Care Home: Elmfield House

What the care home does well Prospective individuals are provided with information, including visiting the home in order that they can make an informed choice about using the services provided. People who may wish to use the service have full needs assessment prior to using the service in order to ensure that the homes staff have the abilities to meet the individuals assessed needs. Peoples care plans were up to date and the provision of personal care and support reflected a person centred approach. Peoples health care needs are well met and the homes staff have maintained good working partnerships with health care professionals. Support and care is provided in a way which promotes peoples dignity and privacy. Peoples rights to choice about their daily routines and the range of activities offered is promoted. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet in spacious and pleasant surroundings. The physical design and layout of the home continues to support individuals to live in a safe and well maintained and comfortable environment. The control of the spread of infection in the home and cleanliness is robustly managed. Communal and private areas of the home are of a high standard, well furnished and comfortable for individuals. What has improved since the last inspection? The admission and assessment procedures have been improved to ensure that prospective individuals needs are consistently identified and documented to ensure staff have the skills and abilities to meet the persons needs. Intermediate care is not currently offered. The standard of recording, management, regular reviewing and documentation of the care plans had significantly improved to include a more person centred approach toward the individuals health, medical, personal and social care needs. The home have introduced a recognised malnutrition universal screening tool as part of the individuals care plan in order to ascertain the individuals nutritional state to ensure the wellbeing and welfare of the individual. The documentation and monitoring of risk assessments has been significantly strengthened to ensure the safety and well being of individuals and staff in the home. The home has recruited a chef since the last inspection and it was observed that the menus had been developed by the chef and staff listening to what individuals would like to have to eat and their views about the meals provided were considered. The home has updated the complaints policy and procedure following the previous inspection and ensured that all individuals and their representatives have an updated copy in order that they are aware of how to raise any concerns or complaints they may have about the services provided by the home. The home have obtained the local authority multi agency safeguarding vulnerable adults policy and procedures 2008 and ensured that homes safeguarding policy complies with the local authority protocols in order to promote peoples rights to safety and protection from harm or abuse. The home have improved the recruitment procedures for the safe vetting of staff. The management of the homes administration has been strengthened. What the care home could do better: Arrangements must be made for the medication practises of the home to be further strengthened in order to continue to promote safe working practises for individuals receiving medicines in the home. It is recommended that the staff are supported in awareness of appropriate report writing skills and recognise their accountability in reporting factual and accurate records relating to the support and care of individuals in order to ensure the individuals welfare and well being continues to be promoted. It has been recommended that home consider beginning to identify individuals who may wish to take a more active role in the running of the home to assist them in further engaging and interacting within the homes daily routines. Key inspection report Care homes for older people Name: Address: Elmfield House Church Lane Bisley Surrey GU24 9ED     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Suzanne Magnier     Date: 1 7 0 3 2 0 1 0 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 29 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. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 29 Information about the care home Name of care home: Address: Elmfield House Church Lane Bisley Surrey GU24 9ED 01483489522 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): elmfieldhouse@hotmail.com Mrs Linda Ann Marsh,Mr Alex James Findlay Name of registered manager (if applicable) Mrs Linda Ann Marsh Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia mental disorder, excluding learning disability or dementia old age, not falling within any other category Additional conditions: The maximum number of service users to be accommodated is 15 The registered person may provide the following category of service only: Care home only (PC) to service users of the following gender: Either whose primary care needs on admission to the home are within the following category: Dementia (DE) Mental disorder, excluding learning disability or dementia (MD) old age, not falling within any other category (OP) Date of last inspection 0 4 0 6 2 0 0 9 15 15 0 Over 65 0 0 15 Care Homes for Older People Page 4 of 29 Brief description of the care home Elmfield House is a care home providing a service for up to fifteen older persons who may have Dementia, Alzheimers or mental health concerns. The large detached property is located on the village green in Bisley and consists of individual rooms all of which have ensuite facilities. A large communal lounge, dining area and a small conservatory that has patio doors leads onto an enclosed garden which is available and accessible for people to use. The home is adapted to meet the needs of people with physical disabilities and two stair lifts are available enabling people eay access to the first floor. The bathrooms and toilets are accessible for individuals and include a walk in shower facility and hoist support if required to safely assist individuals. Laundry facilities are provided and the home is well presented and the environment well maintained. In the