Care Home: Elwis House, 1

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What the care home does well Prospective residents have comprehensive needs assessments and can "testdrive" the home before moving in on a trial basis. Resident`s are supported to make choices in their daily lives and are able to choose activities they like to take part in. They are supported to develop their daily living skills and are also enabled to follow their own chosen routines. Residents are offered healthy food and can choose what they want to eat. The people living in the home are supported in a manner that protects their privacy and dignity. Staff deal with some difficult situations in a calm manner and communicate well with social services about resident’s incidents and safety issues. Each person is supported to access professional healthcare based on their individual needs. What has improved since the last inspection? The home is very clean and in good repair, and there are enough staff who have now had training in how to help residents with their medication. Activities are happening in a planned way and all residents are supported to go out on a daily basis to do things they like to. Care plans are now being done using lots of pictures to help residents understand their own plans. There is a new acting manager who is well regarded and who feels she is getting support from her manager to sort out the things that need to be improved. She is well informed and was very efficient during the inspection at finding everything and in making sure that the things that need to be improved are talked about and planned. Medication and keeping residents safe are now managed much better. What the care home could do better: The home must not admit residents without first getting a complete assessment of their care needs, and residents must be given written information about the cost of their care and support and other important information about their rights as residents.Elwis House, 1DS0000025617.V377569.R01.S.docVersion 5.3There must be a formal decision in writing about the use of bedside rails for individual residents so that these will always be used for the benefit of the residents. The Parker bath must be repaired or replaced so that residents who want to can enjoy a bath. The water temperature in bathrooms must be kept cooler so that residents are not at risk of being burned. All staff need to finish their induction with the manager and more staff need to be qualified so that residents have well informed staff to help them. Training in how to help residents with dementia and epilepsy needs to be provided for staff. All staff must be checked for Criminal Record Bureau history before starting work so that residents are better protected. The home must register a manager with the Care Quality Commission. Key inspection report CARE HOME ADULTS 18-65 Elwis House, 1 2-8 Bell Green Lane Sydenham London SE26 5TB Lead Inspector Sean Healy Key Unannounced Inspection 14th August 2009 09:40 Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care home adults 18-65 can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 3 SERVICE INFORMATION Name of service Elwis House, 1 Address 2-8 Bell Green Lane Sydenham London SE26 5TB 0208 778 9485 0208 297 1207 ask@providenceproject.org.uk 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) PLUS (Providence & Linc United Services) Vacant Care Home 4 Category(ies) of Learning disability (4) registration, with number of places Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care Home Only - Code 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 - Code LD The maximum number of service users who can be accommodated is: 4 21st August 2008 Date of last inspection Brief Description of the Service: Elwis House provides a residential service to a maximum of four people with learning disabilities and high support needs, including older people suffering from dementia. The home is run by a registered charity PLUS in (Providence & Linc United Services). Accommodation is provided in a purpose built ground floor home, designed to meet the needs of people using wheelchairs. All residents have their own bedroom. The area is served by public transport and has a selection of shops and local amenities. Currently there are three residents and one vacancy. At 14/8/09 the homes fees for support for three residents range between £1,066 and £1,461 per week for support and are paid by Lewisham local authority. Food and accommodation provided are charged separately and charges for these range from £279.60 to £432.40. The reason for the difference in support charges is explained in the homes Statement of Purpose but individual residents do not yet have adequate contracts to describe the fees or the reason for differences in charges. Residents have to pay for other personal expenses such as hairdressing, transport and personal shopping. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is one star this means that people using the service receive an adequate service. This inspection site visit took place over one day on the 14th August 2009. It was unannounced, and was facilitated by the Manager, who has not yet registered as care manager with the Care Quality Commission. The service manager was also present for the majority of the inspection. During the inspection three residents were observed being helped by staff and their assessment/planning files were examined. Two residents returned completed inspection surveys and comments were brief but positive. One support staff was interviewed and four staff files were examined to see recruitment, supervision and training records. Three staff also returned completed inspection surveys and these stated that they felt they were now being well managed and supported. The inspection included examination of records and policies and procedures, and a tour of the building. A health care professional involved in the development of support for some residents also commented positively on the staff regarding their ability to provide information and to support residents. However there was historically some important development work for one resident, which had not been adequately actioned by the home. It was felt that the new management may be more effective in acting on plans put in place. All six of the requirements made at the previous inspection have now been met. The main area lacking in progress is that the home does not yet tell residents in writing the cost of their service, staff training needs to be improved to include epilepsy and dementia training, and the management need to be more careful in making sure that all new staff are properly CRB checked and receive a full induction after they start work. Staff formal supervision and appraisal also needs improvement. It is clear however that the new acting manager who only recently was appointed is working hard to deal with these problems. Residents seem to be generally happy living at the home, but comments from commissioning authorities suggest that they have had concerns about the home’s management in the past. However it may be the case that the new manager can make a difference and improve the quality of care for residents and in the management and support for staff. The atmosphere was relaxed and friendly. The manager and staff involved residents and spoke with them regularly. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 6 What the service does well: What has improved since the last inspection? What they could do better: The home must not admit residents without first getting a complete assessment of their care needs, and residents must be given written information about the cost of their care and support and other important information about their rights as residents. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 7 There must be a formal decision in writing about the use of bedside rails for individual residents so that these will always be used for the benefit of the residents. The Parker bath must be repaired or replaced so that residents who want to can enjoy a bath. The water temperature in bathrooms must be kept cooler so that residents are not at risk of being burned. All staff need to finish their induction with the manager and more staff need to be qualified so that residents have well informed staff to help them. Training in how to help residents with dementia and epilepsy needs to be provided for staff. All staff must be checked for Criminal Record Bureau history before starting work so that residents are better protected. The home must register a manager with the Care Quality Commission. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 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 Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 and 5 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents have comprehensive assessments and can test-drive the home before moving in. However they are not given adequate information about the cost of their service or their rights and obligations. EVIDENCE: The home has a Statement of Purpose which was reviewed in 2009. This contains information helpful for current or new residents to understand the service which is promised to them and includes information on charges to residents for care and support provided. This is adequate and helpful for residents. There is a separate Service Users Guide, which was last updated in 2007 and contains good helpful information for residents about their rights and the care they can expect. However this needs to be updated to reflect up to date information regarding the Care Quality Commission. (See Recommendation YA1) I examined three resident’s files for information about residents care assessments and found that two had full core assessments and one did not. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 10 There was detailed information about this residents care needs in the care plan and health action plan, and the manager and staff are aware of all areas of care and support and have included these in the care plan. The home however does not have its own system for assessing care needs in place of the core assessment. Management have prompted social services to provide one but have not yet received a response. This resident needs a full core assessment to be provided by Lewisham social services. (This is not the homes fault but Ive emphasized that no new admissions should be accepted without one) The provider must prompt social services again to ensure that a full core assessment is in place and must not admit new residents without the support of a full care assessment. (Refer to Requirement YA2) It is recommended that the provider develop a system for carrying out complete care assessments when needed to avoid having to refuse a service, and to train key staff in carrying out these assessments when the need arises. (Refer to Recommendation YA2) The home has good general information in its Statement of Purpose about the care provided and the fees charges for care and support. However residents do not yet have complete contracts or statements of terms and conditions showing how this information applies to them. The home must provide each residents with a contract showing the service provided, rooms to be occupies and the cost of care accommodation, food and transport and who is responsible for paying these fees. It should also include information about reasons for charges being higher than those of other residents where appropriate. Contracts must be agreed and signed by residents or an appropriate other person on their behalf. (Refer to Requirement YA5) Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 6,7 and 9 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents can be sure that all of their assessed needs and personal goals are reflected in their individual plan, and they do get help to make decisions about their lives. They are supported to take assessed risks, which enable them to be more independent. EVIDENCE: I examined three residents care plans and risk assessments. Each of these residents has a personal profile and a personal care plan, which has been regularly updated. There is also a person-centred plan showing their personal needs and plans for the future. This allows the residents to have a better voice in their care planning. All have had an annual review during the past 12 months and all except one had a six month review during that time. The annual reviews were attended by the resident, social worker, the Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 12 resident’s keyworker and the registered manager. There was also involvement from relevant GPs and other health care professionals. Although care reviews have happened for all residents in the past 12 months involving social services, the home has only received review notes from social services for one of these reviews. Some review notes from social services are outstanding for up to 8 months. The home has prompted Lewisham social services learning disabilities team services for these in writing. They have to their credit continued to update the residents care plans anyway. Each resident has a named key worker who has an additional responsibility for supporting the resident they work with by helping with personal shopping, attending healthcare appointments, ensuring all the residents personal care needs are met. There is good