Care Home: Elmsfield House Limited

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What the care home does well There is a good admission process, that helps new people, and their families, settle into the home. People told us; "....staff support you in the early stages of a person being taken into care..." People felt, and appeared, well looked after, saying; "I have lots of confidence that everyone is looked after so well...". "The home owners and carers show a warmth to the people in their care, which comforts families". There were good arrangements in place for people to access health care support from their doctor, community nurse or other specialists. The care home staff worked well with other professionals and agencies to provide people with the care and support they needed. The manager and staff had reviewed the management of medicines following concerns raised at the last pharmacy inspection. This has resulted in many improvements to make sure that residents receive safe and effective treatment. The routines within the home were flexible and enabled people to make choices about their day to day lives. There was a good provision of regular activities and entertainment, as well as the special Christmas events planned. The provision of meals was excellent. There was good home cooking, regular consultation with people about the menu, food was available when people wanted it, and good quality produce was used. People said; "The catering staff do a first class job in providing all the home made food and cakes". The home was warm, clean, safe and comfortable. There were suitable adaptations and equipment to help people with mobility problems. Further improvements were planned, along with a new eight bed extension. The home operated good recruitment practices for new staff, and offered sound induction and on going training to help staff do their jobs well. Staff felt supported and were encouraged to take on additional training. People told us; "The staff are friendly and loving". "They are very caring...and pleasant". The overall management of the service was good. Management consulted with people, through meetings, surveys and informal chats. There were newsletters to keep people informed of what was happening in the home. The owners had continued to invest in the business and ran the home in peoples` best interests. What has improved since the last inspection? Since the random pharmacy inspection, the manager and staff had reviewed and updated peoples` care plans so they contained more detail and information to guide staff. They had made good progress and improved the way medicines were being handled. Records for medication were good, showing the treatment received, and our checks showed that people received their medication in the prescribed dosages. Changes to medication were well documented, easily tracked and implemented promptly so that people receive new treatments without delay. Since the last full inspection in 2007 the manager has made a number of changes and improvements to the service. There had been an increase in the level of activities and entertainment provided, with regular events taking place, as well as events for special occasions. A lot of refurbishment had been completed, including new flooring, wall coverings, furniture and equipment, in corridors, bathrooms, bedrooms and the dining room. A new laundry had been provided and there were new arrangements for handling clinical waste. There were further plans to upgrade the remaining bedrooms, the lounges, garden and kitchen. An eight bed extension was being built. There was a new staff structure in place. The retired head of care had been replaced with a deputy manager who had completed a National Vocational Qualification in management at level 4. Team leaders had been appointed and they were being trained and supported in their new role. The registered manager had completed a leadership training course and was cascading to this to his new team leaders. What the care home could do better: We have recommended that the manager continue his improvements in the way medicines are managed by; ensuring that records for disposal of medication are complete so that medicines can be accounted for at all times, and providing more detailed care plans for complex and `when required` medication, so that staff have clear guidance for managing these. We also recommended the manager should provide up to date information on the local authority safeguarding procedures for staff to refer to. Key inspection report Care homes for older people Name: Address: Elmsfield House Limited Elmsfield House Limited Holme, near Milnthorpe Cumbria LA6 1RJ     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: Jenny Donnelly     Date: 0 8 1 2 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 28 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 28 Information about the care home Name of care home: Address: Elmsfield House Limited Elmsfield House Limited Holme, near Milnthorpe Cumbria LA6 1RJ 01539563896 01539563896 chriselms1@btconnect.com Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Elmsfield House Limited care home 20 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 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, Dementia - Code DE The maximum number of service users who can be accommodated is: 20 Date of last inspection Brief description of the care home Elmsfield House is registered to provide care and accommodation for up to 20 older people some of whom may have dementia. Mr Christopher Wilson is the registered manager. Elmsfield House is set in a rural location close to the village of Holme and three miles from Milnthorpe. There are extensive views over the open countryside of the South Lake District. The home is a Georgian property that has been extended and adapted for its present use as a care home. There are gardens on all sides of the property, part of which have been landscaped and provide a pleasant area for the residents to sit in during the summer months. Care Homes for Older People Page 4 of 28 Over 65 0 20 20 0 Brief description of the care home Accommodation