vicinity of the home are a selection of shops, the village post office and a public house. Care Homes for Older People Page 5 of 29 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Quality rating for this service is 2 star. This means that the people who use this service experience good quality outcomes. The last inspection of the care home was on the 4th June 2009. This inspection was an unannounced Key Inspection conducted by Ms S Magnier Regulation Inspector. The registered manager represented the service throughout the day. For the purpose of the report the people using the service are referred to as people or individuals. The inspector arrived at the service at 07.30 and was in the home for six hours leaving the service at 14.30. The inspection was a thorough look at how well the service was meeting the key National Minimum Standards for Care Homes for Older People and has in this report made judgements about the standard of the service. The Care Quality Care Homes for Older People Page 6 of 29 Commission Inspecting for Better Lives involves an Annual Quality Assurance Assessment (AQAA) to be completed by the service, which includes information from a variety of sources. This document was received by the commission by the deadline set and it was noted that the document was well written and gave clear information about the service generally. Some information from the submitted AQAA has been included within the report. The information contained in this report was gathered mainly from observation by the inspector and speaking with a number of residents and care staff. The commission have received responses to questionnaires sent to the home prior to the inspection which included ten from individuals, some of which had been written on their behalf and ten from staff. The comments received have been included within the report. Documents sampled during the inspection included some residents care plans, daily records and risk assessments, medication procedures, some health and safety records, staff training and recruitment records, and some of the homes policies and procedures. The final part of the inspection was spent giving feedback to the registered manager about the findings of the visit. No complaints or safeguarding vulnerable adults referrals have been received by the home or the commission. From the evidence seen by the inspector it is considered that the home would be able to provide a service to meet the needs of individuals who have diverse religious, racial or cultural needs. Care Homes for Older People Page 7 of 29 What the care home does well: What has improved since the last inspection? The admission and assessment procedures have been improved to ensure that prospective individuals needs are consistently identified and documented to ensure staff have the skills and abilities to meet the persons needs. Intermediate care is not currently offered. The standard of recording, management, regular reviewing and documentation of the care plans had significantly improved to include a more person centred approach toward the individuals health, medical, personal and social care needs. The home have introduced a recognised malnutrition universal screening tool as part of the individuals care plan in order to ascertain the individuals nutritional state to ensure the wellbeing and welfare of the individual. The documentation and monitoring of risk assessments has been significantly strengthened to ensure the safety and well being of individuals and staff in the home. The home has recruited a chef since the last inspection and it was observed that the Care Homes for Older People Page 8 of 29 menus had been developed by the chef and staff listening to what individuals would like to have to eat and their views about the meals provided were considered. The home has updated the complaints policy and procedure following the previous inspection and ensured that all individuals and their representatives have an updated copy in order that they are aware of how to raise any concerns or complaints they may have about the services provided by the home. The home have obtained the local authority multi agency safeguarding vulnerable adults policy and procedures 2008 and ensured that homes safeguarding policy complies with the local authority protocols in order to promote peoples rights to safety and protection from harm or abuse. The home have improved the recruitment procedures for the safe vetting of staff. The management of the homes administration has been strengthened. What they could do better: 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. Care Homes for Older People Page 9 of 29 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 29 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective individuals are provided with information, including a visiting the home, in order that they can make an informed choice about using the services provided. The admission and assessment procedures have been improved to ensure that prospective individuals needs are consistently identified and documented to ensure staff have the skills and abilities to meet the persons needs. Intermediate care is not currently offered. Evidence: The Statement of Purpose and the Service User Guide were sampled and both documents were up to date and contained appropriate information about the facilities and services provided by the home in order that prospective individuals and their representatives could make an informed choice about receiving care, support and accommodation at the home. The AQAA advises that the home have an Internet website where prospective individuals can view the home before visiting if they wish to Care Homes for Older People Page 11 of 29 Evidence: and information regarding the home can be provided in different formats including braille and other languages. The home have developed new pre admission assessment documentation which includes an improved person centred approach to ensure that prospective individuals holistic preferences and needs can be met within the home and to ensure that inappropriate admissions to the home do not occur. Three individuals care plans were sampled during the inspection which provided evidence to support that