed any pressure sores during the last year. The manager monitored accidents within the home and said that they tried to discover why residents were having accidents or falls and to take action to prevent it. For example one resident kept getting up in the night and falling so they encouraged the resident to stay in the sitting room, chat to the staff and have a snack and then go to bed later when they were sleepy and this reduced the number of accidents they had. The home also had a number of pressure mats, which could be used to alert staff if residents got out of bed at night and might be at risk of falling if not supervised. A risk assessment was carried out before the mats were used and agreement was gained from relatives where appropriate. The manager told us that accident rates had halved over the past year. The medicine administration records (MAR) we sampled were well completed. The controlled drugs balances were checked and found to be correct. The date of opening of medicines with a limited shelf life on opening was recorded on medicines in the drugs trolleys but this was not always done with medicines such as topical creams in residents’ rooms. This could mean that medicines could continue to be used beyond the date at which they were safe to be used. The manager told us that they aimed to check any handwritten changes made to the MAR. Eye drops were sometimes labelled on the outer carton and not on the actual container. This could lead to potential cross infection if more than one resident was on the same medicine and the cartons were lost or inadvertently swapped over. Staff told us that they would raise this matter with the pharmacist. The temperature of the room where medicines were stored was being monitored but no action was taken when the temperature was regularly recorded at above 25c which is the maximum safe storage temperature for the majority of medicines. The room temperature was recorded as 30.1 on the day of inspection. Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 14 Staff who administered medicines told us that they completed a distance learning pack on administering medicines, they then observed medicine rounds being carried out and carried out a number of rounds under supervision before they were assessed as competent and allowed to administer medication on their own. A relative sent the home a complimentary letter about the end of life care received by a resident. They said “Thank you for all the loving care, attention and understanding shown during the past two years. We couldn’t have wished for a better home. Elm Tree Close DS0000017811.V376836.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14, 15 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. Residents are encouraged to retain independence but more activities would improve their quality of life. EVIDENCE: Residents told us that they very much enjoyed the seated exercise class and music and the singer who visited the home, both of these sessions were usually held once a month. They told us that they sometimes had games and some residents had enjoyed potting up some bulbs. Another resident told us they enjoyed activities when they were arranged and said “I join in nearly everything”. The manager told us that a barbecue was due to be held at the end of August. Staff told us that some activities did take place but not on a regular basis. The manager said that they sometimes held bingo sessions, arts and crafts, cake making and flower arranging. The home did not have an activity coordinator. Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 16 However, in their absence the manager did not identify a person to lead on activities and stimulation every day. We looked at the activities file but there was no record of any activities for the past eighteen months. Two members of staff considered that residents would benefit from more activities. Staff told us that they would like training on the types of activities suitable for residents at all stages of dementia. One relative told us “I think residents could do with more exercise, stimulation and motivation daily”. Relatives told us that they were made to feel very welcome when they visited. Staff had a communication sheet to state that they had talked with relatives but did not record what issues had been discussed. The manager amended the form following the inspection to encourage staff to record details of the discussions held. The manager told us that they encouraged residents to attend the local day centre to see if they might enjoy it but although a number of residents had visited the centre only three residents attended on a regular basis. A service with communion was held in the home twice a month and the manager confirmed that they would contact any minister of religion if residents wished to have a visit in the home. There was evidence that staff offered choices and tried to encourage residents’ independence. Residents told us that they got up and went to bed when it suited them and spent their day where they wanted. One resident told us that they were “scared” of having a bath and were therefore pleased that staff helped them to have a good wash every day in their room. Although staff encouraged residents to join in any activities and have meals in the communal areas, residents who wanted to remain in their room had their wishes respected. One member of staff said that they tried “to maintain residents’ independence” and felt that this gave them more quality of life. One resident told us “I enjoy all the food here”. However, two residents told us that the standard of cooking was very variable. We asked one resident what the meals were like and they said “it depends who’s cooking” and they added that the manager was “a lovely cook”. Another resident said that the food “could be better. I’d like them to change the menu more”. The manager told us that one of the cooks had retired and the person recruited to replace them did not stay, so they were recruiting for the post again. There was a choice on the menu but residents we spoke with were not always aware that they could have something else if they did not like what was on the menu. The manager told us that they would remind staff to check that residents were happy with the choices on offer for each meal. The kitchen was clean and looked well organised but care staff were entering the kitchen without any protective apron or white coat. When we requested one it took staff some time to find the blue plastic aprons. Elm Tree Close DS0000017811.V376836.