Care Home: Elmwood

Similar services:

• Henry Nihill House
• Birchwood
• The Infirmary
• Orchard House Nursing Home
• St Josephs Rest Home
• Red Court Nursing Home
• Spinney (The)
• Queen Elizabeth House

What the care home does well Elmwood is an extremely well presented property. Several of the relatives that we spoke with or received comments cards from, told us that they particularly liked the fact that it didn`t look like their idea of a nursing home when you went into the reception area. One said, "the fresh flowers always look so nice" another likened it to " a seaside hotel reception." All of them agreed that the home was always very clean and fresh.The manager`s office and administrators are located on the ground floor and during the day, there is someone sitting at the desk so that people know where to go when they first come in to the home. On the walls are posters advertising various forthcoming events and activities and a resident was heard playing the grand piano during the afternoon. Staff were very welcoming when we arrived and several of them approached us to ask if they could help. The Mission Care Group has developed comprehensive information packs so that anyone considering moving into the home would be able to see what services they offer. If they then decided to come and live there, when a room became available, a senior staff member would undertake a health needs assessment to make sure that they could provide the care that was required. This then forms the basis of a care plan, which sets out, in detail, the way that individualised care is to be delivered in the way that the resident prefer. Most people who were spoken with considered that life in the home suited them. They told us "they feel safe here" that" staff are very kind" although some of them did say that they felt that there were not always enough staff employed by the home. They said that the food served in the home was "very nice"" and " always good" although there were some comments about a lack of variety especially the mousse served for desert. This has now been addressed. One relative said that her family had been able to join her mother for lunch and "it had been really tasty and well presented". Both residents and their families had praise for the enthusiasm of the activities coordinator in the home and her staff. Many of them said how much they enjoyed the events that were arranged, their only complaint was that there were limited activities at the weekend. Records that are maintained by the home as evidence of their commitment to the health and safety and protection of the people who use the service were generally in order. What has improved since the last inspection? At the last inspection, Mission Care had just appointed a new manager for this home. She has now been registered with The Commission and displayed a thorough knowledge of the principles and focus of the service. Previous inspections had found problems with medication procedures in the home. This had lead to a specialist pharmacy inspector joining two other inspectors for a random unannounced inspection in December 2007.At that visit a total of five requirements were issued, which have now been addressed. Although some errors were noted they were not attributable to the home and are being managed appropriately. There had also been a number of concerns around communication and interaction between staff and residents. Many of the staff come from overseas and their knowledge about what life has been like for elderly people who have always lived in Britain is limited. This, combined with the difficulties experienced by residents, especially if their hearing is impaired, in understanding the accents of some staff, had contributed to carers being seen as "task orientated" rather than engaging with the people that they care for. A series of workshops and training sessions has taken place to try and overcome these problems. There has also been an emphasis on gathering information about residents past lives and achievements to help carers understand more about them. This has improved the way that some staff are now interacting with residents although some areas where it could still be better were noted. The last inspection also highlighted the need for people who live in the home to have an opportunity to comment on the service that they receive and influence their care. This is now being done and the home has carried out a survey to gain their views. There are also regular meetings held for residents and their relatives to allow them to voice their opinions. A member of the organisation is carrying out regular visits to the home to check that it is being run in a way, which complies with The Mission Care ethos. CARE HOMES FOR OLDER PEOPLE Elmwood 42-44 Southborough Road Bickley Kent BR1 2EN Lead Inspector Alison Ford Unannounced Inspection 27th May 2008 10:00 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 Elmwood DS0000066220.V362900.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. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Elmwood Address 42-44 Southborough Road Bickley Kent BR1 2EN 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 8249 1904 020 8249 4117 sylvia.onyekwelu@missioncare.org.uk www.missioncare.org.uk Mission Care Sylvia Onyekwelu Care Home 67 Category(ies) of Old age, not falling within any other category registration, with number (67) of places Elmwood DS0000066220.V362900.