Care Home: Elmhurst Residential Home

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What the care home does well The home provides good information to prospective service users and they are able to visit the home before deciding to move in. Each person has their needs assessed before they are admitted and an individual care plan is drawn up, based on the persons needs. Appointments are made for residents with a range of healthcare professionals as necessary, and their medication is stored and administered safely. The care staff treat the residents with respect and dignity and there is a good variety of activities that people can choose from. Residents say their meals are of a good quality and they say they are satisfied with the care they receive. The home environment is generally well-maintained and comfortable and has a pleasant appearance. Any concerns or complaints are recorded and responded to promptly and staff are trained to be aware of potential abuse. The staffing levels are good at the busiest times of the day, and the staff are trained in health and safety and the care of people with dementia. The home has a consistent record of meeting relevant health and safety requirements and legislation, and they consult residents and staff about how the home is run. What has improved since the last inspection? We had some concerns at the last inspection about a residents bedroom being used to store other peoples walking frames. The home has resolved this issue satisfactorally. Some maintenance issues we raised have also been addressed. For example, replacement of faulty taps and repairing a fire door which did not close properly. We saw that worn chair tables in the dining room have been replaced, and a bedroom was thoroughly cleaned to remove an offensive odour. Visitors to the home now sign out when they leave the building which ensures that everyone is accounted for in the event of the building having to be evacuated. What the care home could do better: We have made no requirements at this inspecton, but we would ask the manager to consider rearranging the lounge chairs less formerly so that people can sit face to face to enhance communication. Key inspection report Care homes for older people Name: Address: Elmhurst Residential Home 81-83 Holden Road North Finchley London N12 7DP     The quality rating for this care home is:   three star excellent 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: THOMAS McKERVEY     Date: 0 2 0 6 2 0 0 9 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 26 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 26 Information about the care home Name of care home: Address: Elmhurst Residential Home 81-83 Holden Road North Finchley London N12 7DP 02084456501 02084465319 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Bernadette Tisdall care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: Date of last inspection Brief description of the care home Elmhurst is a privately run care home, first registered in 1967 for 30 older people, male and female, some of whom may have dementia. The stated aim of the home is to promote the dignity and privacy of service users who are frail and have dementia, thus ensuring their maximum quality of life. The home is a large two storey, detached building. The bedrooms, which are located on both floors, comprise twelve single and nine double rooms. All bedrooms have a washbasin, and three bedrooms have en-suite facilities. A passenger lift provides access to the first floor. The communal lounge and dining areas are on the ground floor, and the kitchen, laundry, office and staff room are all in the basement of the building. At the front of the building there is a large car park, and there is an attractive garden at the rear of the building, which is partly paved, with a ramp for and access by wheelchair users. Care Homes for Older People Page 4 of 26 Over 65 30 30 0 0 Brief description of the care home The home is located in an attractive residential area of North Finchley and close to Woodside Park tube station. It is well served by a variety of shops, restaurants, transport and other community facilities located along Ballards Lane and High Road , North Finchley. The fees for the service range from £489 to £650 per week, depending on whether bedrooms are shared. Copies of this and other inspection reports are available on request at the home. Care Homes for Older People Page 5 of 26 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: three star excellent 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 3 Stars. This means the people who use this service experience excellent quality outcomes. This unannounced inspection, which was carried out as part of the Commissions inspection programme and to check compliance with the key standards, was completed in five and a half hours. We thank the registered manager and deputy who were present during the inspection and fully cooperated in the process. The inspection consisted of a tour of the premises, including bedrooms, reading residents case files, and discussing with them about their experiences of living in the home. We spoke to a residents relative who was visiting the home during the inspection. We observed the staff interacting with the residents and how they provided care and support to them. Several staff were interviewed individually and in a group, about their knowledge and experience; this was independently of the management. Care Homes for Older People Page 6 of 26 We inspected many documents relating to the running of the home and at the end of the inspection, we fed back our findings to the managers. Care Homes for Older People Page 7 of 26 What the care home does well: What has improved since the last inspection? 