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16, 18 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. Residents can be confident that their concerns are promptly addressed and they are protected from abuse. EVIDENCE: The complaints procedure needed to be updated to reflect the change of the regulator to the Care Quality Commission’s and its role in monitoring the complaints process and to state that complaints investigations were undertaken by social services where appropriate, when the complainant had used the internal process within Southern Cross. The complaints procedure was written in a positive way, encouraging feedback and comments about the services provided. It stated All complaints will be received and acted upon as useful means of reviewing and improving standards”. The manager told us that they tried to address any concerns immediately in order to prevent them developing into complaints. Relatives who responded to our survey told us that they knew how to make a complaint and considered that staff “always” responded appropriately if they raised any concerns. One resident told us “Absolutely everything’s OK, I’ve never had any complaints, if I have a problem I ask staff”. The majority of staff whom we spoke with and who responded to our survey told us they knew what to do if someone had Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 18 concerns about the home. The complaints procedure was on display in the entrance hall along with information about local advocacy services and contact details of the citizens advice bureau. We had received no concerns about the service since the last inspection. The home had a procedure for safeguarding adults and a whistle blowing procedure (reporting potential abuse and poor practices). There had been one safeguarding referral in the past year but it was not upheld. The home had a form that identified the potential forms of abuse that could occur for different residents in order to highlight these issues for staff. All residents who could have a conversation told us that staff provided care in a way that they felt comfortable with and told us that they felt “safe” in the home. Staff had received distance learning packs for safeguarding. However, two staff did not consider that they had received safeguarding training although they did have an understanding of the different types of abuse and the action to take if abuse or poor care practices was suspected. The manager said that they would ensure that staff received some face to face training following completion of the distance learning pack in their induction. A number of safeguarding training sessions were due to be held between September and December 2009. Elm Tree Close DS0000017811.V376836.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 26 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. Residents cannot be assured that good infection control procedures are always followed. EVIDENCE: The home was all on one level and was divided into five eight-bedded areas known as bungalows. Each bungalow had its own bathroom and shower and a communal lounge/dining area. Each of the bedrooms had an en-suite toilet and hand wash basin. The rooms we looked at were personalised with residents’ belongings. One resident told us “I’ve got a nice room”. The home was generally well maintained but parts of the premises were in need of decoration as some paintwork was very chipped and a few sections of Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 20 wallpaper were peeling. Some armchairs were in need of a clean and in some the surface of the chair was peeling off. It was obvious from discussions with residents that they very much enjoyed the garden. There was plenty of seating and parasols to provide shade. The home also had a number of straw hats for residents to use and provided sun block if the weather was very sunny. The manager confirmed that the garden was secure and safe for residents with dementia. Parts of the garden had been planted with colourful flowers. There was a fish pond that was situated near a large window and seating had been placed in front of the window so residents could watch the fish from inside the home. One resident told us “I love the garden”. The home was generally clean on the day of this unannounced inspection. However, some of the carpets seen in residents’ bedrooms and in corridors were very stained, did not smell fresh and were in need of a clean. The manager told us that the carpet cleaner was being repaired at the time of inspection and that quotes were being sought for some of the heavily stained carpets to be replaced. One relative told us “The place is always tidy and clean”. A resident agreed they said “they keep it very clean, wonderful cleaners, they’re so thorough”. The laundry room had washing machines with a sluice cycle. The laundry looked well organised and the clothes we looked at were well laundered. However, staff were still hand sluicing soiled linen and did not have the appropriate bags to handle and wash the soiled linen. This practice put staff and potentially residents at risk of cross infection. Liquid soap dispensers had been installed in all areas where staff carried out personal care but paper hand towel dispensers had not been installed. Staff said that they washed their hands in the communal bathrooms when they had completed the personal care in residents’ rooms, which is not good infection control practice. These issues in relation to infection control were highlighted at the last inspection and a requirement was made but no action had been taken. Elm Tree Close DS0000017811.V376836.