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 (CRH - N) to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: 2. Old age, not falling within any other category - Code OP The maximum number of service users who can be accommodated is: 67 17th December 2007 Date of last inspection Brief Description of the Service: Elmwood is an attractively presented, purpose built facility providing care for up to sixty-seven residents Accommodation is arranged over three floors and a large passenger lift allows for access to all parts of the home. A well-maintained garden to the rear of the home is enjoyed by residents in the warm weather and each floor also has a balcony with seating. On the ground floor there is a large reception area and the managers office is also here. The first floor is dedicated to intermediate care and beds are funded by Bromley Primary Care Trust. A team of healthcare professionals, which includes nurses, physiotherapists and occupational therapists work intensively with people with the intention of them being able to move back in to their own homes. The other two floors provide care for frail elderly people either long term or occasionally, for respite stays. Each floor has a dedicated sitting / dining area and there are also additional facilities by way of a hairdressing room, cinema and coffee shop. The home is close to the centre of Bromley with good public transport links. There is limited off street parking to the front of the building. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 5 Fees range from £503 - £1010 per week; some extra charges would be made for services such as hairdressing or chiropody. These would be discussed prior to admission. Different pricing arrangements are in place for people who fund their placements privately as opposed to those whose funding is arranged by the local authority. Copies of the homes Statement of Purpose and their guide to the home can be requested from them. A copy of their latest inspection report can also be seen at the home or alternatively can be downloaded from the Commission for Social Care Inspection website. Elmwood DS0000066220.V362900.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 was the homes first key inspection for the year 2008/2009. It was an unannounced visit, undertaken by two inspectors, lasting around six hours. We would like to thank the manager and all of the staff for their help throughout the day. During this time, we undertook a tour of the premises and spoke with many of the residents and members of staff on duty. We also looked at various records and documentation that the home is required to maintain as evidence of their commitment to the health and safety of the people who use the service. We assessed a sample of care plans and spent time observing residents in the home to try and reflect on what it is like for them living there. We spoke with the cook, looked at menus and kitchen records and the lunchtime meal was served during our visit. Prior to the inspection we had sent some comment cards to a sample of residents, their relatives, staff members, care managers and other healthcare professionals, inviting them to tell us about their views of the home. We have been able to include some of their responses in this report. We have also taken into consideration other information that we have received throughout the year such as the notification of incidents and complaints. In addition, the homes manager has sent us an Annual Quality Assurance Assessment. This is a document that they complete every year to tell us how their service meets the needs of the people they support, what they think that they do particularly well and about their plans for the future. What the service does well: Elmwood is an extremely well presented property. Several of the relatives that we spoke with or received comments cards from, told us that they particularly liked the fact that it didn’t look like their idea of a nursing home when you went into the reception area. One said, “the fresh flowers always look so nice” another likened it to “ a seaside hotel reception.” All of them agreed that the home was always very clean and fresh. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 7 The manager’s office and administrators are located on the ground floor and during the day, there is someone sitting at the desk so that people know where to go when they first come in to the home. On the walls are posters advertising various forthcoming events and activities and a resident was heard playing the grand piano during the afternoon. Staff were very welcoming when we arrived and several of them approached us to ask if they could help. The Mission Care Group has developed comprehensive information packs so that anyone considering moving into the home would be able to see what services they offer. If they then decided to come and live there, when a room became available, a senior staff member would undertake a health needs assessment to make sure that they could provide the care that was required. This then forms the basis of a care plan, which sets out, in detail, the way that individualised care is to be delivered in the way that the resident prefer. Most people who were spoken with considered that life in the home suited them. They told us “they feel safe here” that“ staff are very kind” although some of them did say that they felt that there were not always enough staff employed by the home. They said that the food served in the home was “very nice”” and “ always good” although there were some comments about a lack of variety especially the mousse served for desert. This has now been addressed. One relative said that her family had been able to join her mother for lunch and “it had been really tasty and well presented”. Both residents and their families had praise for the enthusiasm of the activities coordinator in the home and her staff. Many of them said how much they enjoyed the events that were arranged, their only complaint was that there were limited activities at the weekend. Records that are maintained by the home as evidence of their commitment to the health and safety and protection of the people who use the service were generally in order. What has improved since the last inspection? At the last inspection, Mission Care had just appointed a new manager for this home. She has now been registered with The Commission and displayed a thorough knowledge of the principles and focus of the service. Previous inspections had found problems with medication procedures in the home. This had lead to a specialist pharmacy inspector joining two other inspectors for a random unannounced inspection in December 2007.At that visit a total of five requirements were issued, which have now been addressed. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 8 Although some errors were noted they were not attributable to the home and are being managed appropriately. There had also been a number of concerns around communication and interaction between staff and residents. Many of the staff come from overseas and their knowledge about what life has been like for elderly people who have always lived in Britain is limited. This, combined with the difficulties experienced by residents, especially if their hearing is impaired, in understanding the accents of some staff, had contributed to carers being seen as “task orientated” rather than engaging with the people that they care for. A series of workshops and training sessions has taken place to try and overcome these problems. There has also been an emphasis on gathering information about residents past lives and achievements to help carers understand more about them. This has improved the way that some staff are now interacting with residents although some areas where it could still be better were noted. The last inspection also highlighted the need for people who live in the home to have an opportunity to comment on the service that they receive and influence their care. This is now being done and the home has carried out a survey to gain their views. There are also regular meetings held for residents and their relatives to allow them to voice their opinions. A member of the organisation is carrying out regular visits to the home to check that it is being run in a way, which complies with The Mission Care ethos. What they could do better: This report has tried to acknowledge that the situation within the home has improved and that generally the people who live here consider it meets their needs in a comfortable and safe way. However, it is considered that staff training still needs to continue with regard to interaction between them and residents. Opportunities for them to engage with the people that they care for are not always maximised with some staff still being task orientated. This was especially evident at mealtimes. Staff need to understand that people who use the service are encouraged to think of the home as their home and that their role encompasses more than just providing personal care. Staff understanding about issues concerned with adult protection and the identification and reporting of abuse was also variable and training will need to be reinforced regularly to ensure that all of them are aware of the procedures to be followed. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 9 Some issues were noted with regard to recruitment and the home must ensure that evidence that appropriate checks have been made is absolutely clear to us when an inspection is undertaken. Individual care plans show that a concerted effort has been made to improve them however, there still needs to be some evidence that residents or their relatives, if they are not able, have been able to contribute to them. It is important that people are aware of the plan and able to influence the way that care is provided so that it suit their preferences. 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 DS0000066220.V362900.R01.S.doc Version 5.2 Page 10 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 Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 11 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): Standards1, 3,6 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The people who use this service are able to get comprehensive information that will help them decide if they will like living in the home. Before they move in an assessment of their healthcare needs will be carried out to make sure that the home will be able to offer them the care and support that they need. The intermediate care unit is managed in a way that helps to maximise people independence and help them return home. EVIDENCE: Elmwood has produced a comprehensive guide for residents and their relatives which outlines the services that will be provided by the home and gives lots of useful information to help people decide if life in the home will suit them. This information has been recently been improved, in as much as a leaflet has also been produced for those people who will be staying in the intermediate Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 12 care unit. This helps them to understand about the purpose of their stay and who will be supporting them while they are there. All of those who responded to our survey confirmed that they had been given both a contract and also all of the information they needed at the point of admission, which is coordinated by the administrator of the home. If people were able, they would be encouraged to visit the home to see if they liked it. In reality, most people are quite frail when the time of admission comes however, their relatives would be encouraged to participate in the process. If they then decide that they would like to move in to the home, when a room becomes vacant a senior nurse would undertake an assessment to make sure that their needs could be met. For those who are funded by the local authority a care manager’s assessment would also have been undertaken. Evidence of these assessments was seen and forms the basis of future care planning. For those people admitted for intermediate care, whose placement is funded by the Primary Care Trust, a very detailed assessment would accompany them showing exactly how they should be supported throughout their stay. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 13 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): Standards 7,8,9,10 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The people who use this service generally consider that their healthcare needs are being met in a way, which suits them. They are able to access care from other healthcare professionals when it is needed and they are protected by the homes medication procedures. EVIDENCE: Each person in the home has an individualised care plan which should set out the care and support that they need and exactly how it is to be delivered. If it is possible there should be contributions from the resident and their families so that the care is delivered in the way that they prefer. This should then be available to all of the staff that care for the person to ensure that they are all working in the same way. Eight care plans were assessed. Although they were slightly variable in standard there have been improvements in them since the last inspection. This is due, in part, to the appointment of a Practice Development Nurse who has Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 14 been working alongside staff. This work will be continuing and we are confident that further improvements will be seen at future inspections. We did see some examples where problems had been identified and appropriate action did not seem to have been taken however, it is acknowledged that these issues are continuing to be identified and addressed. Work also still needs to take place to make sure that residents are given the opportunity to contribute to these care plans so that they can influence the way that support is given. There was evidence of input from other healthcare professionals. Our surveys showed that people felt that they were always able to access medical support that they needed and the home has regular visits from the chiropodist, dentist and optician. Factors that indicate a predisposition to pressure sores were being monitored regularly and pressure relieving aids were evident throughout the home. Residents all looked clean and well cared for and our surveys showed that relatives always felt that this was the case. Both male and female staff are employed so that residents would be able to have a choice if they wished. Medication storage and procedures were assessed on the ground and second floors. They were generally in order although there seems to have been some issues with the supplying pharmacist. It was noted that medicine was not always being supplied according to the prescription. Staff are monitoring this to prevent any errors in administration and discussions are being held with the pharmacist. There are still some issues with the temperature of the medication fridge on the ground floor. This is monitored appropriately but records show that is sometimes too cold. We were told that efforts are being made to rectify this. It must be addressed as soon as possible as it could affect the efficacy of some medication that is stored in it, especially vaccines. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 15 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): Standards 12,13,14,15 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use this service appreciate the activities that are arranged for them however opportunities for engagement and interaction with staff are not always maximised. They are able to maintain their relationships with their families and friends and they generally enjoy the meals that are served in the home. EVIDENCE: The people that we spoke with during the inspection and the survey cards that we received told us how much they enjoyed the activities that are arranged for them. There was a lot of praise for the enthusiasm of the activities organiser and her team. Posters around the home show forthcoming events and a garden party is currently being planned. A newsletter is distributed to residents weekly so that they know what will be happening that week. Pastoral support is available to residents, there are weekly prayer meetings and Sunday worship and some residents are able to attend church. Many of the staff come from overseas and their knowledge about what life has been like for elderly people who have always lived in Britain is limited. This, Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 16 combined with the difficulties experienced by residents in understanding the accents of some staff, especially if their hearing is impaired, had lead to carers sometimes being seen to be “task orientated” rather than engaging with the people that they care for. A series of workshops and training sessions has taken place to try and overcome these problems. There has also been an emphasis on gathering information about residents past lives and achievements to help carers understand more about them. However, it was observed that some of the care staff still do not realise the importance of every interaction between them and the people that they care for. There is still some element of task orientation to their work, with them just doing things to people rather than engaging with them. We sat in the dining rooms on the ground and second floor during the lunchtime meal service. Tables were nicely laid with clean cloths and drinks for everyone. Most people said that they enjoyed the meals in the home although there were some complaints about a lack of variety in relation to desert. This is now being addressed. Meals are chosen, from a 4-week menu, the previous day. Special diets could always be catered for. Some staff offered to help residents, explaining what the meal was and offering gravy. They said, “ I hope that you enjoy your meal” and asked if there was anything else that was needed. However, we also saw some staff putting meals in front of people without explaining what was on the plate, pouring gravy on to food without asking and others pushing people around without explaining to them what they were going to do or where they were going. One relative commented that when a resident smiled at a carer they didn’t realise it was sometimes just a response and did not necessarily indicate that the person had understood what was being said. It is recommended that staff should have additional training which focuses on the importance of their behaviour at mealtimes. In the upstairs lounge, the television was on throughout the inspection although, two residents sitting in there said that they were not at all interested in what was on. There did not seem to have been any discussion about the choice of programme or even the wish to have it on at all. One relative that we spoke with also raised some concerns about activities for people that wish to stay in their rooms and not join other residents. As discussed in relation to standard 30 the recent training will need to be continued and the home will need to find a way to ensure that it is reinforced in order to raise an awareness of all of these issues. Care staff must be made aware that their role encompasses more than purely carrying out tasks relating to personal care, and become more involved in the daily lives of the people that live in the home. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 17 Elmwood DS0000066220.V362900.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): Standards16, 18 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use this service have access to a clear complaints procedure and are confident that any concerns will be addressed appropriately. Procedures are in place to protect them from abuse and from people who have been judged as being unsuitable to work with vulnerable people. EVIDENCE: Mission Care has a clear complaints procedure. All of those people that were spoken with or returned comment cards were aware of this and confident that any concerns that they might have would be addressed. The home always notifies us of any incidents that have occurred, in line with the regulations. There have not been any complaints made to The Commission about the service since the last inspection. There is an adult protection policy in place and we were told that all staff have received training with regard to this. We spoke with two staff members who were generally aware of the procedures to be followed if they suspected abuse. however, their knowledge regarding whistle blowing was limited and they were not aware of any outside agencies that they might refer to if they had any concerns. As discussed in relation to standard 30 training in these issues must be ongoing so that all staff are aware of the procedures to be followed. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 19 Robust recruitment policies are generally in place to ensure that people who have been judged as being unsuitable to be working with vulnerable adults are not employed. Elmwood DS0000066220.V362900.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): Standards 19,26 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. The people who use this service live in an attractively presented and well maintained home which suits their needs, however there are still some issues with storage, which could compromise their safety in an emergency situation. EVIDENCE: Elmwood is an extremely well presented property. Several of the relatives that we spoke with or received comments cards from, told us that they particularly liked the fact that it didn’t look like their idea of a nursing home when you went into the reception area. One said, “the fresh flowers always look so nice” another likened it to “ a seaside hotel reception.” All of them agreed that the home was always very clean and fresh. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 21 The manager’s office and administrators are located on the ground floor and during the day, there is someone sitting at the desk so that people know where to go when they first come in to the home. On the walls are posters advertising various forthcoming events and activities and there is a grand piano in the reception area as well. Resident’s bedrooms are spacious and all have en-suite facilities. They all have televisions and people have been encouraged to personalise their rooms with pictures and other items from home. The only exception is the intermediate care unit where people are only staying for a limited time. We did discuss this with the management team and although we accept that residents do not view these rooms as their home, we have suggested that they could perhaps be brightened up with some more pictures. There are appropriate aids and adaptations throughout the home such as ramps and handrails so that residents can move around easily and safely and there is a large passenger lift. The standard of this building would exceed those laid down in the regulations however; there is an ongoing issue with a lack of storage facilities for equipment such as wheelchairs and linen trolleys. This has meant, that in order to keep the home tidy, some equipment is being stored in bathrooms and stairwells. It is considered that the issue of storage in stairwells particularly is not good practice and could be a hazard in the event of a fire. The home was very clean and fresh and everyone that we spoke with agreed that it is always so. Appropriate measures are in place to help control the spread of infection such as antibacterial hand wash, gloves and aprons. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 22 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): Standards 27,28,29,30 People who use this service experience adequate quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use this service are satisfied that there are usually enough staff to meet their needs and that they have the skills to support them. The manager has recognised shortfalls in the staff training programme and has plans to address them. In general, appropriate checks seem to be in place to ensure that staff who have been judged as unsuitable to be working with vulnerable adults are prevented from doing so. EVIDENCE: Off duty rotas showed that staffing levels generally remain at the levels agreed at registration although there is some reliance on agency staff as there are several vacancies. The home does try to ensure that the same temporary staff are used wherever possible and certainly those that were spoken with had worked in the home on several occasions before. They were able to describe the induction that they had undertaken and they had a good knowledge of the people that they were caring for. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 23 There is always at least one trained nurse working on each floor in the home supported by care staff. One of those nurses on each floor has been designated as a “clinical lead” and given extra responsibilities to manage and supervise staff. On the first floor there are extra staff, employed by the Primary Care Trust, to provide extra care with regard to rehabilitation. Some residents complained that the home sometimes seemed short staffed and that they had to wait for a long time for help. The training records for six staff members were assessed and the training that they had received seemed variable. The Bromley Consortium with whom the home has a contract provides training. It is acknowledged that the new home manager is taking a very proactive role in making sure that all of the staff are receiving training appropriate to the work that they undertake and she also attends some of the training herself so that she can assess how good it is. We are confident that we will see an improvement in this area in the future. As previously highlighted, we would expect to see that the training regarding interaction and engagement between staff and residents, especially with regard to mealtimes, and adult protection continues. Staffing files showed that pre-employment checks were being carried out to ensure that people who use the service are being protected from those who have been judged as being unsuitable to work with vulnerable adults. It was unclear if staff who were employed to work on the bank had appropriate clearance from the Criminal Records bureau prior to starting and this must be addressed. Also it seemed that some references had been received from colleagues of the applicant rather than employers. In order that references are seen to be legitimate and objective employers must be approached for references in future. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 24 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): Standards 31,33,38 People who use this service experience good quality outcomes in these areas. This judgement has been made using available evidence including a visit to this service. People who use this service can be confident that it is being run in their best interests and that their opinions are being used to influence the care that they receive. Policies and procedures are in place to ensure their health and safety. EVIDENCE: Since the last inspection a new manager has been appointed and registered with The Commission. She is a trained nurse with a great deal of experience and during the inspection she displayed an in-depth knowledge of the key principles and focus of the service and an enthusiasm for her role. Prior to the inspection she had completed The Annual Quality Assurance Assessment, which highlighted areas that the home is aware need improvement and explained how this will be achieved. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 25 The appointment of nurses designated as “clinical leads “ on each floor also helps to promote clear lines of accountability throughout the home. A recent satisfaction survey was carried out asking residents about their views of the home and the services that are offered and most of the responses were very positive. The home will need to ensure that this survey is repeated at regular intervals. Monthly visits are also now being carried out by a member of the organisation, in line with regulation 26, to monitor the situation within the home. Equipment and services, including kitchen records, are being appropriately maintained to ensure the safety of residents. The management of residents financial affairs was not assessed at this visit so will be addressed at a later date. Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 26 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 3 X 3 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 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 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X X X X 3 Elmwood DS0000066220.V362900.R01.S.doc Version 5.2 Page 27 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 OP8 Regulation 15 (1) Requirement Any support that is identified as being needed must have an appropriate care plan which enables all staff to deliver care in the way that complies with best practice guidelines and suits the preferences of the resident. There must be evidence to show that residents or their representatives have been invited to participate in the care planning process and are aware of the support that is being given. In order to protect residents, there must be clear evidence to show that for those people employed on a bank contract appropriate clearance from the Criminal Records Bureau was obtained prior to them starting work. Pre - employment references must be obtained from employers rather than colleagues in order to show that they are legitimate and professional. There must be evidence to show that all staff continue to receive DS0000066220.V362900.R01.S.doc Timescale for action 30/09/08 2 OP8 15 (1) 30/09/08 3 OP29 19 30/09/08 4 OP29 19 30/09/08 5 OP30 18 (1) (c) 30/09/08 Elmwood Version 5.2 Page 28 6 OP30 18 (1) (c) 7 OP30 18 (1) (c) training and updates appropriate to the work that they undertake. Training in issues around adult abuse and protection must be updated regularly so that staff are always aware of the procedures to be followed. Training which increases staff’s understanding of the lives of the people that they care for must continue so that they can understand the problems that they now experience. 30/09/08 30/09/08 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 OP30 Good Practice Recommendations It is recommended that some staff training should specifically focus on their behaviour towards residents at mealtimes. Elmwood DS0000066220.V362900.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 Elmwood DS0000066220.V362900.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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!