for residents is over two floors, the upper being served by a stair lift. There are eighteen single rooms and one double although currently all rooms are used for single occupancy. Some bedrooms have en-suite facilities. There are two lounges and a separate dining room, which give ample communal space for the residents to meet with visitors, enjoy activities or watch television. Information on fees are available from the service with extra charges for newspapers, magazines, hairdressing, chiropody and some personal toiletries. This service does not provide intermediate care. Care Homes for Older People Page 5 of 28 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: This was the main or key inspection for the year. The lead inspector Jenny Donnelly asked the manager to fill out a form called the Annual Quality Assurance Audit (the AQAA). This asks for details of what has improved in the home since the last inspection and for the plans for the coming year. This was fully completed and returned to us by the date we asked. We also sent surveys to some people who live in the home, and to staff. The responses are included in this report. Jenny Donnelly, inspector, and Angela Branch, pharmacist inspector made an unannounced visit to the care home on 8th December between the hours of 08.15 and 15.45. During this visit we toured the building, spent time in the lounges, and dining room where we watched lunch being served. We spoke with people living in the care home, their visitors and with the community nurse. We also spoke with the manager and the staff on duty. We looked at files and documents that backed up what we were told and what we saw. Care Homes for Older People Page 6 of 28 Since the last key inspection in October 2007, we completed an Annual Service Review in 2008. An annual service review is where we look at all the information we have gathered about a service over the year, including the AQAA and surveys that we sent to people. From this we make a judgement about whether the home is continuing to provide a good service to people, or whether we need to inspect sooner than planned. We received positive feedback in the annual service review. In October 2009 the home received a random pharmacy inspection, at which time we found some shortfalls in the management of medicines and care planning, and made requirements for the service to improve. We looked at these issues again at this inspection, to check that the necessary improvements had been implemented. Copies of all these reports are available on request from us, or from the care home. Care Homes for Older People Page 7 of 28 What the care home does well: What has improved since the last inspection? Care Homes for Older People Page 8 of 28 Since the random pharmacy inspection, the manager and staff had reviewed and updated peoples care plans so they contained more detail and information to guide staff. They had made good progress and improved the way medicines were being handled. Records for medication were good, showing the treatment received, and our checks showed that people received their medication in the prescribed dosages. Changes to medication were well documented, easily tracked and implemented promptly so that people receive new treatments without delay. Since the last full inspection in 2007 the manager has made a number of changes and improvements to the service. There had been an increase in the level of activities and entertainment provided, with regular events taking place, as well as events for special occasions. A lot of refurbishment had been completed, including new flooring, wall coverings, furniture and equipment, in corridors, bathrooms, bedrooms and the dining room. A new laundry had been provided and there were new arrangements for handling clinical waste. There were further plans to upgrade the remaining bedrooms, the lounges, garden and kitchen. An eight bed extension was being built. There was a new staff structure in place. The retired head of care had been replaced with a deputy manager who had completed a National Vocational Qualification in management at level 4. Team leaders had been appointed and they were being trained and supported in their new role. The registered manager had completed a leadership training course and was cascading to this to his new team leaders. 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 28 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 28 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. People are provided with information to help them make a decision about moving into this care home. The assessment process helps people to know if the home will be suitable for them. Evidence: The manager had provided written information for people about the services and facilities offered at Elmsfield House. People were able to visit the home to look around and ask questions, and to have a short stay to see if they liked it. We received positive comments about the experience of moving into this care home, one person wrote; When you visit, staff are lovely and support you in the early stages of a person being taken into care. I have lots of confidence in that everyone is looked after so well and all staff do their jobs well. Care Homes for Older People Page 11 of 28 Evidence: Before new people are admitted, the manager and one of the care staff, will go and meet with the person, to talk about the home, and assess their care needs. We saw evidence of these assessments on file. We also saw that the manager had obtained copies of relevant information from the persons social worker or other professionals involved in their care. This helped the manager and staff develop a more complete picture of the person and their care needs. We saw that people had a set of terms and conditions covering their stay in the home. This was either through a private contract with the care home, or through an agreement with the local authority. Care Homes for Older People Page 12 of 28 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. People were receiving a good standard of personal and health care, delivered in a way that was acceptable to them. Evidence: Following a random inspection in October 2009 by our pharmacist inspector, we asked the manager to improve they way medicines were being managed in the home. We also asked that care plans be updated to include more detail about peoples needs. The home uses an annual care planning booklet for each person, and the manager told us that at the October inspection, they had just started new annual booklets for everyone, and the information from the old booklet had not been transferred fully. At this visit we looked at a selection of care plan booklets and found improvements in the standard of record keeping. Senior staff are each responsible for keeping a number of care plans updated, and the manager told us he checks this monthly and speaks to staff about any information that may be missing. The care plans we looked at contained a good level of detail about peoples care Care Homes for Older People Page 13 of 28 Evidence: needs, their personal history, interests and hobbies, and any risks staff needed to be aware of. We saw that where there were risks to a persons safety, such as falling over, staff had liaised with other professionals to look ways of reducing this where possible. Where people expressed aggressive behaviour there were plans guiding staff in how to handle this and keep the person calm. There was evidence that staff asked for mental health referrals and took advantage of any help and advice supplied as a result. We saw evidence that people had good access to other health care professionals including their doctor and the community nurse. We spoke with the community nurse who told us that there was good communication with the care staff and she confirmed that staff listened to and acted on her advice. We saw a speech and language therapist visiting to assess a persons swallowing and advise on the type of food the person should be given. There were also health care staff visiting the home to give people flu vaccinations, and the care staff made sure the people who were due to be vaccinated were correctly identified and happy to have it done. Throughout the day we saw that people looked well cared for, were smartly dressed in clean clothing and were assisted by staff in a respectful and friendly way. People told us; They makes you feel at home rather than in a home. They keep residents clean and tidy and give a good choice of food. The home owners and carers show a warmth to the people in their care, which comforts families. Elmsfield looks after all of their clients with concern for them ... treats all clients as individuals. The pharmacist inspector examined the handling of medication by looking at relevant documents, storage and meeting with the manager and other staff. Overall, we found that the manager and staff had reviewed the management of medicines following concerns raised at the last pharmacy inspection. This has resulted in many improvements to make sure that people receive safe and effective treatment. We looked at records for receipt, administration and disposal of medication for a period of just over four weeks. Administration records were accurately completed and showed the treatment received by people and, if medication was not given, the reasons for omission were mostly recorded. We saw that medication that was disposed of, especially medication that people had refused, was not always recorded and the Care Homes for Older People Page 14 of 28 Evidence: manager should ensure that this is reviewed so all medication can be accounted for. We counted a sample of medicines and compared these with records to check if they tallied and to show they were administered in the prescribed dosage. All of these samples, with only very occasional discrepancies, were in order. We also checked a sample of files for information related to changes in medication. Overall, these were well kept so that we could easily track when and why medication had changed. These changes were implemented accurately and promptly so that people received their new treatment without delay. We looked at a sample of care plans for managing people with when required medication such as sedatives and those with complex medication needs. Some care plans contained little guidance for staff to follow to ensure that medication was managed safely and given effectively with appropriate monitoring. In one case the care plan for the administration of medication via a feeding tube did not give any guidance on how this was to be done safely, or the monitoring that was required. Staff were however, able to give an accurate description of the process involved. Overall, the storage of medicines was in order. The home did not have any medicines liable to misuse, called controlled drugs. However, we found that the the home had recently obtained a new cabinet for storage of controlled drugs and a register in which to record them in case they have some in the future. We discussed training of staff in medicines administration. Carers with responsibility for administering medication had recently received training in its safe handling. The manager had started to do monthly checks, or audits, of medication and this ensures that concerns are highlighted and dealt with promptly to keep people safe. Care Homes for Older People Page 15 of 28 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People were able to make choices about how to live their life and had access to a good variety of activities and entertainment. The provision of meals was very good, with plenty of variety and quality products being served. Evidence: The daily routines of the home were flexible and enabled people to make choices. We saw that some people chose to stay in bed late and heard one person request a cooked breakfast at 11 am, which was provided. The cook told us there was no cut off time for breakfast, and if people wanted this instead of, or as well as lunch, this was no problem. Menus showed a good variety of home cooked dishes were served including, beef and ale casserole, tarragon chicken, roast lamb, baked fish. Lunch was the main meal of the day with a lighter evening meal of things like fish fingers, a