Care Home: Elmslea

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What the care home does well People who use the service were positive about the care and support provided by the staff and said the staff were flexible and responsive to their needs. Some comments include `staff are helpful` and `staff listen to me`. People who use the service also stated they were always treated with dignity and respect. Residents said that flexible visiting arrangements are in place. People who use the service are positive about the varied and nutritional menu that reflects their preferences and choices. Some saying the food is `excellent`. The kitchen is suitably equipped and good standards of cleanliness are maintained. Residents said they felt there was enough to do in the home and that it was their choice if they joined in the activities or not. No one was able to identify any further improvements to the service that they received. The environment is homely, clean and comfortable and the people who use the service said they were satisfied with the accommodation provided. The home is maintained to a good standard ensuring that all health and safety and fire checks are carried out as per legislation. What has improved since the last inspection? From previous inspections twenty one requirements to improve the quality of care were identified. It is to the management teams credit that all of these requirements have been complied with and therefore met. Therefore it was evident at this inspection that the management team have focused on driving up the quality of care and this is reflected in the rating of the home improving. The areas of care that they have made significant changes in are as follows: the pre admission assessment is now more comprehensive; care plans have been improved and are now written in the first person and identify the persons care needs more clearly; risk assessments have also been developed and identify particular risks and in the main what actions are needed to minimize future risks; records of specific dietary needs are now kept; a robust medication policy and procedure is now in place as is the system for receiving, administration, storage and disposal of medication and accurate records are now kept; people who use the service said that if they have any concerns these will be listened too and action will be taken if appropriate; new staff have been provided with a induction to their work; a training plan for staff has been implemented to ensure staff attend mandatory and relevant training to their work; the registered providers are engaging with the inspection process and working in a professional manner; a comprehensive and implemented set of policies and procedures to underpin and guide the operation of the home is in progress. Good arrangements are in place to meet individuals health needs and people who use the service were confident that medical services are promptly accessed when required. Residents felt that the main area of change has been the introduction of new activities in the home, such as the `Monday club` and the `sewing club`. Residents were able to tell us of many group activities that they participate in which center around the church they attend. They stated that the group activities are optional. In addition individual activities and work placements were also evident and residents stated how much these activities were enjoyed. What the care home could do better: The trainee manager was appointed end of March 2010 to support the registered providers in the day to day running of the home. The trainee manager has brought new skills and implemented new procedures in the home which has assisted in improving the quality of service delivery. However the management arrangements are new and the management team need to evidence that they can maintain the changes that they have made consistently. Hence why the rating for the home has increased to adequate at this time. In addition to continue to improve the quality of outcomes for residents some areas for further improvements have been identified and these are as follows: the care plans would benefit from further expansion so that they inform, direct and guide staff interventions in all areas of the persons individual care. Likewise the individual risk assessments would benefit from further expansion. Examples of this were discussed with the management team who agreed that further development of the care plans and risk assessments were needed. Whilst it is acknowledged that care staff have completed e learning training on medication it is recommended that more formal training in this area is undertaken to ensure safe systems of practice at all times. Residents confidentiality needs to be promoted. It was observed during the inspection a health professional meeting with a resident in a public area, plus residents whereabouts details were on public display. Residents confidentiality needs to be respected at all times. The management team agreed to address this. A policy and procedure in respect of the management of residents monies must be implemented so that all are aware of the process of managing monies and prevents errors and potential abuse. Interview records for new staff should be kept so that evidence is gained as to the persons suitability for the post they applied for. The quality assurance system must be reviewed so that the management team can gain residents, their representatives and stakeholders views on the service. From this a action plan can be devised as to how to develop the service further for the benefit of those who live and work at the home. The inspectors would like to thanks the residents, staff and management team for their cooperation and assistance during this inspection process. Key inspection report Care homes for adults (18-65 years) Name: Address: Elmslea 34 Dunheved Road Launceston Cornwall PL15 9JQ     The quality rating for this care home is:   one star adequate 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: Lynda Kirtland     Date: 0 4 0 8 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Adults (18-65 years) Page 2 of 30 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 Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 30 Information about the care home Name of care home: Address: Elmslea 34 Dunheved Road Launceston Cornwall PL15 