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 8 of 26 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 9 of 26 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. New residents can be confident that they are provided with a contract which sets out what is included in the fee, the role and responsibility of the provider, and the rights and obligations of the individual. They can also be assured that their needs will be assessed before they are admitted to ensure the home is suitable for them. Evidence: At the time of the inspection, there were twenty eight residents in the home and there were two vacancies. One resident was in hospital. We examined six residents case files at random. Three of these residents were privately funding their care and the others were funded by the local authority. The files contained signed copies of contracts with details of the fees and any extras to be paid for, such as hairdressing. The case files showed that an assessment of the persons needs had been carried out before they were admitted to the home. There were also assessments that were completed by local authority care managers who also carry out annual reviews to ensure that the home continues to meet the persons needs. Care Homes for Older People Page 10 of 26 Evidence: There are twelve single and nine double bedroomslocated on both floors. Three rooms have ensuite facilities. All other bedrooms have a washbasin. The home has a lift to the first floor and there is a ramp to the garden area to assist residents with mobility problems. There is a spacious garden and patio for the residents to enjoy in the good weather, and there are hoists and adaptations in toilets and bathrooms to assist people with mobility problems. Pressure relieving equipment, e.g. air mattresses and cushions are provided for residents who are at risk of pressure ulcers. Care Homes for Older People Page 11 of 26 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live in this home can be confident they are treated with respect and dignity and have a care plan tailored to their needs, which is reviewed regularly. Their healthcare needs are being met by a full range of healthcare professionals, and medication is stored and administered safely. Evidence: All residents had an individual care plan, five of which were examined in detail. The plans were of a very good standard and included a thorough assessment of the persons needs. The areas covered in the assessments included, mobility, communication, physical and mental health. There was clear guidance for staff about the actions to be taken for providing personal care and the care plans were reviewed and updated monthly. We saw comprehensive risk assessments in the care plans, eg. the risk of developing pressure ulcers, danger of falls and choking on food. Several residents have a diagnosis of dementia. Staff records show that they have received training in dementia care, or have been booked on courses in the near future. At the time of this inspection, one of the residents was in hospital, but all others were Care Homes for Older People Page 12 of 26 Evidence: reported to be in good health and noone had a pressure ulcer. We noted that all the residents appeared well cared for and were clean and well dressed. We discussed with the manager the recent inititiative by Barnet PCT relating to the Gold Standard Framework. This is a project for care homes who provide a service for elderly people. The Gold Standard means that the home has enhanced care planning for end of life care. The PCT puts in training for homes who are then assessed before being awarded the standard. The manager and deputy stated they would seriously consider enrolling on this programme. The G.P visits the home routinely once a week and residents records contained references to them being seen by opticians, chiropodists and dentists. There were records of residents being weighed monthly. The residents we spoke to, stated that they were well cared for and they spoke highly of the staff. We also spoke to a residents relative during the inspection. They told us that they visit their mother frequently and in their view, all the residents receive very good care. We observed that the staff treated the residents with respect and dignity and addressed each one in an appropriate manner. None of the residents was self medicating. We found that the medication stocks were being properly stored and the amount coming in to the home and returns to the pharmacy, were accounted for. We checked the controlled drugs, which were properly stored and recorded. There were no gaps in the administration records. We saw a report from a pharmacist from Barnet PCT who carried out a comprehensive audit of the medication standards in the home. This report confirmed that the homes medication practice was safe. Staff records showed that they had attended training in medication and first aid. We were pleased to see that a residents room was not being used to store other peoples walking frames which was a concern at the last inspection. Care Homes for Older People Page 13 of 26 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. People who live in the home can be confident that they have there is a range of stimulating activities they can choose from and meals are nutritious and cater for their cultural and dietary needs. If they need assistance to eat, the staff support them sensitively. Evidence: The AQAA states recent improvements as; new musical equipment provided e.g. videoke, ipod