their needs had been well assessed by the registered manager who has the ability and qualifications to undertake the assessment. There was evidence to support that the health needs assessments were obtained from prospective individuals and where a prospective individual was admitted from hospital a full assessment had been obtained from the hospital in order to ensure that the homes staff could meet the persons health care needs. The registered manager advised that prospective individuals and their representatives are encouraged to visit the home prior to admission in order that they feel they can have the time to make the choice, get to know other individuals and staff at the home and have time to settle in their new surroundings. A welcome pack has been developed since the last inspection which includes information about the home for individuals to browse through if they choose to. The home does not offer intermediate care yet continues to offer respite care for individuals. Care Homes for Older People Page 12 of 29 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples care plans were up to date and the provision of personal care and support reflected an improved person centred approach. Peoples health care needs are well met. The monitoring of risk assessments has improved to ensure the safety and well being of people in the home. Medication procedures have been improved yet, in some areas need to be further strengthened to continue to ensure the safety and welfare of people in the home. Support and care is provided in a way which continues to promote peoples privacy and dignity. Evidence: The principles of the home have been maintained to promote individuals right to remain in control of their daily lives and that the home is home from home. Individuals were observed to be moving freely around the home and having choices about where they wanted to have their meals, where they wanted to be during the day either in their room, having a lie in or nap after lunch, choosing to be in the lounge, dining room or conservatory. Three care plans were sampled and it was evident that those individuals newly Care Homes for Older People Page 13 of 29 Evidence: admitted to the home had had their care plans developed from the pre assessment documentation. The care plans evidenced that the standard of recording, management, regular reviewing and documentation of the care plans had significantly improved to include a more person centred approach toward the individuals health, medical, personal and social care needs. The registered manager advised that a further improvement in the home had been the introduction of a key worker system whereby a names staff member will oversee the care and support of an individual and be a point of contact for the individual and their relatives and friends. The key worker duties also include the monitoring and reviewing of the individuals care plan, risk assessments and ensuring that the individuals daily health and care needs are met and are well monitored to ensure the individuals welfare and well being. The care plans were well written to allow the reader to gain an overview of the individuals medical, social and personal care and how they preferred to receive support and care from staff over a twenty four hour period. There was evidence to support that individuals and their representatives had been involved in the development of their care plans as all three sampled had been signed by the individual. The care plans sampled were person centred and included a range of information about the individual for example their life experiences, past occupation and social history, how they like to communicate, their skills and abilities, interest and hobbies, and how they like to make choices in their daily lives, their likes and dislikes including food, lifestyle preferences for example having a lie in in the morning, and how they liked to be supported if they are experiencing difficulties during the day or night. Additional information about the individuals health care included their moving and handling needs, involvement of health care professionals, nutritional assessments, continence management, history of falls, the individuals tissue viability and any wound care, nutritional assessments and body weight charts. Whilst speaking with individuals they confirmed that the homes staff offer a good quality of care and are kind and attentive toward the individuals in their care. Individuals were well groomed and their clothes including footwear were clean and appropriate for the weather conditions. Following the previous inspection the home have improved the documentation and standard of risk assessments. Within the care plans sampled there were up to date and well documented risk assessments which included the residents mobility, nutritional and tissue viability assessments, safe bathing and medication risk assessments. The registered manager confirmed that staff were more familiar with and recognised their accountability an documenting risk assessment when a hazard had been identified in an individuals life to evidence that measures are in place to Care Homes for Older People Page 14 of 29 Evidence: reduce the hazard as far as reasonably practicable to ensure the safety and well being of the individual and others in the home. There was recorded evidence to support that the home has continued to have strong professional links with the the local general practitioner (GP) who visits the home when required. The AQAA confirms that people can retain their own GP if the GP is within the catchment area. Records confirmed that other health care professionals visit the home that include district nurses, chiropodists, opticians, dentist and specialist health care professional. Referrals to health care specialists for example the falls clinic and speech and language therapists are maintained in order to ensure the welfare of individuals at the home. Several individuals daily records were sampled and the registered manager explained that staff document the daily care which they have provided to the individual. It was noted and brought to the registered managers attention that the records did not include the staff members full name, several