Care Home: Elmstead House

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What the care home does well The home is well maintained and furnished to a high standard, thus providing an attractive home for residents. Residents interviewed were satisfied with their accommodation. Pictures, ornaments and various items in memory boxes were displayed along the corridor to provide sensory and therapeutic stimulation for residents. Residents and relatives interviewed spoke highly of staff and were of the opinion that residents are well cared for. They described staff as "very kind and caring". The home has a comprehensive training programme for staff. Staff were found to be knowledgeable regarding their roles and responsibilities and able to provide care that is responsive and sensitive to the needs of residents. Staff were also aware of Equality and Diversity issues and the need to treat all residents with respect and dignity. Special effort had been made to provide social and therapeutic stimulation for residents. The home has a complementary therapy room, a cinema and a multi-faith room. These were aimed at ensuring that residents are well cared for and they enjoy their stay at the home. What has improved since the last inspection? The pre-admission assessments were noted to be comprehensive and include the appropriate risk assessments. This ensures that residents admitted are appropriate and can be provided with the required care. A safety inspection of the electrical installations of the home had been carried out by a qualified professional. This ensures the health and safety of residents. What the care home could do better: The arrangements for the provision of meals and the menu should be reviewed with residents and their representatives to ensure that they are satisfied with the arrangements and a varied pureed food / soft diet menu is incorporated. In particular, they should be asked if the meals provided are appropriate and whether the terms used in the menu can be easily understood by residents.This is to ensure that residents are aware of the meals to be provided and the meals provided are appropriate for residents. CARE HOMES FOR OLDER PEOPLE Elmstead House 171 Park Road Hendon London NW4 3TH Lead Inspector Daniel Lim Unannounced Inspection 20th October 2008 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmstead House Address 171 Park Road Hendon London NW4 3TH Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8202 6177 020 8202 4157 manager.elmsteadhouse@careuk.com manager.burroughs@careuk.com Care UK Community Partnerships Ltd Ms Diane Maddaford Care Home 50 Category(ies) of Dementia (50), Mental disorder, excluding registration, with number learning disability or dementia (50) of places Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home with nursing - Code N to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Dementia - Code DE 2. Mental Disorder, ecxluding learning disability or dementia - Code MD The maximum number of service users who can be accommodated is: 50 5th June 2007 Date of last inspection Brief Description of the Service: Elmstead House is a care home registered to provide both nursing and personal care for people with dementia and other mental health problems. The home is part of a scheme originally developed by Barnet Health Authority for the reprovision of patients who were receiving long term care at Napsbury Hospital. The original Elmstead House has now combined with April Lodge (adjoining home) and is now registered as a single home. The home may accommodate a maximum of fifty older adults who are over the age of 65 years. It is owned by a Colchester based company called Care UK Community Partnerships Limited. The company has a number of care homes in London. The aims and objectives of the home are; To provide a safe and homely environment To offer a stimulating environment To recruit adequate, qualified and experienced staff. Invest in employees To provide care support in a way which encourages self-determination and Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 5 enable each service user to achieve their best quality of life. To deliver care in a manner which maintains dignity and respect and which recognises service users rights. The home consists of two separate adjoining buildings. The building accommodating service users requiring nursing care is a large single storey building with thirty bedrooms. The manager’s office is at the front of this building. The building accommodating residents requiring personal care is in the adjoining double storey building. It has twenty bedrooms located across both floors. There is a parking area at the front of the home and gardens at the back and sides of the home. The home is situated at the end of a residential street and is close to transport and community facilities around Hendon Central Station. The fees charged by the home range from £520 - £750 per week. The provider must make information about the service available (including reports) to service users and other stakeholders. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 3 star. This means the people who use this service experience excellent quality outcomes. This inspection was carried out on 20 October 2008 and took a total of eight and a half hours to complete. A second visit was made on the 24th October to view documents not examined or available on the first day. We were assisted by the registered manager, Mrs Diane Maddaford and the deputy manager, Mr Biju Abraham. During the first day of inspection, I was accompanied by an “Expert by experience” for three hours. An “Expert by experience” is an interviewer who has experience of being a service user. Five residents and two relatives were interviewed. The feedback received from them was positive and indicated that they were satisfied with the care provided. Completed questionnaires were received from 14 residents, 2 staff and 4 professionals. These were on the whole, positive and indicated that residents were well cared for. Statutory records were examined. These included five residents’ case records, the maintenance records, accident and incident records, financial records, complaints’ records and fire records of the home. The premises including residents’ bedrooms, communal bathrooms, laundry, kitchen, garden and communal areas were inspected. Six staff were interviewed regarding the care of residents and other areas associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. Staff