Care Home: Elmwood

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What the care home does well People are given information in writing about the home before they decide to move in. Someone from the home would visit people who are thinking about moving in to look at what they need. They could also visit the home and stay if they want to. This is how people would know whether the home would suit them or not. There is an open and friendly atmosphere in the home, which is well run and makes sure that people who live there are happy. Staff listen to what residents want and if they are unhappy, sort it out. People enjoy living in a clean, tidy, comfortable and homely house and have a bedroom each. They are able to make up their own minds about what they do. Residents can be themselves and have lots of chances to socialise with other people, enjoy their hobbies and learn more skills; some go to work. Residents are able to see their family and friends when they want to. They can choose the meals they eat. Residents are given the help they need and staff are polite and friendly with them. Some residents help to write down the support that they need. Residents are given help to see a doctor if they need to. There are enough staff in the home to support residents when they need it. Staff are trained to do their jobs properly and the manager checks that this happens. Staff understand residents and fit in with what they need. Residents are looked after and safe. What has improved since the last inspection? The home continues to improve the way they look after people who live there. What the care home could do better: Residents could benefit if the home looked at their contract to make sure it includes all the things they need. The help that one person needs could be better written in their care plan. Residents might be safer if changes were made to the way peoples` medication is looked after, the way records about peoples` money are written and the way some checks on staff are done before they work at the home. CARE HOME ADULTS 18-65 Elmwood 221 Loose Road Maidstone Kent ME15 7DR Lead Inspector Helen Martin Unannounced Inspection 19th August 2008 11:30 Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 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 Elmwood DS0000023930.V369136.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 Adults 18-65. 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. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmwood Address 221 Loose Road Maidstone Kent ME15 7DR 01622 751894 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) maria.edavis@blueyonder.co.uk Mrs Maria Eliza Davis Mrs Maria Eliza Davis Care Home 6 Category(ies) of Learning disability (0) registration, with number of places Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category/ies of service only: Care home only - (PC) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: 2. Learning disability (LD) The maximum number of service users to be accommodated is 6. Date of last inspection 17th August 2006 Brief Description of the Service: Elmwood residential home provides personal support and accommodation for up to 6 people. Twenty-four hour supervision is provided with a member of staff on duty at night and the owner/manager, who lives at the premises, on call. The home provides two lounges, a dining room, craft/activities room and a conservatory. The home has a large back garden, which is well kept. Each service user has a single bedroom. All bedrooms are situated on the ground floor. The premises are suitable for people who use wheelchairs. Equipment that contributes to the comfort of service users is obtained as needed. A new electrically operated bed and a standing-aid hoist have recently been purchased. Car parking is available at the front of the premises. The home has two vehicles for use by staff and service users. Service users have easy access to bus services. There are good day care facilities within the home. The garden is suitable for use by service users, staff and visitors. Details of the weekly fees, additional charges and a copy of the home’s statement of purpose are available from the manager. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 5 Elmwood DS0000023930.V369136.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 2 star. This means the people who use this service experience good quality outcomes. This unannounced visit took place on 19th August 2008 and included talking and spending time with the Registered Manager/Owner, the Deputy Manager, staff and the six people who live in the home. Some judgements about the quality of life within the home were taken from observation and conversation. Some records were looked at. A tour of the premises and garden was undertaken. The home returned a completed Annual Quality Assurance Assessment (AQAA) to the CSCI. The CSCI undertook an Annual Service Review (ASR) in January 2008. The above have been used within the inspection process and mentioned in this report where appropriate. Elmwood provides a service for six residents; there are no vacancies. What the service does well: People are given information in writing about the home before they decide to move in. Someone from the home would visit people who are thinking about moving in to look at what they need. They could also visit the home and stay if they want to. This is how people would know whether the home would suit them or not. There is an open and friendly atmosphere in the home, which is well run and makes sure that people who live there are happy. Staff listen to what residents want and if they are unhappy, sort it out. People enjoy living in a clean, tidy, comfortable and homely house and have a bedroom each. They are able to make up their own minds about what they do. Residents can be themselves and have lots of chances to socialise with other people, enjoy their hobbies and learn more skills; some go to work. Residents are able to see their family and friends when they want to. They can choose the meals they eat. Residents are given the help they need and staff are polite and friendly with them. Some residents help to write down the support that they need. Residents are given help to see a doctor if they need to. There are enough staff in the home to support residents when they need it. Staff are trained to do their jobs properly and the manager checks that this Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 7 happens. Staff understand residents and fit in with what they need. Residents are looked after and safe. What has improved since the last inspection? What they could do better: 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. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR 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) Scoring of Outcomes Statutory Requirements Identified During the Inspection Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 4, 5 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective residents and their representatives are given the written information they need about the home before they decide to move in. They will know whether the home will meet their needs through assessment and trial visits. Residents could benefit from a review of their contract to confirm this fully reflects the service they are offered. EVIDENCE: The information is available for prospective residents and their representatives. The home’s statement of purpose was seen. The manager said that each resident is given a contract. Documentation seen included the room to be occupied and the amount of fees payable. The manager said that they would review residents’ contracts to confirm that the necessary information was included. It was also stated that the inclusion of Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 10 bedding as an item that residents must purchase would be removed. It was agreed that residents could purchase their own bedding if they wished. Residents have been living at the home for some years and the need for any pre-admission assessments in the near future is unlikely as there are currently no vacancies. Pre-admission records for the newest resident admitted two years ago were seen. These were detailed and included records of trial visits to the home. The manager stated that information was also received from the placing authority. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices and decisions about their lives. Their changing needs are reflected in care plans, although one could be improved by greater detail. Some residents benefit from being involved in care plans that they can easily understand. EVIDENCE: A written plan of care and information for each resident is provided. Documentation seen was generally holistic and reflected residents’ changing needs and goals. This included assessments, goals, activities programmes, Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 12 guidelines for staff, risk assessments and daily notes. Care plans contain information regarding residents’ health and social care. Any inappropriate behaviour is specifically monitored and recorded. Regarding the potentially aggressive behaviour of one resident, it was noted that although mentioned in the care plan, detailed staff guidance was recorded in staff meeting minutes. The manager explained that all staff had copies of this. All information seen was up to date. There was evidence of local authority reviews. Four residents are supported to work on their own care plans; one resident spoken with confirmed this. The manager explained that they were in the process of developing others. These are presented in a way that is appropriate for each individual. This work has supported residents to deal well with potentially difficult personal situations. Residents are supported to take risks as part of maximising their independence and these are recorded. Risk assessments seen were up to date and covered a range of activities, both within and outside of the house. Residents are encouraged to make their own decisions and choices. They receive continuity of care by having individual key workers. There is evidence that considerable attention is given to helping residents to make decisions about how to spend their time. Residents are involved as far as possible in decisions regarding the running of the home. They are involved in cleaning, cooking and menu planning. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 13 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17 Quality in this outcome area is excellent. This judgement has been made using available evidence including a visit to this service. Residents enjoy individual lifestyles and are able to choose from a range of opportunities for leisure and personal development. They are able to maintain relationships with their family and friends if they wish. Residents enjoy a good choice of meals. EVIDENCE: Residents are treated as individuals who have different interests and aspirations. Activities and development opportunities are provided accordingly. Residents enjoy a full lifestyle with a variety of options to choose from. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 14 Routines of the home are flexible to accommodate this and are broadly split between term time and holiday time. One resident spoken with said that they could choose the times that they got up and went to bed. Residents are part of the local community. One resident said that they enjoyed attending various day centres and groups. Residents participate in social events and activities that personally interest them or to further develop their life skills. Residents are supported with finding and keeping paid and/or volunteer work. Currently four individuals have a job. One resident spoken with explained what they did for their jobs. During term time residents have the opportunity to attend adult education courses and undertake in-house sessions for literacy, numeracy, money work, Makaton signing and cookery. One resident spoken with confirmed that staff supported them with their work and money. A broad range of leisure activities are available to residents. Activities include swimming, going to the