entries did not reflect the individuals right to dignity and respect and some records did not describe the individuals general demeanour and lacked an understanding of the way individuals may communicate anxiety through behaviours that may test the service. It is recommended that all staff are supported in the awareness of appropriate report writing skills and recognise their accountability in reporting factual and accurate records relating to the support and care of the individuals in order to ensure the individuals welfare and well being continues to be promoted. The home has updated the medication policy and procedure and has introduced a dossett medication process which the registered manager explained would be changed to a monitored dosage system. The overall medication procedures in the home have improved and the home have built strong links with the dispensing chemist. Several medication shortfalls were observed during the day of the inspection which included a staff member signing that the individual had received their medicines before they had received them. This was brought to the staff members attention and confirmed independantly by two other staff and the registered manager as not general practce. One medication administration chart indicated gaps in a signature and one individual had run out of medication, which could have been purchased from a dispensing chemist as the medicine was to be taken when necessary. The commission acknowledge that the home have made significant overall improvements regarding the ordering, delivery, administration and disposal of medicines yet it is required that procedures need to be further strengthened. Each individual had a section within their medication folder which contained their up to date photograph, their known allergies and how they liked to take their medicines. It was confirmed that individuals have a Care Homes for Older People Page 15 of 29 Evidence: right to refuse their medication and that the home promotes peoples rights to independence, and where possible, following appropriate risk assessments individuals would be supported to manage their own medication. Care Homes for Older People Page 16 of 29 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights of choice about their daily routines and the range of activities offered is promoted. Visitors are welcomed to the home to maintain contact with their family members and friends. The home provides a healthy and balanced diet in spacious and pleasant surroundings. Evidence: Peoples comments about the home included every thing is good including the food,my general living is good, the staff look after me well, they look after me well and the carers really do care, hot food should always be served on hot plates not cold ones. Good food, they give me help when I need it, the home does well in everything. Whilst speaking with individuals during the inspection all people stated how well the home was run and how they felt content and well cared for by staff. The home have continued to offer meaningful leisure activities for individuals and these include staff having one to one time with people, some individuals go to a venue for older people for coffee mornings, one person attends a local dancing group, some individuals have an accompanied stroll to the local green and a music and health Care Homes for Older People Page 17 of 29 Evidence: company visit the home to entertain and engage individuals in singing. The home have improved the activities programme provided and have installed a large plasma television and interactive games such as Countdown and Catch phrase have proved popular with individuals. The registered manager advised that the home may have secured the services of a driver for a people carrier which would enable individuals to go out for day trips during the summer months. It was observed, in the staff meeting minutes, that one individual had requested for staff to spend more time with them to listen to them reading and the meeting minutes suggested a particular time in the day when the individual may like to have the opportunity to do the reading in order to continue to maintain their ability to communicate as their formal speech and language therapy sessions had ceased. The homes communal facilities promote individuals to live in a homely atmosphere with a variety of areas where they can continue to take part in leisure and hobby activities. There were a variety of books and board games, jigsaws and music available for individuals to choose from if they wished to and it was observed that some individuals had made strong friendships in the home and helped each other during the course of the day. People are encouraged to be part of the local community and attend local fairs, seasonal occasions and events. The registered manager confirmed that a member of the Christian clergy visits the home to offer spiritual and religious support to individuals. A hairdresser and manicurist visit the home to offer beauty therapy and the landscaped garden has a small green house available for individuals wanting to potter about making hanging baskets or potting plants. People were seen to move around the home freely and the atmosphere in the home was was quiet and relaxed. It was observed that staff were calm and flexible to adjust to peoples choices which indicated the service was led by the individuals living in the home rather than by the homes procedures. The breakfasts and midday meal served were well presented. People were offered choice if they wished to have their breakfasts in their rooms or in the lounge and most people had their breakfasts in their rooms. It was observed that the dining room tables had been set for lunch time by the night staff and although staff advised individuals could sit at the dining tables for breakfast it was observed that three individuals had their breakfasts in the lounge. It was observed that individuals who may choose to could be more involved in some of the day to day living activities which could include assisting with tidying cupboards, laying the tale, involvement in peeling Care Homes for Older People Page 18 of 29 Evidence: or washing vegetables. It has been recommended that home consider