Care Home: Elmglade

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What the care home does well Despite the increase in size this care home is still has the atmosphere of relatively small family-style care home. It aims to provide a high standard of care. Administration continues to improve. The newer bedrooms are to a much higher standard than the older ones and provide a greater level of comfort and space for residents. What has improved since the last inspection? The manager is now registered with the Commission. Most of the requirements arising from our last inspection visit in 2007 have now been addressed. A passenger lift has been installed and this will give better access to most bedrooms on the first floor. CARE HOMES FOR OLDER PEOPLE Elmglade 399 London Road North Cheam Surrey SM3 8JH Lead Inspector Michael Williams Unannounced Inspection 8th May 2008 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmglade Address 399 London Road North Cheam Surrey SM3 8JH 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) 020 8393 5593 020 8393 5593 nihal888@hotmail.com Mr Tissa Nihal Atapattu Mrs Nelum Vijayanthi Atapattu Dawn Barnes Care Home 23 Category(ies) of Dementia (23), Old age, not falling within any registration, with number other category (23) of places Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - Code OP 2. Dementia - Code DE The maximum number of residents who can be accommodated is: 23 Date of last inspection 19th June 2007 Brief Description of the Service: Elmglade is owned by Mr and Mrs Atapattu and Dawn Barnes was, on 29th April 2008, registered as the manager. Elmglade provides care for older people, over the age 65, with dementia. The home itself is a large detached property (formally two houses adapted into single unit). It is situated in a residential area of North Cheam. It is within reasonable walking distance of shops and transport. Built over two floors and, following the construction of a new extension, the home now has 23 beds in all. Some of the newer bedrooms have ensuite facilities; some bedrooms have a very limited view from the window. There are two separate communal areas comprising open-plan lounges and one is used as single large lounge/dining area. Sufficient numbers of bathroom and toilet facilities are conveniently located throughout the home. The home has the usual facilities including a small kitchen, and equally small laundry area, a very small office, and rather limited general storage space. A passenger lift has been installed so access to some, but not all, of the first floor bedrooms is now considerably improved. This care home has been extended several times resulting in a rather labyrinthine layout but is otherwise a homely building. Fees as at May 2008 were £419 to £490. Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating of the service is 2 stars. This means the people who use this service experience good quality outcomes. This inspection took place in May of 2008; the extension to the home is completed and registered and fully operational. To monitor all aspects of care the inspector ‘tracked’ the care provided to a sample number of residents and cross checked this information by examining the documentation supporting care, by observing the meals provided, and by cross-checking the arrangement for dealing with medication, handling money, and other records. Staff providing care were interviewed, and where possible the inspector met with relatives as well as interviewing or observing the people who this service, residents themselves. Questionnaires were also distributed and feedback noted. All care homes are expected to respect the diversity of the residents and in Elmglade they do this by assessing the residents’ individual needs; by speaking to their relatives to ascertain specific needs and preferences; by providing services for those with diverse needs including sensory impairments and by employing staff from a range of backgrounds – although the background of staff in Elmglade does not reflect the racial and cultural backgrounds of residents - who are mostly English. There are both male and female staff to give residents choice in respect of gender. What the service does well: What has improved since the last inspection? What they could do better: Some bedrooms do not contain all the furniture and equipment listed in the National Minimum Standards [the Standards]; for example bedside lights not operational in all cases and lockable units missing in bedrooms. Some Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 6 requirements remain to fully dealt with such as the door locks. Kitchen hygiene needs reviewing and security of chemicals. More than one hoist is needed. These matter must be addressed to ensure the welfare and safety if residents. 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. Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 3: People using this service experience good quality outcome in this area We have made this judgement using a range of evidence, including a visit to this service. New service users are being admitted only on the basis of a full assessment, so residents know that they will be provided with sufficient information about the home and that their needs have been fully assessed and can be met in this home. EVIDENCE: To assess this section we checked the Statement of Purpose, the Resident’s Guide and residents case files, we also spoke to residents, staff and the manager. The home provides a Statement of Purpose that is specific to the individual home, and the resident group they care for. It clearly sets out the objectives and philosophy of the service supported by a Resident Guide. The guide details what the prospective individual can expect, a description of the accommodation, information about the qualifications and experience of staff, and how to make a complaint, how to access recent Commission inspection findings. However it does not contain comments and experiences of residents living at the home. All residents are given a copy of the Guide. When Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 9 requested the service could provide a copy of the Statement of Purpose and guide in a format, such as large print. Admissions are not made to the home until a full needs assessment has been undertaken, usually by a care manager and these assessments now held on residents’ case files as required by the Commission. The home has a very good care plan format that enables senior staff to assess residents who do not have care managers or nurses to undertake the pre-admission assessment. The assessment, we are advised, is conducted professionally and sensitively and involves the individual and frequently their family or representative where appropriate. Where the assessment has been undertaken through care management arrangements Elmwood is now insisting upon receiving a summary of the assessment and a copy of the care plans. Areas of strength include the home acquiring care managers’ assessments and the provision of a guide to each new resident; and as no matters required attention on this occasion this section, about choice of home, is assessed as good. Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 7 to 10: People using this service experience good quality outcome in this area We have made this judgement using a range of evidence, including a visit to this service. The arrangements for care planning, the provision of health care and the procedures for dealing with medication are all satisfactory so as to ensure the social, and health care of residents can be met. EVIDENCE: Personal care needs including and health, dietary and social requirements are clearly recorded in each resident’s plan; they give a comprehensive overview of their health needs and act as an indicator of change in health requirements. Care Plans are in the form of booklets and provide formats for assessing and planning care. These documents also refer to the skills and ability of the staff group. But they will need to be updated to make clearer the criteria for admission and to include any items not already listed such as the existing residents’ views of the home. The manager asserts that personal support is responsive to the varied and individual needs and preferences of the residents as outlined in each care plan. The home therefore aims deliver personal care that is individual and is flexible, consistent, reliable, and person centred. Staff are usually respectful privacy Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 11 and dignity and are sensitive to changing needs and no lapses in upholding residents’ dignity were observed during this visit. The manager listens and responds to individuals’ choices and decisions about who delivers their personal care; the home does employ male and female staff so a choice about gender can be made but, as most residents are English and few of the staff are, residents have little choice about being cared for by staff who share a common background (as indicated in regulation 12, which requires a home to give due regard to this aspect of residents’ care). Residents are supported and helped to be independent and can take responsibility for their personal care needs when possible but many residents are very frail and need a lot of support but good examples of staff supporting independence were noted such as use of chair lift and accessing bedrooms independently. Staff listen to residents and take account of what is important to them – one good example is the manager’s willingness to provide two dining areas as some residents would prefer a quieter setting in which to eat than the very busy main dining room, which now caters for up to 23 people. Residents have access to healthcare and remedial services, such as the dentist who was on site at the time of our visit and confirm the service he provides to residents. The Dentist did however confirm that residents are now assessed the same as other people in the community and some will have to pay either NHS or Private fees when the service is not free at point of delivery. Staff make sure that those residents who are fit and well enough are encouraged to be independent and go out to attend local health care services (rather than have all services coming into the home). For the frailer residents the home ensures that the health care needs of residents unable to leave the home are managed by visits from local health care services including dentists, nurses, chiropody, options and so forth. Residents have the aids and equipment they need and these are well maintained to support both residents and staff in daily living. However, this home is based upon a pair of family homes and is not ideal for residents with mobility problems, for example residents who use walking frames or wheelchairs. The home has no passenger lift but does have to chair lifts. The corridors are narrow and winding and many rooms, both communal and private bedrooms, are not large enough to manoeuvre wheelchairs. The home has just one lifting hoist and it can’t be used upstairs so only easily accessible ground floor bedrooms should be used for residents with restricted mobility. Staff now have access to training in health care matters and they are now encouraged and given time to attend seminars on specialist areas of work such as dementia care as required by the