gym, pottery, riding, soft play sessions, going to the cinema, meals out, going to the pub and shopping. One resident spoken with enjoyed that leisure activities provided by the home. All residents go on holiday and this year enjoyed Camber Sands. Staff support residents with budgeting towards the costs of this. Residents have ample transport. The home provides one car whilst another is one resident’s motability vehicle. One resident said that they are encouraged and supported with their own domestic tasks such as shopping, cooking, cleaning and laundry. Laundry and kitchen facilities are domestic in nature. There are agreed routines for residents to take part in shared household activities. Residents are able to relax in the home; one resident explained that they enjoyed watching television doing jigsaws. At the time of this visit one resident attended a day centre, two went bowling, one completed house chores and two were enjoying working with a Craft Coordinator who attends the home three times per week. The home provides a room especially for residents’ activities, which is well stocked with art and craft materials. Later in the day, all residents attended a relaxation session led by staff and one resident enjoyed completing a jigsaw puzzle. Residents are able to see their family and friends as often as they wish. The maintenance of personal relationships is an important part of residents’ support and guidance is provided by staff. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 15 Residents are supported in cooking and menu planning; a meeting is held once a week. They go shopping all take it in turns to choose what they like. Records seen indicated a variety and choice of meals. One resident spoken with said that they could choose what they wanted to eat. Records are kept regarding all aspects of residents’ lifestyles. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 16 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from support which meets their individual health and social care needs. They may be better protected by improvements to the system for the administration of medication. EVIDENCE: Residents are given the personal support they need to maximise their independence, while respecting their dignity and privacy. The manager an understanding of the preferred routines of each resident. Care plans contain information regarding residents’ social and health care. Residents have access to social and health care professionals, and this was confirmed by one resident spoken with. Residents’ inappropriate behaviour is Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 17 monitored with specialist health care professionals being accessed where necessary. Residents are supported with any medical appointments. Residents’ weight is monitored and their nutrition assessed. Separate health care records and staff guidelines are kept for individual residents as necessary such as continence and seizures. The manager said that all staff had been trained to administer rectal diazapam very recently by the District Nurse. Risk assessments for falls, manual handling and pressure relieving equipment are undertaken where appropriate. Arrangements are in place for the storage and administration of medication by staff. Currently the home does not administer any controlled drugs. There are written guidelines for staff about giving medication prescribed to be take on an if and when basis. The manager said that all staff had been trained in the administration of medication and this was confirmed by the training matrix seen. A signature list of staff trained to administer medication was seen. Photographs of residents are kept close to medication administration records sheets. Storage of drugs is appropriate with the exception of medication that needs to be refrigerated. A designated medication fridge is not provided. The home does not use an easily monitored dosage system. The home produces their own administration record sheets. Entries are not double signed as accurate by two members of staff in order to reduce the risk of errors from copying information. The manager stated that they would request pre-printed administration record sheets from the supplying pharmacy. There is a system in place for medication that needs to be taken whilst residents are out; although this is indicated in records, it is not signed by staff. Some every day homely remedies are kept for all residents. There is no written evidence that the GP has confirmed these remedies as appropriate to be administered together with residents’ prescribed medication. The manager assured the inspector that homely remedy creams would no longer be shared by more than one resident. It was agreed that this could pose a high risk to infection control and that separate homely remedy creams would be purchased for each resident if necessary. The manager stated that they would obtain the latest guidelines for the administration of medication in social care from the Royal Pharmaceutical Society. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 18 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents’ views and concerns are listened to and acted upon. Systems are in place to protect residents from potential abuse, although these could be enhanced by improvements to financial records. EVIDENCE: Residents are at ease and confident talking with the manager and staff who listen to their views and concerns. The home provides a written complaints procedure. Residents have access to this in a format that they can easily understand. One resident spoken with confirmed that they knew their keyworker and how to complain if they needed to. Written policies regarding the protection of vulnerable adults are available for staff. The manager said that all staff had received training in adult protection and this was confirmed by the training matrix seen. It was evident that the home had acted appropriately with regard to one incident; the manager assured the inspector that other residents are not at risk. Residents are supported with their money and budgeting. The home has systems in place, which aim to protect the financial interests of residents. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 19 These include the holding of small amounts of cash on behalf of residents. All money is stored individually and kept securely. Transaction records are maintained. Cash checked tallied with accounts seen. Entries are signed by two staff members; they are not signed by any residents. Receipts are kept for purchases made. The system is audited regularly by the manager and deputy manager. The manager assured the inspector that the system for accessing residents’ accounts was secure. A risk assessment for this system is not recorded. The home is not an appointee for any resident. Agreement to this system by residents’ appointees and/or representatives, relatives and care managers is not evidenced in writing. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 29, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in attractive, comfortable, clean and wellmaintained accommodation. EVIDENCE: The building fits in with the local community and has a style and atmosphere that meets individuals’ needs. Residents have unrestricted access in any area of the house and back garden. Residents benefit from living in attractive, comfortable and well-maintained accommodation. The premises are clean and hygienic and are suitable for residents’ current needs. Adequate recreational, dining, toilet, bathing and individual accommodation are available to residents. The home provides two lounges, a dining room, Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 21 craft/activities room and a conservatory. The home has a large back garden, which is well kept. Residents clearly like their rooms, which are individual and highly personalised. This was confirmed by one resident spoken with who was able to choose colour schemes and how their furniture should be arranged. Bedrooms meet service user’s needs and are well furnished. All residents’ rooms are on the ground floor; the upper floors being for the staff office and the manager/owner’s personal accommodation. Specific environmental adaptations and/or disability equipment is provided where necessary. There is a staff call system. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 34, 35, 36 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from a sufficient number of appropriately qualified, trained and supervised staff who have a good understanding of their needs. Their safety could be improved if all staff pre-employment checks could be evidenced. EVIDENCE: The manager and staff demonstrated a good understanding of residents’ needs. Residents benefit from good support and interaction. The manager, staff and residents communicate well with each other. The home has a stable staff team. Staffing hours are flexible dependant on the needs of residents and records seen confirmed this. There were sufficient staff on duty at the time of this visit. Staff support residents with cooking, cleaning and laundry tasks wherever Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 23 possible. The home employs a manager, deputy manager, support staff, a craft co-ordinator and a cleaner. The home is fully staffed and uses no agency workers. A procedure is in place that aims to appoint suitable staff who can support the needs of residents. Two staff files were seen. These evidenced that preemployment checks had been undertaken and the appropriate information supplied such as a Criminal Records Bureau (CRB) disclosure, a Protection of Vulnerable Adults (POVA) check, two references and a full employment history. Although proof of identity, including photographic proof of identity was provided for the CRB disclosure, there is no evidence of which items were seen and checked. The manager explained that the current induction training available was mapped to Skills for Care; documentation was seen. The home maintains a staff training matrix, individual records and certificates; these generally indicate the appropriate ongoing training of staff. The training matrix detailed training such as first aid, fire prevention, food hygiene, moving and handling, medication, rectal diazapam, adult protection and Makaton. In addition individual records included a range of courses such as bereavement, autism, epilepsy, downs syndrome, infection control, keyworking and cerebral palsy. The manager said that all staff had been trained to administer rectal diazapam very recently by the District Nurse; it was mentioned that certificates would be supplied. The manager stated that out of the total support staff team, all except one were either qualified to NVQ level 2 or 3 or were in the process of undertaking the course. The manager stated that staff are provided with formal supervision on a regular basis and appraisal; records seen confirmed this. Two staff meetings are held per month, one of which is minuted and the other more informal. In addition staff regularly meet at handovers on a daily basis. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 24 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 40, 41, 42 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Residents benefit from living in a well run home with a relaxed atmosphere. Their best interests are promoted. Residents’ health, safety and welfare could be enhanced by the regular servicing of the gas and heating system and risk assessment with regard to the regular testing and recording of hot water temperatures. Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 25 EVIDENCE: Previous inspection identified that the manager/owner has run Elmwood for ten years and has acquired wide experience in supporting people with learning and physical disabilities; they have undertaken a range of courses relevant to the support of service users. During this visit, the manager stated that they had a diploma in business management and personal management and were also an NVQ assessor. There is an open and inclusive atmosphere in the home. At the time of this visit residents were confident and relaxed chatting and spending time with staff and the manager. The home has a quality assurance system. The manager explained that the quality of the service is monitored on an ongoing basis both internally by themselves informally and externally by residents, their representatives and care managers. It was mentioned that any monitoring by the CSCI was included in this. The manager stated that they had used questionnaires to send to residents and/or their representatives, staff and care managers. The home has a range of written policies and procedures designed to provide guidance for staff. These have been detailed within the home’s completed Annual Quality Assurance Assessment (AQAA). Although policy dates range between 2004 and 2007, the manager assured the inspector that these were reviewed on a regular basis; it was said the date was only changed if any changes to the document needed to be made. A number of records have been looked at as part of this inspection. These have been mentioned within this report where appropriate. Information provided in the AQAA indicated the regular testing and maintenance of systems and equipment within the home, with the exception of the gas heating system, which was last serviced in 2006. The manager explained the problems involved and that this was now resolved. The manager assured the inspector that arrangements had been made for the gas heating system to be serviced by a new contractor in the coming week. Appropriate fire prevention checks and records are maintained. Risks regarding fire, dangerous substances and the environment have been assessed and recorded. The kitchen is maintained in a clean and hygienic manner; fridge and freezer temperatures and kitchen hazard analysis are recorded. The Environmental Health Officer visited the home in September 2007 and is due to return shortly. The home was rated as 5 stars. Hot water temperatures are checked by hand when necessary, although these are not tested and recorded regularly. The manager said that the bath and Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 26 shower are thermostatically controlled; sinks are controlled by the boiler temperature. The manager agreed to undertake and record a risk assessment with regard to the regular testing and recording of hot water temperatures, in order to reduce the risk to residents from scalding. Elmwood DS0000023930.V369136.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 Adults 18-65 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 3 2 3 3 3 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 4 25 3 26 3 27 3 28 4 29 3 30 4 STAFFING Standard No Score 31 3 32 3 33 3 34 2 35 4 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 3 3 X LIFESTYLES Standard No Score 11 4 12 4 13 4 14 4 15 4 16 4 17 4 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 2 X 3 3 3 3 3 2 X Elmwood DS0000023930.V369136.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. 1 Standard YA20 Regulation 13(2) Timescale for action The registered person shall make 30/09/08 arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received into the care home. In that: 1. A review of the systems in place for the administration of medication must take place in line with the latest guidelines supplied by the Royal Pharmaceutical Society. 2. A designated medication fridge must be provided for the storage of medication that needs to be refrigerated. 3. All information on medication administration record sheets that is not pre-printed by the supplying pharmacy must be checked and signed by Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 29 Requirement two qualified members of staff in order to reduce the risks of errors in copying. 4. The system in place for double dispensing medication for residents who need to take this when they are away from the home must be reviewed in order to reduce the risks of errors. 5. Written confirmation from the prescribing GP must be sought in order to evidence that homely remedies are appropriate to be administered together with residents’ prescribed medication. 6. Homely remedy creams and lotions must not be shared between residents. If necessary, creams and lotions must be purchased for individual residents in order to reduce the risk to infection control. 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 Refer to Standard YA5 Good Practice Recommendations It is recommended that the manager should complete their stated intention to review residents’ contracts to confirm that the necessary information is included. It is strongly recommended that the detailed staff DS0000023930.V369136.R01.S.doc Version 5.2 Page 30 2 Elmwood YA6 guidance regarding the potentially aggressive behaviour of one resident should be transferred from the staff meeting minutes to the individual’s care plan. 3 YA23 It is strongly recommended that, with regard to the system in place for residents’ finance: 1. Transaction records should be signed by residents where possible. 2. A risk assessment, taking into account the Mental Capacity Act 2005, should be recorded for the system of accessing residents’ accounts. 3. Agreement to this system by residents, their appointees and/or representatives, their relatives and care managers should be evidenced in writing. 4 YA35 It is strongly recommended that the proof of identity checked as part of the staff recruitment procedure, should be evidenced in records. It is strongly recommended that the manager complete their stated intention to oversee the servicing of the gas heating system within the near future. It is strongly recommended that the manager complete their stated intention to undertake and record a risk assessment with regard to the regular testing and recording of hot water temperatures, in order to reduce the risk from scalding. 5 YA42 6 YA42 Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Maidstone Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT 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 Elmwood DS0000023930.V369136.R01.S.doc Version 5.2 Page 32 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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