beginning to identify individuals who may wish to take a more active role in the running of the home to assist them in further engaging and interacting within the homes daily routines. The home has a chef and it was observed that the menus had been developed by the chef and staff listening to what individuals would like to have to eat and their views about the meals provided were considered. A menu was available to support that a varied and nutritious diet was available for people. There was evidence to support that individuals with specific dietary preferences for example vegetarian diets were catered for and a choice of cereals and food at breakfast and lunch time was available. The breakfast and the midday meals were served in an efficient manner. The dining area contained small tables which had been had been set with appropriate condiments,crockery, tablecloths and napkins. People were observed during the midday meal and staff were on hand to support anyone who needed assistance. Care Homes for Older People Page 19 of 29 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to be protected are supported by the homes complaints and safeguarding adults procedures. Evidence: The home has updated the complaints policy and procedure following the previous inspection and ensured that all individuals and their representatives have an updated copy in order that they are aware of how to raise any concerns or complaints they may have about the services provided by the home. The AQAA advises that regular resident meetings are held and it was confirmed that individuals can raise any concerns they have at the meeting or speak with their individual key worker. The registered manager confirmed that no complaints had been received by the home and any complaints received would be fully investigated and that records would be kept by the home to evidence this. Several people told the inspector that they would talk to the staff or their family members if they had any concerns or were unhappy. There was evidence to support that the registered manager and staff have knowledge regarding peoples human rights with regard to the Mental Capacity Act and Deprivation of Liberty safeguards and the home have maintained access to an advocacy service as required. The home have, following the previous inspection been more mindful and have implemented risk and multi agency assessments regarding any actions by the homes staff that may constitute deprivation of liberty of individuals for Care Homes for Older People Page 20 of 29 Evidence: example covert medicines and have ensured that appropriate advise is sought and agreed by the appropriate parties to ensure any deprivation of liberty is lawful and individuals protected. The home have obtained the local authority multi agency safeguarding vulnerable adults policy and procedures 2008 and during the inspection made some minor adjustments to the homes safeguarding policy which complies with the local authority protocols. The registered manager, when questioned, was clear in detailing the process of reporting alleged harm or abuse and three staff records sampled indicated that staff had attended safeguarding vulnerable adults training. The home have a whistle blowing procedure in order that staff are aware of their duty of care to report any safeguarding incidents. The three staff files sampled evidenced that Criminal Record Bureau checks had been obtained. Care Homes for Older People Page 21 of 29 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The physical design and layout continues to support individuals to live in a safe, well maintained and comfortable environment. The control of the spread of infection in the home and cleanliness is robustly managed. Evidence: The care home continues to meet the needs of the individuals currently residing at the home. The standard of accommodation, cleanliness and hygiene standards of the home remain excellent. The homes housekeeper was observed to interact with individuals during her tasks and it was apparent that the individuals enjoyed the banter and expressions of interest exchanged. The home was exceptionally clean throughout with no malodour present and and all areas of the home were well maintained. Care Homes for Older People Page 22 of 29 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff in the home are in sufficient numbers to support the people who use the service. The home have improved the recruitment procedures for the safe vetting of staff and the management of recruitment practises have been strengthened to protect the welfare and safety of individuals at the home. The induction and training development practises of the home currently ensure staff receive training to ensure peoples needs are appropriately met. Evidence: The home currently employs fourteen permanent care staff nine of whom have achieved their National Vocational Qualification NVQ Level 2 or above. The staffing levels at the home during the inspection were considered to be appropriate to meet the care needs of the individuals residing at the home. The general atmosphere was quiet and orderly and staff were observed to undertake their duties in an efficient and professional manner. Staff relationships with individuals were professional and the use of terms of endearment supported trusting relationships between the individual and the staff member. Peoples preferences on how they like to be addressed were documented in peoples care plans. Staff written comments received by the commission about the home included The quality of care given to residents is of a high standard and there is a home from home Care Homes for Older People Page 23 of 29 Evidence: atmosphere which residents like. As it is a small home you get to know the residents likes, dislikes and there is a good quality of personal choice for meals. The activity rota now being introduced and the staff team work well together. I love my job at Elmfield and am very happy. More outings for the residents would be good if they feel up to it and few more staff meetings. I think Elmfield House cares for all residents individual care needs and there are different options for residents. Finding more activities for residents to take part in would be