speakers so residents can sing along and enjoy the afternoon; one to one activities e.g. initiating conversation that could interest them, reading papers, showing family albums, taking people for a walk if the weather permits etc. Residents likes and dislikes, interests and pastimes are assessed and recorded in their case files on admission to the home. There is a personal activity chart for recording the activities each person takes part in. The general programme includes music, exercise and art and craft sessions. The home has purchased a large television which is mounted on the lounge wall. This makes it easier for all residents to see. However we noted that the lounge chairs are laid out in rather straight lines which gives a rather institutional impression. We recommend that the lounge chairs are rearranged less formerly so that people can sit face to face to enhance communication Care Homes for Older People Page 14 of 26 Evidence: between them. Several residents go to a weekly club that is held in a nearby church hall. Some people tolf us they choose not to participate in planned activities, preferring instead to do their own thing. A session on physical exercise and reminiscence is also held twice a week, led by an occupational therapist. We observed one such session taking place during the inspection. Individual activities include hand massage and manicures. We saw some residents reading newspapers and one person was enjoying the sunshine in the garden, accompanied by a member of staff. A check of the visitors book indicated that residents receive frequent visits from relatives at all times of the day and evening. The relative we spoke to said that they were always welcomed warmly by the staff and could visit at any time and see the resident in their room if they wished. Residents who were able to converse, said that they chose their own clothes, when to rise and go to bed, and said they could choose alternatives to the menu. They also said that the meals were always very good and they had plenty to eat. The menus we looked at showed a good variety and were well balanced. The cook informed us about which residents have special diets, including vegetarian, low fat etc. We saw chair tables being used for some residents who are unable to feed themselves. They were assisted by staff in a dignified and unhurried manner to eat their meals, some of which were pureed to prevent choking. We saw that the lunch was a hot meal that day and it was well cooked and presented in an appetising manner. We noted that there was ample food stocked and it was stored at the correct temperatures, properly labelled and dated. There were records kept of the temperatures of cooked food. Catering and care staff have been trained in food hygiene. Care Homes for Older People Page 15 of 26 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. The residents and their representatives can be confident that any complaints will be taken seriously and addressed. There are good policies and procedures in place to ensure that residents are safeguarded from abuse. Evidence: It is stated in the homes AQAA; All complaints received are treated seriously and recorded. It is the policy of the Home that a resident should be able to bring complaints on any subject without fear of disapproval and that it will be dealt with strict confidence. Complaints are reported to the senior in charge who will investigate and resolve the problem as soon as possible. If the complaint is not resolved, it should be brought to the attention of the manger or deputy manager and further investigation will be done. We give it a two weeks timescale. All complaints will be responded to in writing within 28 days. If it still continues to cause concern, the resident/representative has the right to refer the matter to the proper authority (CSCI) All allegations and incidents of the abuse are dealt with the strictest confidence. We make sure that the care staff have the knowledge of Protection of Vulnerable Adults. We checked the complaints log. No complaints had been recorded since the last inspection and we were informed that none were pending. The residents and visitors we spoke to said they knew how to raise any concerns, but at the time we inspected, they were satsfied with the service they received. Staff records showed that they had attended training in safeguarding procedures, and Care Homes for Older People Page 16 of 26 Evidence: the staff we spoke to, were knowledgeable about abuse issues and how to report any concerns. Care Homes for Older People Page 17 of 26 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 good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The residents can be confident that they live in a home that is well maintained, attractively furnished and kept clean and fresh. Evidence: We visited all areas of the home and found that there was a good standard of internal and external maintenance. We checked the requirements we made at the last inspection about the environment and found they had all been fully complied with. Earlier this year, the home was in dispute with their gas supplier, but the manager informed us that this was now resolved and a contract with a new supplier is now in place. The manager states in the AQAA that improvements made in the last year include; necessary changes to the toilets, assisted bath and furnishings to suit the service users increasing needs. Roof repair was also done in March 2009. Faulty faucets were replaced with new ones which are easier for the service users to use. We visited several bedrooms at random, and found that they were attractively