cold buffet, sausages. There were hot and cold desserts and home made cakes were served in the afternoon. Food supplies were locally sourced with quality ingredients being used. We saw breakfast and lunch being served and noted that staff assisted people who needed help discreetly. Meal times were relaxed and unhurried, and people were able to remain at the table to chat if they wished to. A few people chose to have their Care Homes for Older People Page 16 of 28 Evidence: meals in their bedroom and staff accommodated this. Everyone we spoke with said they enjoyed their meals and thought they were very well fed, one person wrote; The catering staff do a first class job in providing all the home made food and cakes. We saw a number of events were advertised during the run up to Christmas including two visiting choirs, one from a local school and another from the church. There was a Christmas party and concert advertised, and during the afternoon we heard residents practising their carol singing for this. The home had visiting Tai Chi classes, music for health sessions and regular visits from the clergy. There was a 7 seater vehicle for outings. There was an activity organiser trained in health, beauty and massage. There was a very large screen TV with a surround sound system which one person told us was really good for film afternoons. The manager produced periodic newsletters advertising forthcoming events and updating people on what was happening in the home. The manager told us that once building work was completed, there were plans to provide access to a secure garden, with raised beds, a covered seating area, a water feature and a childrens play area. This will be very welcome as two people told us they would like more fresh air and exercise, and a number of people had an interest in gardening. Care Homes for Older People Page 17 of 28 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. People felt safe in the home and told us there was someone they could talk to if they were worried. Staff had received training and knew how to report any safeguarding concerns. Evidence: The service had a complaints procedure which was on display, and this told people how and who to make any complaints to. People we spoke with told us they would be able to speak with the manager if they had any concerns. Our surveys indicated that some people did not know how to make a formal complaint, although those people also said there was someone they could talk to if they were worried. We asked the manager how the complaints procedure was advertised, apart from being on display in the home. We were shown the homes newsletter and saw that there was a section inviting people to speak with the manager, or other staff, if they had concerns, complaints or worries. The manager had not received any complaints since the last inspection. Staff had received training about abuse and their role in safeguarding people from harm. Staff we spoke with were aware of the different types of abuse and understood the process to refer any concerns to the local authority for investigation. The manager had rightly told us about the safeguarding referrals he had made, which enabled people to get the support and protection they needed. Care Homes for Older People Page 18 of 28 Evidence: Although staff had received recent training and were aware of the safeguarding process, the homes policies and procedures, should staff refer to them, were quite confusing. We recommended the manager obtain an up to date copy of the Cumbria Council multi agency booklet, which sets out the information in clear simple steps. The manager agreed to do this. We did not see or hear anything of concern on the day and people told us they felt safe and content living in the home. Care Homes for Older People Page 19 of 28 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. People live in a clean, comfortable home, that is being upgraded to a high standard, and has suitable adaptations and equipment to meet their needs. Evidence: Elmsfield House is set in a rural location close to the village of Holme and three miles from Milnthorpe. There are extensive views over the open countryside of the South Lake district. The home is a detached Georgian property that has been extended and adapted for its current use. The home was well maintained and over the last year a lot of refurbishment had taken place to improve the decor and fittings. A new extension was being built at the time of our visit, to provide eight additional bedrooms and a bathroom. The building works were away from current accommodation and did not appear to be disrupting peoples day to day life. The entrance hall and corridors had been upgraded, with new floor covering, plaster work and paintwork. The majority of the bedrooms had been refurbished with new sinks, furniture, floor covering and bedding. There were plans to upgrade the remaining bedrooms. The dining room had been refurbished, again with new furniture, flooring and wall coverings. The two lounges were warm and comfortable, and these were also about to be upgraded, with new decor and seating. There was a new call bell system, and CCTV Care Homes for Older People Page 20 of 28 Evidence: cameras monitoring the grounds. The ground floor bathroom had been completely re-decorated, and fitted with a new hi-low bath, with bath seat. New sani-bins were in place, which double bagged and sealed clinical waste, preventing any odour escaping. There was a second bath, with a raising seat. There was a hair wash basin. The home had handrails, two hoists, and a stair lift to help people with mobility problems. The kitchen was tidy and organised, although there were plans to extend this and provide new equipment. The laundry had been re-located into a new building, and fitted with new machines. There was plenty of shelf storage and hanging space, for peoples clothes to be ironed and sorted before being returned. We saw that peoples clothing was nicely laundered. There were good infection control procedures in place, hand washing facilities were provided for staff, and there were alcohol hand gels for staff and