Care Home: Elm Tree House

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What the care home does well The residents we spoke with and those who responded by survey said they are able to choose how to spend their day and they are treated well by staff who listen to them and act on what they say. The relatives who responded by survey said the home does meet the needs of each individual and provides the care and support they expect.The health professionals who responded by survey said residents` needs are well met, their privacy and dignity respected and they are supported to live the life they choose. The home promotes a person centred approach in providing care and support to each of the residents. Their views are listened to and acted upon. There are good relationships with health care professionals who support the home to provide a good service, which meets each resident`s current or changing support needs. The staff members we spoke with said they enjoyed working in the home, feel well supported in their roles and are committed to providing a good quality service to each person who lives in the home. The home ensures that staff are skilled and have the relevant training to be able to fulfil their roles. This supports them to provide a good quality service to each person who lives in the home. The home is well run and there are efficient systems in use. This ensures a safe, responsive and accountable service is provided to each resident. What has improved since the last inspection? We did not ask for any improvements to be made following the last inspection. However, the home has robust auditing and quality assurance procedures in place to ensure a good quality service continues to be provided to each resident and areas for improvement identified where possible. What the care home could do better: The planned maintenance should be completed to ensure a homely and comfortable environment continues to be provided for the people who live or work in the home. CARE HOME ADULTS 18-65 Elm Tree House 8 Chandag Road Keynsham Bath & N E Somerset BS31 1NR Lead Inspector David Smith Unannounced Inspection 18th March 2008 09:45 Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 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 Tree House DS0000008164.V359914.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 Adults 18-65. 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 Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elm Tree House Address 8 Chandag Road Keynsham Bath & N E Somerset BS31 1NR 0117 9867791 0117 9867791 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) Treehome Ltd Mr Stephen Charles Wilkins Care Home 8 Category(ies) of Learning disability (8) registration, with number of places Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. May accommodate up to 8 persons aged 18 - 64 years with Learning Disabilities 6th March 2007 Date of last inspection Brief Description of the Service: Elm Tree House is a registered care home owned by Treehome Ltd a subsidiary of Craegmoor Healthcare (Parkcare No 2 Ltd), which provides accommodation and personal care to eight people with a learning disability aged between 1864. It is a two-storey property situated in a residential area of Keynsham. Local amenities include a leisure centre, shops and recreational park. Transport to Bristol and Bath and other areas can be accessed by rail or bus. Due to the accessibility of the building, the home is unable to provide a service to people with a physical disability or for those people who use a wheelchair. The home has a ‘basic’ weekly fee of £985.00, although the precise fee for each resident is determined by the support they require to meet their care needs which are detailed in the assessment drawn up by the placing authority. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. This was an unannounced visit to the home as part of a Key Inspection of this service. The review of evidence and pre-inspection planning involved reviewing the report of the last Key Inspection carried out in March 2007 and the service history, which details all contact with the home including notifications of significant events which they have reported to us. We (the CSCI) provided the home with their Annual Quality Assurance Assessment (known as an AQAA, pronounced as ‘aqua’) and a range of survey forms for residents, their relatives, carers, advocates and health professionals, prior to our visit. The AQAA was completed and returned, together with ten surveys. We gathered additional information during this visit through informal discussions with residents, the Deputy Manager, Senior Support Workers and Support Workers. Interaction and communication between staff and residents was also observed. Care plans and associated records were examined together with Risk Assessments, complaints procedures, medication administration, staff personnel and training records and health and safety records. We also viewed all communal areas of the home and some of the resident’s own rooms. The people who live in the home wish to be known as ‘residents’. This has been acknowledged and this term has replaced ‘service user’ in this report. What the service does well: The residents we spoke with and those who responded by survey said they are able to choose how to spend their day and they are treated well by staff who listen to them and act on what they say. The relatives who responded by survey said the home does meet the needs of each individual and provides the care and support they expect. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 6 The health professionals who responded by survey said residents’ needs are well met, their privacy and dignity respected and they are supported to live the life they choose. The home promotes a person centred approach in providing care and support to each of the residents. Their views are listened to and acted upon. There are good relationships with health care professionals who support the home to provide a good service, which meets each resident’s current or changing support needs. The staff members we spoke with said they enjoyed working in the home, feel well supported in their roles and are committed to providing a good quality service to each person who lives in the home. The home ensures that staff are skilled and have the relevant training to be able to fulfil their roles. This supports them to provide a good quality service to each person who lives in the home. The home is well run and there are efficient systems in use. This ensures a safe, responsive and accountable service is provided to each resident. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents have the information they need to decide if this is the right home for them to live in. Each individual knows their needs and aspirations will be assessed and met by the home and that they will have the terms and conditions of their stay explained to them. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 9 EVIDENCE: The home has a Statement of Purpose, which was last updated in November 2007. A copy of this is displayed in the entrance to the home. Each resident also has their own guide to the service and there is written confirmation in each care plan to shows when each person was provided with their copy. One person has moved into the home since our last visit. We therefore took this opportunity to speak to this individual and examine their care plan. This resident said they are very happy living at Elm Tree House and decided to move here to be closer to their family. They said “ it is a nice place to live, the staff are nice they help me to be independent”. The care records for this person contain comprehensive assessment information, which includes a life history. This information was used by the home to determine whether they could provide a good service to this individual and whether they would be compatible with the people who were already living in the home. Each resident has a copy of the contract between their Funding Authority and the home. These are kept as part of each person’s care plan. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 10 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 and 10. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home ensures that the service provided to each resident takes into account their changing needs and personal goals, supported by both written information in care plans and risk assessments which are subject to ongoing review. Residents know that information about them is handled appropriately and their confidences are kept. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 11 EVIDENCE: We examined three care plans during this visit. Each plan is written in a person centred way and covers key areas of support people require, such as communication, personal care, healthcare, finances, support to achieve their goals and how they wish to spend their leisure time. The format used by the home is very clear and effective. The headings in each section of the care plan are all related to the resident and are written in plain English, such as ‘Important People in My Life’ and ‘What I Do’. Regular formal review meetings are held, which include residents, their families, staff members, Social Workers and Keyworkers. Each resident is supported to prepare for, plan and attend their review meeting. These meetings are clearly recorded and the outcomes used to update individual care plans. The home operates a keyworking system whereby each resident has a named member of staff who plays a key role in co-ordinating the services they receive. Between each formal review Keyworkers ensure that residents’ changing needs are monitored through regular review of their care plans. The care plans examined during this visit are reviewed each month. This is good practice. Interactions between staff and people who live in the home were observed at various times during our visit. These demonstrate the staff have a very good knowledge of the support needs of each resident and how to communicate effectively. Discussion with the Deputy Manager and other staff members also confirmed this. Residents spoken with and those who responded by survey said they are ‘always’ treated well by staff who listen to them and act on what they say, make decisions about what they would like to do each day and felt that they generally do the things they choose. There are regular resident’s house meetings, where a variety of topics are discussed. Staff help residents to keep a record of what was agreed at each meeting. Care and support is provided within a risk assessment framework. Healthy risk taking continues to be encouraged and supported, as evidenced within the wide range of opportunities and activities residents are able to enjoy. Each of the person centred risk assessments we examined are detailed and have been regularly reviewed. Each resident has a document describing the right of access to their personal records, which forms part of their care plan. This ensures confidentiality is promoted and explained to each person who lives in the home. All records relating to residents are stored securely in the main office. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 12 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16 and 17. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Each resident has opportunities and appropriate support to develop, access leisure and educational facilities both locally and in the wider community including holidays, day trips and visits to family and friends. Each person’s rights and responsibilities are recognised in their daily lives. A healthy and balanced diet for each individual is promoted. EVIDENCE: The home has a person centred approach in supporting each resident to develop. The records maintained within the home enable each person’s progress towards their goals to be assessed and the support provided adapted accordingly. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 13 Each resident has their own timetable of activities. These show regular access to local community facilities such as colleges, shops and other activities such as kept fit sessions, ‘dance voice’, art group and ‘music space’. One resident spoken with said they are learning about healthy living at college. Residents spoken with and those who responded by survey said they made decisions about how to spend their day and felt they were supported to do the things they chose. One person said the home “help me to be independent”. It was evident that many residents had made significant progress since moving into the home. One relative said the home has “made a big difference to my (relative’s) life. They now join in and make their own decisions, without the care of the staff I’m sure (they) would not of done so”. Residents are supported to choose, organise and attend holidays. The records examined showed recent trips to Exmouth and Weymouth. Staff spoken with explained that they work hard to ensure each person is provided with opportunities to do things which they enjoy. Each person is seen as an individual and is respected as such. Individuals are supported with maintaining friendships and contact with families. The staff have known the residents relatives for a number of years and promote ongoing communication with them. The relatives who responded by survey said the home ‘always’ provided the care and support they expected for each resident, helped them keep in touch and kept them informed of important issues. One relative said “the home provides a happy environment for all the residents” and another said the home “is the best care home my (relative) has ever lived in”. The health professionals who responded by survey said the home does support people to live the life they choose, respects individual’s privacy and dignity and is good at meeting individual’s differing needs. Each resident has access to the kitchen where they can prepare their own drinks, snacks and meals. Staff spoken with said the menus are planed in consultation with residents and they encourage them to try a wide range of food to promote a healthy and balanced diet. Each person’s likes, dislikes and allergies in relation to food are known and clearly recorded. Residents usually eat their meals in the dining area, which overlooks the back garden. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 14 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 and 21. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported in their preferred manner and their personal and healthcare support needs are well met. Residents retain and administer their own medication where possible and the policy relating to administration of medication ensures their welfare and safety. The ageing, illness and death of a resident would be handled with respect and as the individual would wish. EVIDENCE: The care documentation in place for residents provides clear guidance for staff on how they should support those living at the home with their personal care. The care plans examined showed that individuals are registered with a local GP, dentist and optician. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 15 Other specialist services are accessed when an identified need arises. These are provided by the local Community Learning Disability Team (known as ‘CLDT’). Care records show the home is regularly supported by the Consultant Psychiatrist, Occupational Therapists and other relevant health care professionals. Contact with each professional is recorded and forms part of each persons care plan. The home has an experienced staff team who have a good knowledge of residents’ healthcare needs. Any changes, which may cause staff concern, are noted and acted upon. It remains evident that the management and staff spoken with are sensitive to the personal, healthcare and emotional needs of those living at the home. The health professionals who responded by survey said the home meets each person’s health care needs, seeks their advice and acts upon this to manage and improve individual’s health care. One professional said the home is “very quick to respond” to any changes and “supports each person to maintain a healthy lifestyle”. The home uses the Boots Monitored Dosage System of medicine administration and this is well managed. One individual partially self-medicates and there is a Risk Assessment in place to support this practice, which is regularly reviewed. The medication administration file contains the home’s medication policy, a recent photograph of each resident, profiles of prescribed medication, examples of staff signatures and the initials they use on medication records and the Royal Pharmaceutical Society’s guidance relating to medication administration in care homes. Each resident’s medication record was correctly completed, signed by staff with no gaps evident in the records. Staff have formal training in relation to medicine administration, which is provided by Boots. In addition to this, each member of staff is also assessed ‘in-house’ each year. The health professionals who responded by survey said the home does support residents to administer their own medication and manages it correctly where this is not possible. During the last year the home has supported residents to develop a plan which clearly describes their wishes in the event of ageing, illness or their death. Where it is appropriate to do so, families and relatives have also been involved in these discussions. Both residents and family members have signed these plans. This is good practice. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 16 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to communicate their views and they can be confident that they will be listened to and their views acted on if necessary. Clear policies and procedures are in place in order to protect individuals from the likelihood of abuse, neglect and self-harm. EVIDENCE: The home has a formal Complaints Policy, an Adult Protection Policy and a Whistle Blowing Policy, which staff can use in confidence to raise any issue or concern they have regarding the service. The information provided on the home’s AQAA confirmed that there have been four complaints in the last twelve months. We examined the details of each complaint and the records show that each has been investigated in accordance with the home’s policy, within the specified time scale and a clear record kept. Residents spoken with and those who responded by survey said they know who to speak to if they are unhappy, know how to complain and confirmed that they feel safe living at the home. They feel that staff listen to them and act on what they say. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 17 Resident meetings continue to be used as a forum where resident’s views are sought on the care and support provided by the home. It is evident that residents are empowered to discuss all aspects of the running of the home and supported to address any issues before becoming formal complaints. Relatives who responded by survey said they know how to make a complaint. Both relatives and health professionals felt the home had responded appropriately if they had raised any concerns about the care provided by the home. All staff are provided with training in relation to the Protection of Vulnerable Adults (known as ‘POVA’) and are subject to ‘enhanced’ Criminal Record Bureau disclosures (known as CRBs) before they start work in the home. The home has clear guidelines and risk assessments in place for supporting residents who are distressed or presenting behaviours which may be perceived as challenging the service provided. Each care plan has details of known trigger points and the appropriate defusing techniques. Staff receive training in responding to these behaviours, using the Non Violent Crisis Intervention system (known as ‘CPI’), which is accredited by the British Institute of Learning Disabilities. Staff record each incident of challenging behaviour. These records describe the incident, diffusing techniques used, staff members involved, timings, details of any interventions used and what the outcome was for the resident. The home maintains clear records of all accidents and incidents. It also notifies us of any significant event which occurs within the home. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28 and 30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Elm Tree House provides a homely, comfortable and safe environment for residents to live in. EVIDENCE: Elm Tree House is a two-storey property in keeping with the local area. The home is close to services and amenities in Keynsham and there is regular transport to Bristol and Bath. There are eight single bedrooms, a communal lounge, dining area, utility room, kitchen, toilets, showering and bathing facilities. Due to the accessibility of the building the home is unable to provide a service to people with a physical disability or for those people who use a wheelchair. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 19 We did view all of the communal areas of the home during our visit, along with some of the resident’s rooms. All areas of the home were clean and tidy and furnishings and fittings are of a good quality. The house is tastefully decorated and there are many photographs of residents displayed, which help to personalise the home. The home employs a member of staff employed as a domestic, who generally works during the week. This staff member also has ‘care’ hours as part of their weekly work schedule. One resident who showed us their room said they though it was ‘lovely’ and they had everything they wanted in it. Each person’s bedroom has been decorated and furnished to make it personal to them. There were lots or personal effects, pictures and photographs which added to this. The residents who responded by survey said the home is ‘always’ kept ‘fresh and clean’. The home has a programme of redecoration and renewal. Although improvements continue to be made to the environment, such as the addition of a toilet and shower room on the ground floor, more are planned. These include renewing the ceiling in the pantry, improving the utility room and redecorating some of the communal areas of the home. Some areas were being painted on the day of our visit. The home benefits from a large back garden. This area is also in the process of being developed and improved for the benefit of residents. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35 and 36. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The clarity of staff roles and responsibilities along with staff training, appraisal, meetings and supervision helps to provide a consistent approach to the support of staff and residents. The home’s recruitment policy promotes both residents’ rights and their safety. EVIDENCE: There remains a well-established staff team with varying abilities who are skilled and experienced to meet the needs of those living in the home. Three members of staff have left the home in the last year, however new staff have been recruited to fill these vacancies. Staff spoken with were able to demonstrate a clear understanding of their role and responsibilities within the team and their own personal role and accountability. They said that the staff team continues to be very open, honest and supportive. Each commented on how nice it is to work in the home. They feel well supported by the management team and are able to discuss issues in an open and honest way. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 21 Staff were observed interacting well with each resident and those spoken with demonstrated a good understanding of the support needs of each person in the home. Residents appeared comfortable and relaxed in the company of staff. The residents we spoke with said they like the staff and felt they are well supported by them to live the life they choose. Residents who responded by survey said the staff always listen to them and act on what they say. The relatives who responded by survey said the staff team have the right skills and experience to support the people in the home live the life they choose. One relative said the staff team “are very good with the care they give each resident” and another said “staff are very kind and helpful”. The health professionals who responded by survey also said that the staff team have the rights skills and experience to support each individual. The staff team continues to meet regularly. Records examined show that attendance is generally high and a variety of topics are discussed. Each member of staff spoken with said they feel they can speak openly and honestly at team meetings and that their views are valued. The home has recruited new staff since our last visit and we therefore examined two of their personnel files. These contained a photograph of each staff member, copies of their Application Form, at least two satisfactory references, documents confirming identity and eligibility to work in the UK, contracts of employment and a health questionnaire. (The details of Enhanced Disclosures from the Criminal Records Bureau are discussed earlier within this report). Staff continue to be provided with a variety of training opportunities. The mandatory training includes First Aid, Manual Handling, Fire Safety, Health and Safety, Food Hygiene and POVA. Other more specialist training, such as dementia awareness, is provided to enable staff to meet the support needs of residents. Staff are encouraged to work towards a National Vocational Qualification (known as an ‘NVQ’) and the home has made significant progress in this area. At present seven staff have already completed their awards, with three staff currently working towards theirs. Each member of staff is provided with regular formal supervision with their line Manager. Staff spoken with said they continue to find supervision helpful and supportive. In addition to this, staff are also appraised on an annual basis. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 22 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. Service users’ rights and best interests are safeguarded by the home’s record keeping policies and procedures. The health, safety and welfare of service users are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 and 43. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is well run and residents benefit from the ethos, leadership and management approach of the home. Residents’ views are central to the monitoring and review of the service provided by the home. Residents’ rights and best interests are promoted by the home’s policies and procedures and the quality of the home’s record keeping. The health, safety and welfare of residents is promoted and protected. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 23 EVIDENCE: The Registered Manager, Mr.Wilkins, has managed the home since 2003. He has attained NVQ Level 4, the Registered Managers Award and also undertakes periodic training to maintain his knowledge and update his skills and level of competence. The current management team consists of the Registered Manager, Deputy Manager (who has recently completed their Registered Managers Award), Team Leader and two Senior Support Workers. Each member of this team has their own responsibilities, which ensures the workload is evenly distributed and the management team works effectively. The management approach remains open and positive, with a clear sense of direction and leadership. The ethos of the service is person centred with the views of residents central to this process. In addition to the monthly residents meetings, the home also uses questionnaires to obtain the views of residents and their families regarding the quality of care provided. Staff spoken with said their views are always listened to, and that they are well supported by the management team. They described an ‘open door’ policy where they feel comfortable discussing any issues at any time and did not feel that had to wait for supervision or a team meeting. There are efficient management systems and structures in place to ensure the home runs effectively. The quality of record keeping in the home is good, with all records required during our visit easy to access and stored securely when not in use. The home has a number of policies and procedures, which are designed to ensure it complies with the law and remains aware of good practice guidelines. Full details of each policy were provided by the Manager as part of the AQAA he completed for us as part of this Key Inspection process. There are recording systems in place to support Health and Safety within the home, which are being used consistently. There are monthly audits on the environment to check it is clean and safe and weekly tests on the temperature of hot water used in the home. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 24 Fire safety procedures are good. A Fire Risk Assessment has been carried out, there are regular fire drills, which both residents and staff members take part in and the alarm system and fire-fighting equipment is tested regularly. Staff attend Fire Safety training and one senior member of staff has completed training as a ‘Fire Warden’. The registered provider’s representative makes regular visits to the home, and produces a comprehensive report of their findings. A copy of each report continues to be sent to us. The organisation has robust auditing systems in place, with recent finance and care plan audits taking place. It is noted that although we did not ask for any improvements to be made following our last inspection, the home has identified areas for improvement through their own quality assurance and auditing processes and acted on these. Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 3 2 3 3 3 4 X 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 X 27 3 28 3 29 X 30 3 STAFFING Standard No Score 31 3 32 3 33 3 34 3 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 4 3 3 3 3 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 3 3 3 3 3 3 3 3 Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? N/A 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. Refer to Standard YA24 Good Practice Recommendations Elm Tree House DS0000008164.V359914.R01.S.doc Version 5.2 Page 27 Commission for Social Care Inspection South West Colston 33 33 Colston Avenue Bristol BS1 4UA National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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