Commission. The home has a medication policy supported by procedures and practice guidance, which staff understand and follow. Medication records are fully completed, contain required entries, and are signed by appropriate staff who have received training. The manager advised us that she regularly checks to monitor compliance. No problems with the administration of medication were identified on this occasion. Residents are given the support they need to manage their medication. If individuals prefer o lack capacity, care staff can manage medication and this is Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 12 the case for almost residents in Elmglade. Thought has been given to providing safe but sensitive facilities for keeping medication such as a lockable cabinet but not all bedrooms have this facility. The home has a good record of compliance with the receipt, administration, safekeeping, and disposal of medication including Controlled Drugs. Staff who administer medication have completed a medicine course, with a certificate in their staff folder, and the manager has confirmed that these staff are competent to handle, record and administer medication properly. Areas of strength include the detailed care planning books, the caring approach of staff in meeting residents’ needs, access to health care services and medication is safely managed. Other shortcomings in the environment including aids and adaptations, are dealt with under the environment section. This section, about health and social care, is assessed overall as good. Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 12 to 15: People using this service experience good quality outcome in this area We have made this judgement using a range of evidence, including a visit to this service. The daily routines in this home are reasonably flexible, within the constraints of a large service. Residents are being supported and encouraged to maintain links with family, friends and to exercise choice and control over their lives in so far as they wish and are able to do so. Residents are receiving a reasonably wholesome, appealing and well balanced diet in a fairly congenial setting in accordance with their recorded requirements and preferences but improvements are indicated. EVIDENCE: Residents are involved in some meaningful daytime activities according to their interests and capability and, in so far as it is possible, the residents and their families have been involved in the planning the way they will spend their time in Elmglade. The manager states that she is committed to the principles of inclusion and is promoting good relationships with neighbours and other members of the community. To this end the home is planning a garden fete later in the summer so as to involve residents, visitors and close neighbours. The manager has also widened the range of social and recreational activities offered to residents and has learned from experience that brief local trips to local places of interest are more manageable and popular then large scale trips Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 14 over greater distances (such as coach trips to the South Coast) which residents, and staff, found rather exhausting in the past. Within the home there is to be a designated member of staff whose role will be to develop daily activities. On the day of inspection residents were playing a variation of Bingo using pictures. There is now a revised weekly programme for residents compiled from a longer list of possible events and this is commended. Unfortunately the two long, narrow lounge/dining areas rather limit the way in which communal space can be used in this home so residents have limited choice about where they sit each day and with whom; we have suggested that better use is made of the layout by re-arranging dining and seating areas so residents have optimum choice. The range of meals appear balanced and nutritional and can cater for the varying cultural and dietary needs of the individuals using the service – we understand that almost all residents prefer ordinary English fare to Continental or Asian meals. Meals provided must however be reviewed periodically, if necessary in consultation with a nutritionalist - as well as residents and families. The home was also advised that the Food Standards Agency provides detailed information in their report “Food served to older people in residential care”. We require that the range of meals is increased, that the cycle of menus is increased from two weekly cycle to at least four-weekly and is periodically changed to suite the changing seasons. For a home catering for 23 residents we required that for the main midday meal a second choice be offered – in addition to any snacks prepared as ‘alternatives’. This is now in place. We note that the acting cook has a rather poor grasp of English, a point conceded by the manager since we found it difficult to communicate with her and get satisfactory answers. If there is to be effective communication between cook and manager then the communication skills of staff including ancillary staff such as cooks and cleaners must be improved to avoid the risk of misunderstandings that might lead to a poorer service for residents. We note and commend however the manager’s use of the ‘Better Food, Better Business’ kitchen guidance and records. Whilst many residents were unable to give an opinion about the quality of food several residents commended the cooking in Elmglade and we observed that care staff were sensitive to the needs of those residents who find it difficult to eat and generally gave assistance with feeding in a kindly and dignified way. Staff were however aware of the importance of feeding at the pace of the resident, making them feel comfortable and unhurried. Areas of strength include the increased range of activities and opportunities to go out and the involvement of friends and visitors in events such as a summer fete; resident meetings are now being held and along with meetings for family and friends this commended. This section, about daily life, is assessed as good. Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 15 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 16 and 18: People using this service experience good quality outcome in this area We have made this judgement using a range of evidence, including a visit to this service. The home has a clear and simple procedure for dealing with complaints and safeguarding issues so residents are confidant their concerns will be dealt with promptly and effectively. EVIDENCE: The service has a complaints procedure. The procedure and is on display in the entrance hall and similar locations throughout the home, alongside a notice about ‘whistle-blowing’ (reporting abuse). It is not yet available in any alternative formats such as large print or alternate languages but could be transcribed if needed. Staff are aware of the complaints procedure. Complaints from individuals appear to be fully recorded and those we examined appeared to have been dealt with in a timely manner, outcomes and action taken by the home is now being properly logged. One complaint drawn to our attention during our visit, about an apparent loss of personal possessions, is to be taken up by the manager. Policies and procedures for safeguarding residents from abuse are in place. Staff knew that any concerns of this nature should be reported either to the manager, owner or to a relevant outside body such as the Social Service or Commission. So in practice staff know what to do is such cases. Staff are being booked onto relevant training courses as required by the Commission but not all staff have undergone this training as it relies upon training opportunities being available. Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 16 Residents who were able to express an opinion say that they are satisfied with the care in the home and feel safe and several visitors agreed that they feel their relative is being cared for in a safe and comfortable manner. Areas of strength are the willingness of the acting manger to listen to concerns and deal with them in a very positive manner; staff are also aware of the need to deal with complaints and allegations of abuse in a timely and effective way and some information about this is available. So this section, about complaints and protection is assessed as good. Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 19, 24, 26: People using this service experience adequate quality outcome in this area We have made this judgement using a range of evidence, including a visit to this service. The layout of the home and the manner in which it is being maintained means that this is a reasonably safe, comfortable, clean and suitable environment for the people who use this service. There were however a number of matters requiring attention and they are outlined below. EVIDENCE: To a large extent Elmglade provides a physical environment that meets the needs of the people who live there. The home is comfortable, and has a programme to improve the decoration, fixtures and fittings but there are shortcomings in this home. It has narrow winding corridors and until very recently had no passenger lift so moving people with physical disabilities was problematic; the lift now improves access to the first floor for most, though not all residents are there are several staircases to negotiate with stepped landings. In addition to the new lift there are two chair lifts for residents who can manager this form of aid. The home has just one lifting hoist (to move residents from bed to chair etcetera) but that is located on the ground floor Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 18 and can’t be used on the first floor, even with the lift it can’t be readily moved to all part of the home so a review aids and adaptations is needed. Not all bedrooms meet modern standards although the new bedrooms do and this includes ensuite facilities in each of the newer bedrooms. Some bedrooms, old and new, have a very poor outlook – looking onto a brick wall within about five feet. Some of the older bedrooms are in need of improvement either to the general décor or to the old and worn furniture. Residents can personalise their rooms but quite a few were rather bare and without adornment so residents probably need support to personalise their rooms and staff have been directed to help in this. Some bedrooms did not have lockable facility for storing their valuables in their bedroom and one had a bedside light – but on closer inspection it was not plugged in and there was no electrical socket within reach of the lamp. This meant the resident would not be able to switch on a light from his bed in the night. During our inspection we observed that the Elmglade is reasonably clean, warm, well lit and there is sufficient hot water. On this occasion there was no malodour. The owner states that the water system has been checked for compliance with the relevant Water Regulation compliance. The kitchen was not being well managed; an area of the floor was not suitably covered and clean’ chemicals were left on the floor, the cook was unaware of the correct temperatures for cold storage and was not recording the actual temperature of the fridge. Toilets for the use of people using the service are appropriately located within the