9JQ 01566777661 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mrs Irene Stanbury,Mr Henry Stanbury Name of registered manager (if applicable) Type of registration: Number of places registered: care home 15 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 mental disorder, excluding learning disability or dementia Additional conditions: Service users to include up to 15 adults aged 18 - 65 on admission with a mental illness (MD), some of whom may have a secondary minor learning disability. Total number of service users not to exceed a maximum of 15 Date of last inspection Brief description of the care home Elmslea is registered to provide accommodation and personal care for 15 adults with a mental health needs, some of whom may have a secondary minor learning disability. The care home is situated in a quiet residential area of Launceston. The recreation park and leisure centre are nearby and the town centre amenities are a short walking distance. All the bedrooms are single, and all but one have with en suite facilities. There are various communal spaces and garden areas for residents to use. Details of Care Homes for Adults (18-65 years) Page 4 of 30 Over 65 0 15 2 8 0 5 2 0 1 0 Brief description of the care home the cost of care, and information about the home (Statement of Purpose and Service User Guide) are available from Mr and Mrs Stanbury. Care Homes for Adults (18-65 years) Page 5 of 30 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: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: Two inspectors undertook an unannounced key inspection at the home on the 4th August 2010 that lasted for six hours. Information about the home received by the Care Quality Commission since the previous inspection was taken into account when planning the inspection. The purpose of the inspection was to ensure that the care needs of people who use the service are appropriately met in the home, with particular regard for ensuring good outcomes for them. On the day of inspection eleven people were resident at the home. This involved interviews with people who use the service, observation of their daily life and care provided. There was an inspection of the homes premises and of written documents concerning the care and protection of the residents and the ongoing management of the home. We talked to staff who were on duty and at times during the day were able to observe their care practices. We also spent time in discussion with the registered providers and trainee manager, referred to in the report as the Care Homes for Adults (18-65 years) Page 6 of 30 management team. The principle method used was case tracking. This involves examining the care notes and documents for a select number of people who use the service and following this through including talking to them and the staff working with them. This provides a useful, in-depth insight as to how their needs are being met in the home. At this inspection, four people who use the service were case tracked. In talking with some of the people who use the service they said that they were happy, I dont know what would have happened to me if i didnt have the support of this home and its good here. Seven residents told us that they were very satisfied with the care that they receive and the caliber of the staff team. Care Homes for Adults (18-65 years) Page 7 of 30 What the care home does well: What has improved since the last inspection? From previous inspections twenty one requirements to improve the quality of care were identified. It is to the management teams credit that all of these requirements have been complied with and therefore met. Therefore it was evident at this inspection that the management team have focused on driving up the quality of care and this is reflected in the rating of the home improving. The areas of care that they have made significant changes in are as follows: the pre admission assessment is now more comprehensive; care plans have been improved and are now written in the first person and identify the persons care needs more clearly; risk assessments have also been developed and identify particular risks and in the main what actions are needed to minimize future risks; records of specific dietary needs are now kept; a robust medication policy and procedure is now in place as is the system for receiving, administration, storage and disposal of medication and accurate records are now kept; people who use the service said that if they have any concerns these will be listened too and action will be taken if appropriate; new staff have been provided with a induction to their work; a training plan for staff has been implemented to ensure staff attend mandatory and relevant training to their work; the registered providers are engaging with the inspection process and working in a professional manner; a comprehensive and implemented set of policies and procedures to underpin and guide the operation of the home is in progress. Good arrangements are in place to meet individuals health needs and people who use the service were confident that medical services are promptly accessed when required. Residents felt that the main area of change has been the introduction of new activities in the home, such as the Monday club and the sewing club. Residents were able to tell us of many group activities that they participate in which center around the church they attend. They stated that the group activities are optional. In addition individual activities and work placements were also evident and residents stated how much these Care Homes for Adults (18-65 years) Page 8 of 30 activities were enjoyed. 