records, including evidence of CRB disclosures, references, supervision and training records were examined. In addition, the minutes of residents meetings were examined. These indicated that residents had been consulted and informed of changes affecting the running of the home. The completed Annual Quality Assurance Assessment form (AQAA) was received by CSCI. Information provided in the assessment was used for this inspection. What the service does well: Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 7 The home is well maintained and furnished to a high standard, thus providing an attractive home for residents. Residents interviewed were satisfied with their accommodation. Pictures, ornaments and various items in memory boxes were displayed along the corridor to provide sensory and therapeutic stimulation for residents. Residents and relatives interviewed spoke highly of staff and were of the opinion that residents are well cared for. They described staff as very kind and caring. The home has a comprehensive training programme for staff. Staff were found to be knowledgeable regarding their roles and responsibilities and able to provide care that is responsive and sensitive to the needs of residents. Staff were also aware of Equality and Diversity issues and the need to treat all residents with respect and dignity. Special effort had been made to provide social and therapeutic stimulation for residents. The home has a complementary therapy room, a cinema and a multi-faith room. These were aimed at ensuring that residents are well cared for and they enjoy their stay at the home. What has improved since the last inspection? What they could do better: The arrangements for the provision of meals and the menu should be reviewed with residents and their representatives to ensure that they are satisfied with the arrangements and a varied pureed food / soft diet menu is incorporated. In particular, they should be asked if the meals provided are appropriate and whether the terms used in the menu can be easily understood by residents. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 8 This is to ensure that residents are aware of the meals to be provided and the meals provided are appropriate for residents. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3, 6 People who use this service experience a good outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. Admissions are not made to the home until a full needs assessment has been undertaken by the manager or a sufficiently skilled member of staff. This ensures that the home is able to meet the needs of residents. EVIDENCE: The pre-admission assessments which were examined were noted to be appropriate and comprehensive. These assessments included details of the personal, mental, cultural and spiritual needs of residents. Risk assessments had also been prepared for residents admitted to the home. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 11 The home’s AQAA stated that “residents’ consent is always sought and where necessary the relatives are included in the assessments carried out at their current address. Prior to their admission residents and relatives are invited to visit the home to view.” Residents in the home were noted to be clean and appropriately dressed. Residents and relatives who were interviewed by the “Expert by experience” and by us indicated that residents were well cared for and their care needs had been attended to. This was reiterated in completed questionnaires received. Comments made by residents included, “ well cared for”, “satisfied” and “ nice home”. The manager stated that the home does not provide intermediate care. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 People who use this service experience a good outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The arrangements for meeting the healthcare and personal care needs of residents are on the whole satisfactory and these are recorded in residents’ care plans. Residents’ are protected by the home’s satisfactory arrangements for the administration of medication. EVIDENCE: Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 13 Comments made by residents and their relatives in interviews indicated that there is a warm and caring atmosphere in the home. Residents interviewed stated that they were well cared for and they had been treated with respect by staff. Case records contained evidence that residents had access to healthcare professionals such as the chiropodist, community nurse and their GP. The home’s completed AQAA stated that progress in meeting the health and personal care needs are recorded in the daily notes and observation charts. This was evidenced in the case records examined. The AQAA stated that individual care plans had been prepared for residents following their assessment. A sample of five care plans which was examined were on the whole well prepared and regular monthly care reviews had been carried out. The care plans were holistic and addressed the cultural and spiritual needs of residents. Nutritional monitoring and weight monitoring charts were evident. These had been completed monthly. Appropriate risks assessments had been prepared for residents. These were generally of a good standard. The care plan of a resident with dementia contained an appropriate and up to date dementia care plan. Staff interviewed were aware of how to care for such a resident. The treatment room was air-conditioned. The temperature records of the room where medication was stored had been recorded daily. There were satisfactory. The medication charts of four residents were examined. These indicated that medication had been administered as prescribed and appropriately signed by staff. The arrangements for ordering and disposal of medication were satisfactory. There were signs in the home encouraging staff to ensure that residents are provided with adequate fluids. The “Expert by experience” noted that staff were attentive towards residents and residents were being provided with drinks. She further added that all staff wore clean and tidy uniforms. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15 People who use this service experience an excellent outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The daily life, meal arrangements and routines of residents are well organised. The views of residents and their relatives are being sought when planning the home’s activities and routine. People using the service are given the opportunity to take part in activities that are imaginative, appropriate and varied. They also have opportunity to maintain important family relationships. EVIDENCE: The “Expert by experience” noted that on arrival at the home, the immediate impression is one of warmth and of lots of activities and carers were seen constantly interacting with the residents. The home had a varied and comprehensive programme of weekly social and therapeutic activities. The programme was available for inspection and on display along the corridor on the ground floor. The manager indicated that the Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 15 programme of activities had been carefully planned to suit the preferences and needs of residents. Activities provided included exercise sessions, music, aromatherapy, hand massage, cookery, bingo, exercise, cookery, entertainment sessions, outings to shops and art and crafts. The home’s AQAA stated that in the previous year staff took a group of about 22 residents on a successful outing to Greenwich. Photos of these activities were on display along the corridors. The home had a sensory therapy room where complimentary therapies such as aromatherapy, light therapy and music therapy were provided. This room had recently been refurbished. The manager stated that residents liked using this room as it induces a calm and relaxed feeling in them. Pictures, ornaments and various items in memory boxes were displayed along the corridor. The “Expert by experience” also noted that in one corner of the home, door handles were attached to boards on the wall, to give the residents who tend to want to rip them off, handles that when ripped off, causes less damage than removing them from doors. The manager explained that these were aimed at providing residents with mental and therapeutic stimulation. The home has a small cinema room with a large screen. The manager explained that the room is used for showing films and DVDs to residents. Comfortable chairs had been provided and the manager stated that the necessary entertainment license had been obtained. The “Expert by experience” also made the following observation: “There was a great dance session in place whilst I visited. A large number of residents were involved and most seemed to be really active and participating with different levels of competence. The manager took one man as her partner and danced with him! This took place in the part of the home where the residents were more able”. The “Expert by experience” noted that she was not able to see the activities organiser working with less able residents (in the afternoon). However, she did have a brief talk with her. The activities organiser said they did have some current affairs`sessions. The “Expert by experience” further noted that for the less able residents there were a number of toys of the activity type available, some of which were being used and seemed to occupy some residents both with and without assistance from staff. There was evidence of paper and crayoning but she was unable to witness any more sedentary activity. (The expert by experience was contracted to stay for only 3 hours in the home). In the area of valuing cultural and religious diversity the home has allocated a small lounge as a multi-faith prayer room. This room was visited by us. We note that it had icons of various religions. The manager explained that this Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 16 room was for the use of residents of different faiths and they may use this room for praying or for religious functions. She added that the room can also be used as a quiet room. Documented guidance on caring for residents of various religious and cultural backgrounds was available in the office. Residents’ case records included a social care plan with details of activities that they had participated in. The kitchen was clean and well equipped. A record of fridge and freezer temperatures had been kept. These were satisfactory. The chef who was interviewed was knowledgeable regarding her responsibilities and the special dietary needs of residents. The menu examined was varied, balanced and there was a choice of main dish. The “Expert by experience” noted that some items on the menu were given names which may not be easily understood by some residents. This was discussed with the manager, who agreed to modify the menu. The “Expert by experience” noted that residents are provided with a hot meal both at lunchtime and in the evening. Milky drinks and biscuits are also available before bed. Residents who were assisted with their meals were not being rushed. However, she commented that the menu contained meals such as chicken drumsticks and pork chops which appeared unsuitable for some residents as they may have difficulty eating them. She further suggested that there should be a soft diet and pureed menu for residents who have problems using their hands or who have dental problems. This is because she noted that the pureed food / soft diet offered is not on the menu. A recommendation is made for the provision of meals and the menu to be reviewed with residents and their representatives to ensure that they are satisfied with the arrangements and a pureed food /soft diet menu is incorporated. The “Expert by experience” further noted that some residents she saw appeared thin. The manager reassured her that they were weighed regularly and if necessary, appropriate action taken to increase calorific intake. The “Expert by experience” said she was reassured by the manager that the dietitian from Barnet General hospital who examined the menu was satisfied that the meals contained adequate vitamins. The case records of residents examined indicated that the weight of residents had been monitored and there were no concerns requiring further investigation. Residents interviewed indicated that they were satisfied with the meals provided. The minutes of a recent residents’ meeting also indicated this. Food hygiene training had been provided for staff and documented evidence was available in staff records. Residents confirmed that they had been visited by friends and relatives. Relatives who were interviewed indicated that residents had been well treated and their care needs had been met. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 17 Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18 People who use this service experience a good outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The arrangements for responding to complaints and for adult protection are on the whole, satisfactory. The required policies and procedures for safeguarding residents were in place and give clear and specific guidance to staff. EVIDENCE: The residents who were interviewed by us indicated that they were well treated and satisfied with the care provided. The home had an adult protection procedure. It included information on examples of abuse and guidance to staff on reporting allegations of abuse to Social Services and The CSCI. The manager and her staff who were interviewed were aware of the home’s policy and procedures for the protection of vulnerable adults. There was evidence that most staff had been provided with the required training. One complaint had been recorded. This was promptly responded to. The home had a record of compliments received. These indicated that relatives thought highly of the home. The “Expert by experience” made the following comments: Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 19 “One resident said that her relatives who live some distance from this area do not visit often because they know I am so well looked after where I am. She herself was very happy with the care she is given and finds all the staff very kind and caring. Another couple were full of praise. They made a comparison between the home where a brother in law resides, saying that the nurses just sit around the table talking between themselves . A residents wife used the word `attitude`saying that the attitude here is so nice and makes the place so pleasant and they would recommend it to anyone. She said he was a bit upset that morning as he wanted to go out and play bowls which was one of his favourite occupations. However he cheered up and agreed with his wife that everything is very nice here. I talked to another relative of a considerably more disabled resident. He came and visited every day and praised the care very highly. I asked if he noticed if she had lost any weight and he said he hadnt. I talked to another resident and complimented her on her hat for a start. She was very nicely dressed and was `playing with some large playing cards. She said she was happy and comfortable and I think she understood what she was saying. She certainly looked contented enough”. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 23, 25, 26. People who use this service experience an excellent outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The home is clean, tidy and furnished to a high standard. The provider and manager have ensured that the physical environment of the home provides for the individual requirements of people who live there. The necessary equipment and adaptations for supporting residents are available. Residents are allowed to personalise their bedrooms. Overall, the home provides a pleasant, comfortable and attractive environment to live in. EVIDENCE: Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 21 On arrival at the home, the “Expert by experience” noted that the reception area was very pleasant and the manager’s office and administrator’s office opened out into it with partial glass walls so that anybody arriving or departing can see and be seen. She further commented that the home is very well decorated with an astonishing assortment of pictures, flowers, hats, soft toys and even a cricket bat and stumps stuck to the walls in the games room. The manager stated that these were aimed at providing sensory stimulation for residents. Residents interviewed by the inspector indicated that they were happy with the accommodation provided and their bedrooms had been kept clean. The home employs two full time maintenance staff on site. The home’s AQAA stated that new furniture had been provided in part of the home (previously called April Lodge) and the kitchen had been refitted. Bedrooms inspected have en-suite facilities and appeared cosy and comfortable. The “Expert by experience” noted that the toilets and hand basins were clean. Bedrooms inspected by us had been personalised by residents with their own pictures and ornaments. The manager stated that the floorings in some bedrooms had been changed to suit the needs and preferences of residents. The “Expert by experience” noted that the manager was full of praise for her handymen who respond to all challenges and have even made a little pulpit for the multifaith / quiet room out of an old bed. Various specialist equipment for the care of residents was available. These included hoists, assisted baths, toilet handrails, wheelchairs, and a call bell system. The gardens were well maintained. It was attractive, colourful and seating had been provided. Hanging baskets were in place by the entrance to the home. There is a path through the garden. This enables residents to walk around it. The laundry was inspected and we note that laundry staff reported that care staff followed procedures for ensuring that soiled linen and clothes are put into the appropriate bags. Soiled laundry items are subject to a special high temperature wash. This ensures effective infection control and protects the health of residents. The required safety inspection had been carried out on the gas, electrical installations and portable appliances and documented evidence was kept in the home’s maintenance folder. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 22 The “Expert by experience” noted that an area near the lounge entrance was dirty and the servery area and sink needed to be repaired. This was brought to the attention of the manager who responded promptly and appropriately. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 23 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30 People who use this service experience a good outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. The service has a good recruitment procedure that is followed in practice. The manager recognizes the importance of training and tries to deliver a programme that meets statutory requirements. Residents and their representatives are satisfied with the staffing arrangements. EVIDENCE: The duty rota was examined. It indicated that in addition to the manager and her deputy, there was normally a minimum of twelve care staff (includes 2 nurses) during the day shifts and six staff on waking night duty during the night shifts (includes 2 nurses). Ancillary staff working at the home comprise four kitchen staff, four cleaners, two maintenance person and two admin staff. The manager is aware of the need to keep staffing numbers under review to ensure that the home can continue to meet the changing needs of the people living there. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 24 Five staff who were on duty were interviewed on a range of topics associated with their work. They were noted to be knowledgeable regarding their roles and responsibilities. There was documented evidence in staff records to indicate that staff had been provided with essential training relevant to their area of work. These included mental healthcare topics such as the management of residents with challenging behaviour and dementia. Staff stated that there is a good team spirit. This was confirmed by the “Expert by experience who noted that “the attitudes and interaction between staff and residents and staff and staff seemed relaxed and gave the impression of there being staff teamwork at all times”. The records of three new staff were examined. These indicated that the required recruitment standards and procedures such as obtaining satisfactory CRB disclosures and references had been followed. There was documented evidence of regular formal staff supervision. This was also confirmed by staff interviewed. The supervision notes indicated that staff had opportunity to discuss any work related problems, issues related to the care of residents and their training. The issue of equalities and diversity was discussed with the manager and her staff. Staff demonstrated an understanding of the need to treat all residents sensitively and with respect regardless of disability, gender, race, religion or sexual orientation. They were aware that they must not discriminate against residents and they indicated that this was stressed to them during their induction. The four residents who were interviewed indicated that they had been treated with respect and dignity by staff. This was also confirmed by the two relatives interviewed. The home’s AQAA stated that “Equality and Diversity” is part of the induction programme for the new staff and these are also discussed in the staff meetings”. The manager informed us that two of her staff had been nominated to receive company awards for “staff of the year”. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 25 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 People who use this service experience an excellent outcome in this area. This judgement has been made from evidence gathered both during and before the visit to this service. People living in the home can be assured that the home is well run and the manager has skills and ability to deliver a good quality of care and meet it’s stated aims and objectives. Equality and Diversity issues are given priority by the manager. Records are well maintained. There is an effective system for maintaining health and safety. Residents and their representatives are consulted regarding the care provided and the management of the home. EVIDENCE: Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 26 Feedback received from residents and their representatives indicated that the manager had been successful in fostering a caring and welcoming environment where residents are cared for with respect and dignity regardless of their background, race, religion, disability or sexual orientation. The “Expert by experience” made the following comments: “The immediate impression is one of warmth and of lots of activity. Talking with the residents and spouses with whom I made contact demonstrated their complete satisfaction with the care their relatives were given and the ambiance of the home.” The registered manager was found to be knowledgeable regarding her role and responsibilities. She is a registered nurse with extensive experience in the care field and has received her RMA (Registered Manager’s Award). She is supported by a deputy manager and an administrator who has been at the home for several years. There was evidence that residents are consulted regarding the management of the home. Residents’ and relatives’ meetings had been held. The minutes of the latest residents’ meeting were examined. It indicated that residents and relatives were informed of progress in the home and their concerns had been responded to. Positive comments regarding the management of the home had been made at these meetings. The home has a development plan. This includes refurbishment of certain areas of the home and further staff training. A consumer survey had been carried out recently and there was evidence that the respondents were satisfied with the management of the home. Weekly fire alarm checks and regular fire drills had been documented. The home had an up to date fire risk assessment. Staff had been provided with training in fire safety and Health and Safety. The accident records were appropriately filled in and the CSCI had been informed of significant accidents and incidents. The maintenance person stated that weekly safety checks had been carried out and these were documented. On a tour of the premises, it was noted that window restrictors were engaged in the bedrooms visited. The home has a current certificate of insurance. The financial records of three residents were examined. These were noted to be well maintained by the administrator of the home. Receipts had been obtained for transactions made on behalf of residents. The AQAA stated that residents and relatives could be provided with monthly expenditure sheets if required. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/a HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 4 X X X 4 x 4 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 x 4 x 3 x x 3 Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 28 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 OP15 Refer to Standard Good Practice Recommendations The provision of meals and the menu should be reviewed with residents and their representatives to ensure that they are satisfied with the arrangements and a varied pureed food / soft diet menu is incorporated. In particular, they should be asked if the meals provided are appropriate and whether the terms used in the menu can be easily understood by residents. This is to ensure that residents are aware of the meals to be provided and the meals provided are appropriate for residents. Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Elmstead House DS0000010436.V372824.R01.S.doc Version 5.2 Page 30 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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