good. We provide a homely environment for the people who live her and being a small home we get to know everybody really well. We develop good relationships with families and friends and the homes management provide good training and are open to us doing that we are interested in as well as training required of us. All people are treated equally and it feels like a big family. Privacy is important and residents are treated with respect. Its a good place to work. The home is run well and all care workers do a good job at caring. We are adopting a person centred care approach which is much more beneficial for residents and staff. Activities are hard to provide on top of our other duties some days and finding activities that everyone enjoys can be tricky, another extra member of staff to accompany residents for walks would be good. More staff meetings for night staff so we are kept up to date verbally as well as written in the care plans, communication book and diary. I enjoy working at Elmfield House and hope to work here for years to come. The homes recruitment and selection policy was sampled during this inspection. The inspector sampled three care staff files. The documents regarding the safe recruitment and vetting of new staff had been improved following the previous inspection to ensure the safety and protection of people in the home. There was documented evidence that a Criminal Record Bureau clearance had been obtained in order to ensure the safety and protection of individuals in the home. The registered manager confirmed that the home is committed to the ongoing training and development of staff and the staff files sampled evidenced that staff had attended induction, statutory training and specialist training including dementia training to support them to care for individuals with specific needs. The AQAA advises that the company has purchased a specific training pack with the intention that staff can undertake training at their own pace and an external company will assess staff progress. Care Homes for Older People Page 24 of 29 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the homes administration has been strengthened. The home continues to be run in the best interests of individuals and their views and opinions and those of others associated with the home are sought and acted upon and peoples general safety and welfare is promoted. Evidence: The management of the home has been consistent and continues to be based on the principles of openness and respect. The registered manager, who has managed the home for fifteen years, demonstrated throughout the inspection a knowledge and understanding of the day to day running of the service for the benefit of the people living at the home. Following the previous inspection it was apparent that the homes management have addressed the shortfalls identified and have met all the requirements. The management of the home has been reviewed to assist the registered manager in Care Homes for Older People Page 25 of 29 Evidence: having the time to delegate more responsibility to staff in the home and to manage the home in a different style which has empowered staff and given the registered manager a time to consolidate and review some of procedures and policies within the home. The registered manager has attained the Registered Managers Award and NVQ Level 4 in Care and continues to offer leadership and stability in the home. It was evident during the inspection that the homes staff have open and professional relationships with individuals living in the home and peoples views about the care and support their friends and relatives receive is listened to and acted upon by the registered manager and staff. The home has maintained an internal Quality Assurance process and there was evidence to support that the views from people living in the home had been instrumental in changing some of the aspects in the home which have included changes in the menu choices to include more exciting recipes and increased number and type of activities. The fridge, freezer and pantry were well stocked. Fresh fruit and vegetables were available for individuals. Records of food temperatures, storage of food in the fridge and pantry was in compliance with food hygiene standards to ensure peoples health and safety. The storage of chemicals in the home were appropriate to ensure the safety and welfare of all people in the home. Fire safety measures were in place and a documented fire risk assessment was sampled. The homes fire procedures confirmed that records were kept of fire tests and equipment checks and signage was available within the home to show people fire exits. The AQAA advises that the home do not have responsibility for individuals money and relatives safeguard individuals financial interests. The home have a current certificate of registration and insurance indemnity certificate displayed within the home. Accident and incident records were sampled which indicated that events which affect the well being and welfare of individuals are reported to the commission without delay and this process must be maintained. Care Homes for Older People Page 26 of 29 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 27 of 29 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 Arrangements must be made for the medication practises of the home to be further strengthened. In order to continue to promote safe working practises for individuals receiving medicines in the home. 30/07/2010 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 10 It is recommended that the staff are supported in awareness of appropriate report writing skills and recognise their accountability in reporting factual and accurate records relating to the support and care of individuals in order to ensure the individuals welfare and well being continues to be promoted. It has been recommended that home consider beginning to identify individuals who may wish to take a more active role in the running of the home to assist them in further engaging and interacting within the homes daily routines. 2 12 Care Homes for Older People Page 28 of 29 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. 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