visitors to use. The home has garden to three sides and once current building work is completed, there are plans to create a secure area, with a patio, a further covered seating area, a water feature, raised beds and childrens playground. The home was warm, comfortable and clean throughout. Surveys told us; The home is always clean and fresh, and Everywhere is always clean. Care Homes for Older People Page 21 of 28 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 were supported by a caring staff team, who were receiving the training and support they needed to do their jobs well. Evidence: Staffing levels were satisfactory with generally 3 care staff plus the manager on duty. This sometimes dropped to 2 care staff and the manager in the afternoons. There were also sufficient domestic and catering staff on duty. We saw that the day ran smoothly, people were not kept waiting unduly for attention, and staff had time to chat with people. The home generally had a low staff turn over but they had recruited several new staff this year, due to retirements. We looked at the recruitment process and saw this was thorough and included applications, interviews, written references and criminal records bureau checks. New staff completed a two day induction training with the manager, which covered health and safety and the homes policies and procedures. Staff then worked a few shifts, where they were in addition to the normal staffing, along side a team leader or other experienced carer. There was a six week review where further training was planned. All staff had completed, or were in the process of completing a National Vocational Qualification in care, at level 2 or above. Care Homes for Older People Page 22 of 28 Evidence: All staff completed mandatory training in fire safety, moving and handling, first aid and safeguarding at regular intervals. Additional training had taken place on dementia care, and further medicines training was planned for January. The manager was a qualified trainer in a number of subjects, but he also used some external trainers with specialist knowledge. Since the retirement of the previous head of care, the team structure had been altered so there was now a deputy manager and several team leaders. They were receiving leadership training and their roles were being kept under review. The manager hoped that each team leader would take on a specific area of interest and develop their skills to become a trainer in that area. This is a good way of developing staff and building expertise across the team. We received positive feedback about the staff group, with people saying; The staff are friendly and loving to the residents especially when they are down. They are very caring, everywhere is always clean, the staff are pleasant. Care Homes for Older People Page 23 of 28 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 live in a home that is safe, well managed and run in their best interests. Evidence: Elmsfield House is owned and operated by brothers; Christopher Wilson acts as the registered manager, while Gary Wilson deals with the financial side of the business. The manager and his deputy have both completed a National Vocational Qualification in management at level 4. The manager had also recently completed a leadership course, which he was in turn delivering to his team leaders. We saw that the manager and deputy were visible around the home, people knew who they were and were happy to approach and speak with them. We saw that resident and staff meetings took place, and there was a newsletter to keep people informed of what was happening in the home. The manager spent a lot of time in the home, and this included some regular late evening shifts. He checked the quality of service being delivered in a number of ways. Satisfaction surveys were sent to people each year, and the results of these were collated, and peoples suggestions, Care Homes for Older People Page 24 of 28 Evidence: such as to improve the garden, were being acted on. The manager checked that peoples care plans were updated each month and had started to undertake medicine audits, to check these were being safely managed. Accident reports were monitored and signed off by the manager, and we had been informed of any injuries or untoward incidents that occurred in the home. Staff received regular supervision to discuss care practices and training needs, and had an annual appraisal of their performance. There was one person living in the home under a Deprivation of Liberty Safeguard; the manager had all the correct paperwork in place relating to this, and staff understood the extent of the restrictions placed on the person. The manager held money for safekeeping on behalf of two people, and this was being safely managed, with all spending accounted for. There was evidence of continued investment into the business, through the improvements to the existing accommodation, and in the plans for expansion. The owners were planning ahead and developing their staff team accordingly. There were good arrangements in place to protect and promote the health, safety and welfare of people living in the home, and staff. We saw evidence that checks and maintenance on the homes services and equipment were up to date. Staff had received regular fire instruction and fire drills. Care Homes for Older People Page 25 of 28 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 26 of 28 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 9 We recommend that care plans are more thorough and provide staff with clear guidance on managing people with specific care needs for the administration of complex or when required medication so that they are managed safely and effectively. We recommend that the manager introduce a safe system of handling and recording the disposal of medication that people have refused. We recommend the manager obtains an up to date copy of the Cumbria Council multi agency safeguarding procedures for staff to refer to. 2 9 3 18 Care Homes for Older People Page 27 of 28 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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