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29, 30 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. Residents’ wellbeing and safety are potentially compromised when care staff work excessively long hours. EVIDENCE: Staffing levels at the time of this inspection were generally eight care staff in the morning, seven care staff in the late afternoon and evening and three care staff at night. The manager was supernumerary to these numbers. The home also had cleaning, laundry and kitchen staff. There were thirty eight residents at the time of inspection, two of whom were in hospital. The manager said that there was an overlap of at least twenty minutes at each handover in order to provide time for good communication and ensure that residents were still supervised during this period. This is good practice. The manager said that they gave the housekeeping staff some care training to enable them to give short term support to the care staff, for example assisting residents at mealtimes. In the AQAA the manager told us that the home had used 130 agency shifts in the three month period before the AQAA was completed. However, the Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 22 manager said that additional staff recruitment had now eliminated the need for agency staff. We looked at the rotas for a four week period and it demonstrated that some staff were working extremely long hours, mixing day and night duty and on occasions working between 77 to 82 hours in one week. A number of the shifts were 14.5 hours long and one member of staff only had one day off in a three week period. These hours put staff at risk of becoming overtired and not able to sustain their best working practice for such long periods, putting residents at potential risk or at a disadvantage. This was highlighted in the last two inspection reports and a requirement was made following the last inspection. One resident considered that the home was “a bit short staffed at times”. A resident with mobility problems who liked to remain in their room had the call bell within reach and told us that although the response time could be variable they usually did not have to wait too long for staff to respond. Care staff told us that they carried out washing up after each meal which took them away from direct care for an hour each time. The manager told us that this was due to a shortfall in housekeeping hours and that they were advertising for an additional housekeeper. We looked at the staff files of three staff and they demonstrated a sound recruitment procedure. All staff had a criminal records bureau (CRB) check, a protection of vulnerable adults (POVA) list check and two references and identification were obtained before they were offered a post at the home. Staff had made a health declaration and a declaration in relation to previous criminal convictions. The home used set questions for the interview and scored the applicants’ responses. The manager said that they were advertising for a cook and housekeeping and night staff. All staff who responded to our survey told us that appropriate recruitment checks had been carried out before they started work. Three staff who responded to our survey told us that the induction covered everything they needed to know “very well” and four told us that the induction “mostly” covered what they needed to know. Staff we spoke with told us that everyone was “helpful” and they felt “well supported” when they first started at the home. Care staff had a week’s induction and then shadowed a senior carer until they felt confident in their role. All staff who responded to our survey told us that they received training that was relevant, kept them up to date and helped them to meet the individual needs of residents. Eleven care staff had completed national vocational qualification (NVQ) at level 2 and four staff were undertaking level 2. Three staff had completed NVQ level 3 and four were undertaking level 3. The manager told us that staff would be receiving training on the Mental Capacity Act and deprivation of liberty and safeguarding. The majority of staff had received moving and handling but a number of staff needed food hygiene, fire safety, infection control and health and safety. The manager told us that they Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 23 was sourcing some training on food hygiene. A number of staff had received training in continence, diabetes, catheter care, optical awareness, first aid and wound care since the last inspection. Only half of the staff had received any dementia care training despite the fact that this was a home that specialised in dementia care. The manager told us that he was arranging additional dementia care training and was hoping to arrange some training in care of people with Parkinson’s disease. Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 24 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35, 38 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. Residents consider that the home is run in their best interests. EVIDENCE: The manager was appointed to the post in September 2007 but we had still not received the application for him to be registered as manager at the time of this inspection. The manager told us that he had completed the application forms but would contact Southend Care head office to check whether they had been sent to CQC. The manager held the NVQ at level 3 and was undertaking a national vocational qualification at level 4 and the registered manager’s award. Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 25 Staff told us that the manager was “very supportive”. “He’s a very good manager”. One resident told us We looked at copies of the Regulation 26 reports. The visits were carried out on a monthly basis and demonstrated that standards in the home were regularly monitored. An external company carried out audits and sent out satisfaction surveys every year. The home held a small amount of money for residents’ day to day expenses. The money was held securely, receipts were kept and a double signature system was used. A monthly audit of the system was carried out. The home had good systems in place to ensure that equipment was maintained and services and in safe condition for residents to use. The manager told us that there were systems in place for monitoring the temperature of hot water from outlets used by residents to ensure that it remained at a safe temperature for them to use. We checked the water temperature of three hot water taps and all were within a safe range for residents to use without scalding. Elm Tree Close DS0000017811.V376836.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 3 X 2 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X X 2 STAFFING Standard No Score 27 2 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes 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 OP3 Regulation 14 Requirement A pre-admission assessment of potential residents’ mental health needs must be carried out before they are offered a place in the home. In order that staff are aware of the psychological support and mental health input that residents will need. 2. OP8 12(1)(a) Staff must receive training to enable them to identify residents at risk of malnutrition and to have an understanding of the actions to take if residents are losing weight. In order that residents at all stages of dementia have their individual nutritional needs met. 3. OP9 13(2) The temperature in the medicines cupboard must not exceed 25c, which is the maximum temperature for safe storage for the majority of medicines and medicines with a limited shelf life must be dated on first opening. DS0000017811.V376836.R01.S.doc Timescale for action 01/09/09 01/09/09 01/10/09 Elm Tree Close Version 5.2 Page 28 In order to ensure that medicines are not given to residents when they are no longer fit for use. 4. OP12 16(2)(m) (n) Residents must be offered stimulation and activities on a daily basis and the opportunity for trips out of the home. In order to improve residents well-being and quality of life. 5. OP15 13(3) Care staff must wear protective clothing when entering the kitchen. In order to reduce the potential risk of cross infection to residents and themselves. 6. OP26 16(2)(j) Staff must be provided with the appropriate equipment to enable them to carry out good infection control, for example bags for handling soiled linen and paper handtowels where they carry out personal care. In order to reduce risk of cross infection to residents and to themselves. This requirement had a previous timescale of 01/09/08 that was not met. Enforcement action is being considered. There must be sufficient 01/10/09 numbers of staff available to work in the home so that they do not have to work so many hours and do day and night shifts in the same week. DS0000017811.V376836.R01.S.doc Version 5.2 Page 29 01/09/09 01/09/09 01/09/09 7. OP27 18 Elm Tree Close These hours put staff at risk of becoming overtired and not able to sustain their best working practice for such long periods, putting residents at potential risk or at a disadvantage. This requirement had a previous timescale of 01/11/08 that was not met. Enforcement action is being considered. 8. OP30 18 Staff must be given training in dementia care, health and safety, infection control, food hygiene, and fire safety. To enable them meet residents’ individual needs and care for them safely. This requirement had a previous timescale of 01/03/09 that was not met. Enforcement action is being considered. 01/12/09 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. Refer to Standard OP7 Good Practice Recommendations Daily care records should provide details of residents’ mood, their health care needs, care provided and how they have spent their day. In order that staff can monitor residents’ condition on a day to day basis. Food charts and fluid charts must be completed accurately. In order that the appropriate information about residents’ condition can be given to their GP. 2. OP8 Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 30 3. OP12 Staff should be provided with training on the different types of activities suitable for residents at all stages of dementia. In order to ensure that all residents have equal access to activities and stimulation. The décor and furnishings in the home should be maintained in a good condition. In order to provide a pleasant environment for residents to live in. 4. OP19 Elm Tree Close DS0000017811.V376836.R01.S.doc Version 5.2 Page 31 Care Quality Commission 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). 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