Care Home: Elmsleigh Care Home

What the care home does well It is to be noted that the operations director and staff have complied with five of the previous requirements identified at the last inspection and two recommendations. These are in relation to care planning and health and safety/ environmental issues as seen below. Two care plans were inspected. The operations director has reviewed the care plans. They are now person centered covering the individuals physical and emotional care needs plus looking at their social interests and wishes. These care plans direct inform and guide staff in what caring interventions are needed and how they are to approach people who use the service so that consistent care is provided to the individual at all times. In discussionswith staff they said that they felt the care plans now accurately describe the current care that an individual person needs and how the care is to be delivered. They felt the care plans were much improved and would assist them greatly in their daily caring interventions with people who use the service. The care plans have been reviewed by the Primary Care Trust and the Department of Adult Care and Support who have told me that they are pleased with the new care planning process. Care plans now identify a persons social and leisure needs and how it intends to meet them. I was told that the local minister has resumed services in the home. During this inspection I observed people socialising in lounges, receiving visitors, individuals having hand care, doing jigsaw puzzles with staff, watching TV in the lounge or in their own rooms or listening to music. I also observed people using the designated smoking area, socialising in the front garden area. The provider has agreed to review, whilst ensuring that people who use the service views are taking into account, a smoking area within the home. Risk assessments have been reviewed and now identify a particular risk and what action is needed to prevent future risks from occurring. The risk assessment also identified what equipment if any is needed in for example how to move a person safely. Information from health professionals were evident on files and showed that there is good communication between the staff at the home and relevant agencies i.e. SALT, Hospital departments and GP`s. Monitoring of weight has much improved. From a tour of the home it was evident that the home provides clean, safe accommodation that is attractive in appearance and in its furnishings. From a tour of the premises it was observed that some bathrooms had been refurbished, call bells in toilet areas were now within reach. The hot water tank area is now locked. Staff stated that there is improved leadership within the home with the appointment of the operational director. Staff meetings have been held to discuss the new systems and procedures that have been put in place so that they are aware of what is expected of them. Staff felt that the quality of care has now risen and that their care practices were now more person centered. They felt that there is sufficient staff on duty to provide good quality care and access to training is being provided to update their skills. The operations director stated that it is her aim that all staff will have a minimum of NVQ level 2 qualifications and is liaising with the college in order for this to proceed. A registered manager, nursing, carers and domestic staff have been appointed. In speaking to some of the new workers all stated that they had a good induction to the home and felt supported in their role and knew what was expected of them. On the day of inspection the operations director, provider, 11 carers, two nurses, cook, kitchen porter, two domestics and an administrator were on duty. The operations director has reviewed the medication policy and this is now put into practice. She has also commenced a new pharmacy contract with Boots pharmacy and during the inspection new medication trolleys were delivered and a Controlled Drugs cupboard had been ordered. A new CD book is now in use and the operations director stated all CD medication now tallied. Boots will be dispensing all medication into the home and arranging pharmacy audits as part of their contractual agreement. It was noted that signatures for the administration of medication were now being completed.The operations director has implemented new policies and procedures in the areas of pre admission assessments, care planning, and medication, to name a few. What the care home could do better: In discussion with the operations director she acknowledged that care plans are a ongoing developing document and that they would benefit from further expansion to show the persons abilities, wishes, goals and aspirations and this is work in progress. In addition she would ensure that if a person managed their own finances this would be reflected in the individuals care plan. From inspecting medication it was noted during a tablet count that those from blister packs tallied. However some loose medication did not tally with the amounts recorded on the MAR sheets. The operations director was aware of this and stated that it was her aim to count all medication in the home and ensure that records tallied until the end of the month. Any surplus medication would be disposed of appropriately. This would then enable next months receipt of medication to be accurate. It was noted that transcribing of medication in a few instances still did not occur and the operations director will discuss this with staff. The operations director acknowledged that some areas of the home have an unpleasant odour. She gave reassurance that this was being looked into. In talking with the domestic staff they stated that they are aware of particular areas where they are offensive odours and do attempt to alleviate them. Some parts of the homes furnishings and decor are looking tired and need updating or replacing. The provider agreed to repair the carpet tear immediately to prevent the risk of tripping and falls. The operations director agreed that when the registered manager is in post she will request that a detailed environmental audit of the home is undertaken with proposed actions as to how the homes environment will be improved. Random inspection report