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 Care Homes for Adults (18-65 years) Page 9 of 30 order line 0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 30 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 30 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. There is a comprehensive admission process to the home so that the persons individual needs are assessed prior to admission and they can be confident that the service is able to meet their individual needs. A introductory process assists the person and the service to make a informed choice as to if the home is suitable for them. Evidence: There have been no new admissions to the home since the last inspection. However the trainee manager has implemented a comprehensive pre admission assessment which covers all the persons care needs, wishes and choices. This also allows for professionals to participate in the assessment. Therefore this requirement in respect of the process of admission is met, however it is acknowledged that this needs to be tried in practice. From discussion with one person who uses the service she told me that a year ago, she had a series of introductory visits to the home so that she could get to know the other residents in the home and them her. She said this started off as invitations to Care Homes for Adults (18-65 years) Page 12 of 30 Evidence: tea and lead to a overnight stay. She said that she felt the introduction to the home went well and could not think of any improvements needed to make this process easier. The homes Statement of Purpose and Service Users guide have been updated and are avialble for people who use the service and any enquirers to see. Care Homes for Adults (18-65 years) Page 13 of 30 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at Elmslea can be confident that the majority of their care needs will be met to a satisfactory standard. Further improvements to expand particular elements of care would benefit the person further to ensure that they received consistent care at all times. Risk assessments are satisfactory and explain how the risk will be managed. Evidence: We inspected four peoples care plans and from this we noted that there is a significant improvement to the written care plans then was seen at the previous inspection. Care plans are now written in the first person and are signed as being agreed by the resident. The persons individual file contains contact details, personal profile including medical and psychiatric background, interests, hobbies, activities, spiritual needs, finance, signs of deterioration, risks, program for week which includes outside contact and indoor household tasks. The care plan covers each care need, for example communication, mobility, diet/ nutrition, sleeping, continence, personal care/room/laundry, pain and medication management, sexuality, finances, specific mental and physical health needs, education, family/social/ occupational activities, Care Homes for Adults (18-65 years) Page 14 of 30 Evidence: spirituality plus maintaining personal safety and a safe environment which identifies risks and a plan to meet these risks. These are reviewed 6 monthly or if the need arises earlier. Whilst the care plans are much improved they would benefit from further expansion so that they inform, direct and guide in what caring interventions are needed so that the person receives consistent care. For example in the area of changing health needs the care plan needs to be updated, also in the area of sexuality how they will assist the person in their appearance and formation of relationships. Some risk assessments were separate from the care planning process. For example in the area of activities, cooking, household tasks, going out and fire which were completed in the last two months. However some risks assessments were absent which related to the care plans for example a risk of falls, also absconding and self harming and how the service will address this. It was noted that DACS have been involved in reviewing the care plans as well as the resident and service. Daily records and contact sheets are kept and these are satisfactory. From discussion with residents they said that they felt able to express their views in the care they receive and felt that they would be listened too. They said that they meet regularly at mealtimes and this is a social occasion where they can discuss any issues plus there is a formal resident meeting, which is minuted where issues can be raised. They stated that they have recently been involved in looking at the range of activities on offer that the service provides and have introduced the Monday club where there is access to laptops which have been recently received in the home. The issue of confidentiality was discussed with the management team as we observed a professional meeting with a resident in a public area and this should have been conducted in private area to discuss any issues. The management team agreed with this view and said in future all visits would be conducted in private. Care Homes for Adults (18-65 years) Page 15 of 30 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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 people who live at Elmslea are offered the opportunity to engage in a wide range of activities and occupations both at home and in the community. People state they have choices about how they spend their time. Residents nutritional requirements are assessed and meals are well and imaginatively cooked with fresh ingredients. Evidence: In the individuals care plan there is a section where the individuals interest and activities are assessed. From discussion with seven residents over coffee they told me of the following activities that they participate in; they have started a Monday club at Elmslea where they now have access to laptops, this occurs in the education room. As the home has two kitchens the smaller kitchen can be used for residents to do their own preparation and cooking of meals, and some said they have invited others to join them for a meal there. Examples of group activities are; attendance at church service, Tuesday coffee morning at the church, Thursday drop in at the church where games Care Homes for Adults (18-65 years) Page 16 of 30 Evidence: are played, womens fellowship, monthly film evening at the church, Friday sewing group at Elmslea where they make clothing for people in Africa, or their own. Residents stated many times that the group activities are optional. Some examples given of individual activities include; work placements at a variety of venues and attend farm with the registered provider. Attendance at slimming world, going out to library, walks on own (or in group), swimming, drumming, music clubs, watching TV and reading on own. Residents whereabouts was written on a wipe board which was available for all to read. Due to confidentiality it was recommended that this is removed and instead individual whereabouts sheets are kept in the office. The trainee manager agreed to this immediately. It was noted in