decorated, clean and tidy and were personalised with photographs and ornaments. We noted that the paved area at the rear of the property was cracked in places and we expressed concern that people could be at risk of falling. The manager informed us that this area will be repaired at the same time as new decking is carried out on the verandah. This work was due to be done in the next few weeks. The home has appropriate equipment, for example hoists, special baths, wheelchairs Care Homes for Older People Page 18 of 26 Evidence: and walking frames to support residents who have mobility problems. Pressure pads and mattresses are also provided to prevent pressure ulcers. We were shown records confirming that regular servicing of specialist equipment takes place. The furniture in the lounge and dining area was comfortable, but could be arranged less formerly, as we have recommended elsewhere in this report. Some old chair tables had been replaced after the last inspection. The garden had tables and chairs and looked very attractive. The laundry was very clean and tidy and all the equipment was in good order. The cook told us that a new range cooker was on order. The home employs cleaners and at the time of this inspection, the home was very clean and tidy throughout. The home smelled fresh, without any offensive odours. Care Homes for Older People Page 19 of 26 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. People who live in this home can be confident that there are sufficient numbers of staff to meet their needs and their carers and well trained to support them. Evidence: Three new staff had started since the last inspection. We checked their files and were satisfied that rigorous recruitment procedures had been followed, including; application forms, proof of identity, references and CRB checks. The rota was examined, which identified the staff on duty that day. There are normally six care staff on duty during the daytime, and three waking staff at night. The shift hours are arranged to ensure that staff are always available at the busiest times of the day. There are also cooks, cleaners a laundry worker and a maintenance person employed. The staff who were spoken to, said the staffing level was sufficient to meet the needs of the residents. Residents confirmed that staff were always at hand to respond promptly to requests for assistance. We were shown a record of the staff training programme. This indicated that the courses provided for staff were relevant to the care they were expected to provide, particularly dementia care. In discussion with them, the staff said they appreciated this training. The AQAA states that twenty one staff have attained a NVQ at level 2 or above, which meets the required standard. We saw records of staff minutes of their monthly meetings where they can discuss issues openly with management. There were records indicating that staff received formal supervision regularly. Care Homes for Older People Page 20 of 26 Evidence: Care Homes for Older People Page 21 of 26 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. People who live in this home can be confident that their home is well managed and their health and safety is safeguarded by good monitoring systems. Residents, relatives and staff are able to influence how the home is run. Evidence: The manager is a qualified nurse and has been managing the home for many years. The deputy manager has also been in post for several years. At the last inspection the manager and deputy were studying to attain the Registered Manager Award. We were informed that problems arose regarding the training provider which resulted in the course being prematurely halted. This has necessitated the manager and deputy having to enroll with another provider to have their previous work validated. We discussed the homes AQAA with the manager which provided good information about the service. We were satisfied that requirements made at the last inspection were all complied with in the timescales we set. There was a relaxed atmosphere in the home during the inspection and from our discussions observations and discussion with the staff, the team appeared to work well Care Homes for Older People Page 22 of 26 Evidence: together. They described the manager and deputy as very approachable and sensitive. We saw a summary of a quality audit of the service which the home conducted in May this year. This took the form of questionnaires about key aspects of the service. Residents, relatives and healthcare professionals comments were very positive about the home. We found that all records and files were well organised and easy to follow. We checked health and safety procedures and service documents. All mechanical equipment had been serviced within the last year. The fire alarm system had been serviced in April 07 and a fire risk assessment of the property was done. Fire drills had been carried out and fire extinguishers were serviced. Portable electric appliances and the water storage system had also been tested and monthly health and safety checks were recorded. We noted that the home has employers liability insurance cover. Care Homes for Older People Page 23 of 26 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 24 of 26 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 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 20 Consideration should be given to arrange the lounge furniture less formerly so that residents can have more face to face contact. Care Homes for Older People Page 25 of 26 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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