Care homes for older people Name: Address: Elmsleigh Care Home Elmsleigh St Andrews Road Par St Austell Cornwall PL24 2LX two star good service 12/05/2009 The quality rating for this care home is: The rating was made on: A quality rating is our assessment of how well a care home, agency or scheme 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 review a ‘key’ inspection. This is a report of a random inspection of this care home. A random inspection is a short, focussed review of the service. Details of how to get other inspection reports for this care home, including the last key inspection report, can be found on the last page of this report. Lead inspector: Lynda Kirtland Date: 2 1 0 9 2 0 1 0 Information about the care home Name of care home: Address: Elmsleigh Care Home Elmsleigh St Andrews Road Par St Austell Cornwall PL24 2LX 01726812277 01726815479 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Name of registered manager (if applicable) Mrs Susan Windsor Type of registration: Number of places registered: Conditions of registration: Category(ies) : Robert Gregory Thomas care home 48 Number of places (if applicable): Under 65 Over 65 0 0 dementia mental disorder, excluding learning disability or dementia Conditions of registration: 48 48 The maximum number of service users who can be accommodated are 48. The registered person may provide the following category of service only: Care home providing nursing or personal care - Code N to service users of either gender whose primary care needs on admission to the home are within the following categories: Dementia, excluding learning disability or mental disorder (Code DE) maximum 48 places Mental disorder, excluding learning disability or dementia (Code MD) maximum 48 places Date of last inspection Care Homes for Older People 2 3 0 7 2 0 1 0 Page 2 of 10 Brief description of the care home Elmsleigh provides nursing care for service users who have a dementia and or a mental disorder. Elmsleigh is a period property in a peaceful area, set in extensive secluded attractive grounds approached by a long drive. Car parking is available. The home is situated in Par, approximately three miles form the town of St Austell. Residents private accommodation is set out across two floors in the main house where there is a stair lift to provide access to the first floor accommodation. Some of the bedrooms are only accessible to residents with good levels of mobility due to relatively steep stairs. All of the bedrooms are for single occupancy and there are sufficient bathing facilities. The new extension known as the bungalow is on one level and all single bedrooms are provided with en suite bathroom facilities. The communal facilities include two dining rooms, a variety of lounge areas and in the bungalow residents and their relatives have access to a communal kitchen. The home is run and managed by the registered provider and registered manager with a team of staff to assist them. The fees range from £357.00 to £775.00 per week. Toiletries, newspapers and certain activities are the financial responsibility of the resident. Care Homes for Older People Page 3 of 10 What we found: An inspector visited the service to undertake a random inspection on the 21 September 2010. The inspection lasted approximately seven hours. I met with the operations director, the provider and spoke with staff and people who use the service to gain their views and experiences of living or working at Elmsleigh Nursing Home. At the time of this inspection 34 people were using the service. The random inspection was conducted to monitor the progress made in relation to the statutory requirements and recommendations that were identified at the previous random inspection which occurred on the 23 July 2010. The purpose of this random inspection was to focus on the following areas, care planning, health needs, staffing and management arrangements in the home. The provider told me that he has employed a Operations Director to oversee the day to day running of the home and to implement new systems, policies and procedures to ensure that high quality care will be provided to people who use the service and that there are safe working practices in the home. The operations director has a six month contract in this role. It is then hoped that she will extend her contract to audit the service monthly to enable monitoring of the new systems that have been put in place to see if they are being maintained. On the day of inspection the provider appointed a registered manger. The prospective manager attended the morning of the inspection in order to gain an understanding of what work is needed to improve the standards in the home. She has the relevant qualifications as a RMN, has training experience, previous experience as a registered manager in another care home in the county and is a NVQ assessor. She aims to commence the managers role by mid October 2010. She will then apply to be registered with the Commission in this role. Daily logs are completed and the quality of records kept varies. Some examples of good recording where staff have written what follow up action has been taken were highlighted to the operational director as examples of good practice. The operations director stated that she is in process of requesting a continence assessment and medication review on all people who use the service in the home. What the care home does well: It is to be noted that the operations director and staff have complied with five of the previous requirements identified at the last inspection and two recommendations. These are in relation to care planning and health and safety/ environmental issues as seen below. Two care plans were inspected. The operations director has reviewed the care plans. They are now person centered covering the individuals physical and emotional care needs plus looking at their social interests and wishes. These care plans direct inform and guide staff in what caring interventions are needed and how they are to approach people who use the service so that consistent care is provided to the individual at all times. In discussions Care Homes for Older People Page 4 of 10 with staff they said that they felt the care plans now accurately describe the current care that an individual person