one care plan that a individual wanted to work but no evidence in how this person was being supported to achieve this. This must be evidenced. In addition the care plan section on sexuality and forming relationships needs to be expanded to demonstrate how the home will assist people in developing mutual and intimate relationships. Residents stated that visitors are welcome at Elmslea at any time, but acknowledged that not many family visits them as they either do not live locally or have no family. In respect of household routines, all residents have signed to state what tasks they agree to help with in the house routines; polish, sweep, wash/ dry dishes. A rota is on display for these tasks as there is for individual laundry. Residents stated they are responsible for their own rooms. Since the last inspection a domestic has been employed who assists with cleaning communal areas and was observed to be doing this on day of inspection. In respect of food all residents said the food was good and that they are involved in the menu planning, which was seen. In addition if the person does not wish to have the main meal of the day a alternative is provided and written records show what food residents had. If there are particular dietary needs a separate menu plan was implemented and again was seen. The cook prepares the main meal everyday and residents prepare their own breakfast. Residents stated that preparation of tea is a group activity and that this works well. From a inspection of the kitchen areas it was evident that this is kept to a good standard. A Environmental Health inspection occurred in October 2009 and did not highlight concerns. Food was stocked with plenty of variety. All records needed where completed ie safer food better business, temperature charts etc. Care Homes for Adults (18-65 years) Page 17 of 30 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. There is a robust system in place to ensure that medication is received, administered and stored appropriately. Residents say they receive appropriate health care which meets their needs. Evidence: Peoples health care needs are recorded in their care plan with a list of what specialist support is being provided. Residents said that they have access to a GP, chiropodist, dentist and optician which was recorded on file. Residents also said that they have choices in when to get up and go to bed. They said that usually everyone is in their rooms by 9pm so that the registered providers can have a break. However they said they are happy with this arrangement as they go to their rooms and are able to watch TV, read books etc in the privacy of their rooms. Residents said if they are out after 9pm they then let themselves in and lock up after them. This was discussed with the registered providers who agreed that this process would not be satisfactory as how do residents know they are the last ones in at night. The registered providers said if someone is out after 9pm they would knock on the door and be let in as they do not have keys to the home. They agreed to consider the Care Homes for Adults (18-65 years) Page 18 of 30 Evidence: use of keys and discuss this with the residents. From inspecting medication records it was apparent that the management team have ensured that this area has improved. All medicines received, administered and stored are now recorded accurately. Verbal dose medication are now recorded correctly as are any medications that needed to be handwritten on MAR sheets (transcribing) as this is now witnessed by two people to prevent medication errors. Risk assessments for those people who wish to self administer is now being done and these were satisfactory. Medication competence forms are now filled in by staff and all staff have undergone some training . It is recommended that staff attend a more formal medication training as the majority of staff have just undertaken the e learning module. The management team agreed to further training needed and therefore a recommendation at this time has been identified. The policy and procedure for medication has been reviewed and updated and is now comprehensive. Copies of guidance on medication are also on site for reference. There was a detailed end of life care plan which reflected the persons wishes. Care Homes for Adults (18-65 years) Page 19 of 30 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The safeguarding and complaints policy are appropriate and evidence that a system is in place in managing areas of concern to ensure that people who use the service are protected. A policy needs to be developed in the management of residents monies to ensure that they are protectd from fianancial abuse. Evidence: The Complaints and Safeguarding policy and procedure have been updated and are appropriate. They both evidence the process needed to follow if a concern is identified. Staff have undertaken some form of safeguarding training. From discussion with people who use the service they stated that if they had any concerns they they would be able to approach the management team or staff to discuss their concerns. They felt that they would be listened too and that appropriate actions would be taken. Residents also stated that they have the venue of residents meeting where they can again express their views positively and negatively about the service if they wish. From inspecting the management of residents money it was evident that all residents have their own bank accounts and the majority of people manage their own monies, and some have power of attorneys. The registered providers have little to do with managing the residents accounts. However they do agree to safe keep small amounts of moneys on behalf of particular residents. All records of monies deposited and paid Care Homes for Adults (18-65 years) Page 20 of 30 Evidence: where kept. However the registered provider acknowledged that there is no policy or procedure in the management of peoples monies and this needs to be implemented to ensure that resident and staff are aware of their accountability and the procedure in the process of receiving and depositing monies to ensure errors are not made and prevent abuse. Care Homes for Adults (18-65 years) Page 21 of 30 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 people who live at Elmslea are provided with a high standard of