home, but are not all easily accessible for less mobile residents because of the layout of the home. Residents are not always able to have the option of a single room immediately on admission and may need to share – this would be agreed at the time of admission and would form part of the contractual fee. Elmwood does not have small group living for residents but the manager is aware of the benefits of re-arranging accommodation to better meet the needs of the two distinct client groups the home caters (those with and those who do not have dementia). In Elmglade we found a fire exit blocked my equipment in the side entrance, a final exit that requires a key to operate and could therefore impede escape from the building in the vent of an emergency. Hygiene equipment is available but chemicals, including white spirit, which a member of staff mistook for water, were seen to have been left in an unlocked areas of the kitchen thus posing a potential hazard to residents. Areas of strength are the homeliness and higher standards achieved in the new extension; matters requiring improvement include the view from bedroom windows; fire safety, chemical storage; décor and furniture; this section, about the environment, is assessed as adequate. Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 27 to 30: People using this service experience good quality outcome in this area We have made this judgement using a range of evidence, including a visit to this service. The number of staff employed and their skill mix are mostly appropriate to the assessed needs of the current residents in this home – so this will ensure that their care needs are being mostly met. EVIDENCE: Residents have confidence in the staff that care for them and some said so during the inspection; staff were described as kind and helpful. “The food is lovely here and the staff are lovely too” and “A nice man comes on Fridays (to entertain us)”. Rotas show well thought out and creative ways of making sure that the home is staffed efficiently, with particular attention given to busy times of the day and changing needs of the residents. But as there is no laundry worker care staff undertake this work so it is recommended that a laundress is employed. Staff members undertake external qualifications including general certificates such as NVQ [National Vocational Qualification] and more specific ones such as dementia care, infection control, and protection of vulnerable adults, etcetera. The manager encourages and enables this and recognises the benefits of a skilled, trained workforce. Accurate job descriptions and specifications clearly define the roles and responsibilities of staff. The manager is designating roles for her staff such as ‘activity leader’ and ‘health & safety monitoring’ and so forth. There are contingency plans for cover for vacancies and sickness and there is little use of any agency or temporary staff. Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 20 The service has improved recruitment procedures and the staff files are now better organised so that in each case the manager can see clearly that the correct process has been followed. The manager does recognises the importance of effective recruitment procedures in the delivery of good quality services and for the protection of individuals but at present is still not involved in the recruitment of her staff team – the owner does this. Nor are residents involved in the recruitment process and as a result we noted that several staff including care and ancillary staff do not have English as their first language so communication between staff and between staff and residents is sometimes inhibited we were told. Involving residents more in the recruitment process may help to identify those staff with good or at least adequate communication skills. The manager recognises this issue and has in the past arranged for staff to attend ‘English as the second language’ classes. The staff we interviewed confirm that the service was clear about what was involved at all stages of recruitment and that it was robust in the following of its procedure for example in the supply of documentation such as passports to confirm legal status and identity. We checked a sample of staff records and confirmed police checks [CRB] were in place for these staff and the manager states that all staff have had this check and in addition for some staff this was preceded by a ‘POVA’ check [Protection of Vulnerable Adults list]. Evidence of staff annual appraisals are now in place along with two-monthly supervision notes. Staff meetings are now taking place regularly and this was confirmed by the written minutes and staff themselves. Individual staff supervision sessions or meetings are now also in place - and will need to be held at least six times each year. The home has no suitable staff room but does have a few lockers. Areas of strength include the caring and professional attitude of staff; improved training opportunities; the improved staff meetings and supervision regime, and matters requiring improvement include the need to ensure staff have an adequate use of spoken and written English as well as reasonable understanding of the residents’ cultural background. A laundry worker is recommended so that care staff do not have to undertake ancillary work and so limit the time they can spend with residents. There is no suitable staff room. However, this section, about staffing, is assessed overall as good. Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): NMS 31, 33, 35, 37 and 38: People using this service experience good quality outcome in this area We have made this judgement using a range of evidence, including a visit to this service. The newly registered manager has been assessed as a person competent to run this home in accordance with its stated aims and objectives and so in the best interests of the s. The home is well managed, including finances, and is mostly safe for s. EVIDENCE: The owner of the home is no longer the manager since Ms Barnes was registered. She was formally assessed as a person with the necessary qualifications and skills to manage the day-to-day running of the home. It is expected that Mr Atapattu, who did not always met the required Standards when he was in day to day charge of the care home, will allow the manager he has appointed to run the home to meet Standards in the best interests of the residents and will do so by delegating roles and budgets where it is appropriate to do so. Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 22 Meanwhile the owner still has on office on-site to oversee the day-to-day running of the home. The position of manager is therefore not consolidated at this point. Staff recruitment, training, development and supervision has been inconsistent and poor at times but is now very much improved. Equal opportunities or an appreciation of diversity and person-centred care is thought to be important by the manager and owner and the very good care planning documentation supports this and the standardised booklets are used for recording individual resident’s wishes and aspirations including their diversity needs such as cultural, religious and gender issues where they are important to a resident. The home has a health and safety policy and there is no evidence of a high number of accidents and incidents within the home. Staff have had recent training to enable them to work safely and are aware of policies and procedures that exist but these are not readily accessible to all staff as there is no suitable staff room to lodge policies and guidance for staff. The owner advises us that the home is not in any financial difficulty but is fully extended following the works to enlarge the home. It is evident that the home is now trying to deliver a good service and the manager has the very laudable aim of attaining an excellent, three star rating with the Commission. Record keeping was checked including, residents’ case files, staff files, food records, complaints, accidents, fire safety, a sample of policies, medication records, visitors signing-in book and so forth. They are being well maintained and any shortcomings have been identified in other sections of this report. An insurance certificate is in place and is up to date. Areas of strength include the appointment and registration of a manager; the improvements to administration and to staff recruitment and support. The residents and visiting relatives speak highly of the home and have every confidence in the manage; so this section about management is assessed as good - and it is to be noted that the overall ‘star’ rating for this home is 2 stars, indicating that residents are receiving a good level of service overall. Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 23 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 3 3 Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 24 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 OP38 Regulation 23(4)(4A) Requirement Fire safety: The entire home must be re-assessed to identify fire hazards such as fire exits with keys, blocked fire escapes, and such hazards dealt with appropriately; so this would impede exit in an emergency. This remains outstanding but it is noted that maintenance people were on site to address this during our inspection visit. Chemical storage: All hazardous chemicals must be held safely under the direct supervision of a member of staff or locked in a suitable cabinet. This is so as to ensure the safety of residents. This repeats a similar requirement but refers to different items and locations. Bedrooms: must be supplied with sufficient and suitable furniture and fittings including accessible and working lights and lockable units. This is so residents have the correct and working equipment in their rooms for their safety and DS0000007141.V363092.R01.S.doc Timescale for action 30/06/08 2 OP38 13(4)a 30/06/08 3 OP24 16(2)c 23(2)m 30/07/08 Elmglade Version 5.2 Page 25 4 OP19 16(2)j 5 OP19 23(2)d comfort. Kitchen: the cold storage units, fridges and freezers must be maintained at the correct and safe temperature so residents’ health is not compromised. Kitchen: the kitchen must be maintained in a clean and hygienic state at all times including all surfaces such as floors and walls so that residents’ health is not compromised. 30/06/08 30/06/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP27 OP22 Good Practice Recommendations Ancillary staff: it is recommended that a laundress is employed so that care staff are not compromised in the time they can spend assisting residents. Adaptations; it is recommended that the home review hoist equipment so as to ensure there are enough hoits on each floor to assist in the moving and handling os residents in safe manner now that less able residents can be accommodated on the first floor. Management delegation: so as to ensure that proper day to day running of the service by the newly appointed manager it is recommended that the owners review the delegation of management duties and budgets so the manager has the necessary authority to take day to day decisions in the best interests of the residents. 3 OP31 Elmglade DS0000007141.V363092.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG 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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