needs and how the care is to be delivered. They felt the care plans were much improved and would assist them greatly in their daily caring interventions with people who use the service. The care plans have been reviewed by the Primary Care Trust and the Department of Adult Care and Support who have told me that they are pleased with the new care planning process. Care plans now identify a persons social and leisure needs and how it intends to meet them. I was told that the local minister has resumed services in the home. During this inspection I observed people socialising in lounges, receiving visitors, individuals having hand care, doing jigsaw puzzles with staff, watching TV in the lounge or in their own rooms or listening to music. I also observed people using the designated smoking area, socialising in the front garden area. The provider has agreed to review, whilst ensuring that people who use the service views are taking into account, a smoking area within the home. Risk assessments have been reviewed and now identify a particular risk and what action is needed to prevent future risks from occurring. The risk assessment also identified what equipment if any is needed in for example how to move a person safely. Information from health professionals were evident on files and showed that there is good communication between the staff at the home and relevant agencies i.e. SALT, Hospital departments and GPs. Monitoring of weight has much improved. From a tour of the home it was evident that the home provides clean, safe accommodation that is attractive in appearance and in its furnishings. From a tour of the premises it was observed that some bathrooms had been refurbished, call bells in toilet areas were now within reach. The hot water tank area is now locked. Staff stated that there is improved leadership within the home with the appointment of the operational director. Staff meetings have been held to discuss the new systems and procedures that have been put in place so that they are aware of what is expected of them. Staff felt that the quality of care has now risen and that their care practices were now more person centered. They felt that there is sufficient staff on duty to provide good quality care and access to training is being provided to update their skills. The operations director stated that it is her aim that all staff will have a minimum of NVQ level 2 qualifications and is liaising with the college in order for this to proceed. A registered manager, nursing, carers and domestic staff have been appointed. In speaking to some of the new workers all stated that they had a good induction to the home and felt supported in their role and knew what was expected of them. On the day of inspection the operations director, provider, 11 carers, two nurses, cook, kitchen porter, two domestics and an administrator were on duty. The operations director has reviewed the medication policy and this is now put into practice. She has also commenced a new pharmacy contract with Boots pharmacy and during the inspection new medication trolleys were delivered and a Controlled Drugs cupboard had been ordered. A new CD book is now in use and the operations director stated all CD medication now tallied. Boots will be dispensing all medication into the home and arranging pharmacy audits as part of their contractual agreement. It was noted that signatures for the administration of medication were now being completed. Care Homes for Older People Page 5 of 10 The operations director has implemented new policies and procedures in the areas of pre admission assessments, care planning, and medication, to name a few. 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 set out on page 2. Care Homes for Older People Page 6 of 10 Are there any outstanding requirements from the last inspection? Yes R No £ 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, Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 9 13 You must ensure that for 06/08/2010 each person living in this home you must always keep accurate, clear and complete records for all medicines received, administered and disposed of. this is to help make sure that all medicines are accounted for, that people receive their prescribed medication correctly and are not at risk of mistakes with medication because of poor recording arrangements. Care Homes for Older People Page 7 of 10 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, Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 9 13 You must ensure that for 30/11/2010 each person living in this home you must always keep accurate, clear and complete records for all medicines received and administered and disposed of. This is to help make sure that all medicines are accounted for, that people receive their prescribed medication correctly and are not at risk of mistakes with medication because of poor recording arrangements. 2 31 9 A qualified, skilled and c competent, person must be appointed in the role as registered manager. This will ensure that a consistent manager is in place to oversee the daily running of the home and that it is run in the best interests for those who live and work at the home. 30/12/2010 Care Homes for Older People Page 8 of 10 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 3 8 12 19 transcribing of medication should be witnessed by two people to prevent errors In consultatn with people who use the service, a smoking facility within the home shoud be considered and provided. A environmental audit of the home should be undertaken to ensure that the decor and furnishings are to a good standard. Any areas for improvement should be identified with a action plan as to how this will be addressed. All areas of the home should be free form offensive odors. 4 26 Care Homes for Older People Page 9 of 10 Reader Information Document Purpose: Author: Audience: Further copies from: Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Our duty to regulate social care services is set out in the Care Standards Act 2000. Copies of the National Minimum Standards –Care Homes for Older People can be found at www.dh.gov.uk or got 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 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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