accommodation. The house is clean and well furnished and people are able to decorate their rooms in a way that suits their preferences. Evidence: A resident showed me around the home, the communal areas and some bedrooms were seen. The home is decorated and furnished to a very high standard. All of the bedrooms have en suite shower rooms with the exception of one which has a bathroom close by. Residents said they have furnished their bedrooms themselves to reflect their interests and particular tastes. All areas of the home were clean and on the day of inspector a domestic was cleaning communal areas alongside residents who were undertaking particular household tasks. Residents said they did not mind doing the household tasks. In respect of the requirement set around window restrictors on the first floor, a risk assessment and consultation with the health and safety department and us has occurred. Appropriate risk assessments are now in place. Care Homes for Adults (18-65 years) Page 22 of 30 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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 people who live at Elmslea are supported by a stable staff team. Access to training has improved so that people who use the service can be more confident that staff have the relevant skills to meet their needs. Recruitment of staff is satisfactory. Evidence: Residents said that they like the staff and find them easy to approach. Two people have been recruited since the last key inspection, a trainee manager and domestic. Their files were inspected and it was evident that all relevant checks have taken place prior to the person being offered employment at the home ie references, ISA, health check. However there was no interview records kept and it is recommended that these are taken in all future interviews. The management team agreed to address this. Job descriptions were on file. It was also noted that there had been a increase in access to training. The trainee manager has created a training matrix which identifies what staff need to attend mandatory courses so that they remain in date. In addition specialist courses have also been identified. Some examples of courses recently attended include, moving and handling, fire, basic food hygiene, diabetes, emergency 1st aid, medication, equality and diversity, safeguarding, NVQ2, DOLs, Mental Capacity Act, introduction to mental Care Homes for Adults (18-65 years) Page 23 of 30 Evidence: health, challenging behavior and introduction to trainer skills. New staff have or are in the process of completing a induction program which is accredited by Skills for Care. New supervision templates have been introduced and were evidenced as being used to record formal supervision of staff. Care Homes for Adults (18-65 years) Page 24 of 30 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. With new management systems in place the organization has improved but it is not certain if these can be sustained and needs to be tested. People who live at and staff who work at Elmslea are able to participate in the development of the home. Evidence: Diana Hill has been recruited as the trainee manager so that the registered providers in the future will be able to delegate more responsibility to her. Diana has many years care experience and has NVQ level 3 in Health and Social Care as well as the Assessors Award plus has attended a variety of training courses. She is currently undertaking NVQ4 and hopes to undertake the managers award once this is completed. Staff meetings and residents meetings are in place to gain the views of those who work and live at the home. Minutes of these meetings are now professionally taken and demonstrated that the home has moved on. In addition Diana Hill has implemented new procedures such as pre admission documentation, supervision records and a training matrix. The policies and procedures either have been or in the Care Homes for Adults (18-65 years) Page 25 of 30 Evidence: process of being updated and these were in some cases very comprehensive and in all cases satisfactory. There has been no quality assurance of the service and the registered providers said this is not due until December 2010. Health and safety checks are undertaken as necessary. No health and safety issues were identified at this inspection. Care Homes for Adults (18-65 years) Page 26 of 30 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 Adults (18-65 years) Page 27 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 6 15 care Plans must be up to 30/11/2010 date and inform, direct and guide the caring interventions needed so that consistent care will be provided to the individual. Care plans must be up to date so that staff are aware of the current care needs and what interventions they need to undertake to ensure consistent care is provided to the individual. 2 9 13 Risk assessments to protect the persons health and wellbeing must be assessed and preventable actions to reduce risk should be made. this will ensure that people are taking reasonable risks and appropriate actions to minimize future risks are put in place. 30/11/2010 3 39 24 A Quality review of care provided must be 30/12/2010 Care Homes for Adults (18-65 years) Page 28 of 30 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 undertaken ensuring that the people who use the service, their representatives, staff and stakeholders views are sought in this process and any issues identified to improve practice must be addressed within timescales. this will give confidence to those who live, work and visit the home that they can participate and be satisfied with the care they receive. 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 2 10 20 people who use the service should be able to have meetings in private to promote confidentiality. All staff who receive, administer, store and dispose of medication should attend formal training so that all are competent to carry out this task. A policy and procedure in the management of residents monies should be implemented to prevent errors and financial abuse. A interview record of potential staff should be kept to evidence their suitability for the post applied for. 3 23 4 34 Care Homes for Adults (18-65 years) Page 29 of 30 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. 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