use of pictures in care plans to enable residents who can’t read to understand them. The three people living in the home have disabilities, which affect their lives in very individual ways and therefore residents are consulted and supported on a one-to-one basis to make decisions about their lives. Three of the people living in the home have very limited verbal communication skills and there is guidance in their care plans for staff regarding how residents express themselves for example by using signs or facial expressions etc. I saw care staff working well in communicating with residents. A visiting healthcare professional commented that the care plan for one resident regarding support to implement a plan to access a communications aid had not been actioned. However it was also said that the new management now seemed to be more active and it is hoped that the necessary work will be done to support this intervention plan. The home’s manager should monitor this closely to ensure that appropriate action is taken. (Refer to Recommendation YA6) There are two residents who have use of bedside rails to prevent falls. The manager said that this is necessary for their safety but also confirmed that the use of these rails had not yet been formally agreed. The home must ensure that the use of these bedside rails are formally agreed with the resident, their relevant representatives, a relevant health care professional and with social services, and that this is written into their care plan and reviewed at least annually. (Refer to Requirement YA6) Discussion with the homes management and staff identified that some residents would benefit from use of a car on a regular basis to make it easier to go out in the community. This has not yet been formally discussed and it is recommended that the issue is raised at the relevant residents care reviews at the next opportunity. (Refer to Recommendation YA6) Residents are supported to make decisions about their lives and their money is managed appropriately. There has in the past been involvement from advocacy Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 13 in supporting some residents to make important decisions. One resident does not have active support currently from advocacy and it is recommended that the home review the need for support from advocacy for this resident and implement any decisions reached. (Refer to Recommendation YA7) There was a requirement made at the last inspection for the home to ensure that risk assessments for supporting residents be improved to enable residents to be safe and independent. This has now been done and examination of a range of risk assessments for three residents showed that this area is now well managed with good written guidance in place for staff in how to provide support. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 14 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): This is what people staying in this care home experience: 12,13 15,16 and 17 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People living in the home are supported to develop their daily living skills and are also enabled to follow their own routine. Staff support residents to enjoy a range of activities based on their individual interests. Residents are offered a healthy and varied diet. EVIDENCE: None of the people living in the home are able to participate in employment or full-time education. However the home has in place an excellent pictorial weekly place for each resident showing a broad range of community and skills development activities which are appropriate to their needs. Staff support residents to go out on a daily basis and activities include visits to local parks, aromatherapy, pub lunch, personal shopping, massage, musical film on TV, going to the gateway social club weekly bowling and other community activities. Comments received from residents were limited due to the nature of Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 15 their disability, but these activities are well thought through and are presented to residents in a way they can best understand them when offered. Two people living in the home have physical disabilities and in the past this has limited their access to participating in a varied range of social activities. Staff now are supported to make every effort to get out to activities and the manager has raised the issue of improving transport which is to be discussed at upcoming care reviews. (See Recommendation YA6) Staff also support residents on individual shopping trips and outings to the local parks and to go on individual holidays. Relatives are welcomed by the home and efforts are made by the home to encourage more regular involvement. Residents food preferences are assessed as part of their person centred planning and detailed records of all food and drink provided to residents during the course of the day are maintained. Records seen indicate people are provided with a varied nutritious diet. The majority of residents require assistance with eating and staff assist people in a calm and relaxed manner. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents receive personal support in the way they prefer and their needs are being met in all other areas. Support with medication is appropriate for the service users’ assessed needs but the home needs to assess resident’s ability to retain control of their own medication. EVIDENCE: During the course of the visit I observed that staff respected resident’s privacy and dignity. Residents were addressed by their preferred name and all the residents were wearing age appropriate clothing that reflected their individual personalities. All residents have a health action plan showing their healthcare support needs including well written guidance for providing support in personal care and in dressing and eating. These include direction for staff in the use of hoists and in manual handling. Support plans reflect the high level of support needed by some residents, and thought is given to enable residents to do things for Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 17 themselves where they can. I looked at the healthcare records for the three people living in the home. They had all been supported to access a range of healthcare professionals including the GP, psychiatrist and other appointments according to their individual needs. Some residents have difficulty verbally expressing themselves and a speech therapist from the Community Learning Disability Team is now re- involved with the resident and staff to provide help in relation to this. (See recommendation Standard 6 of this report) The home has an up to date medication policy outlining the providers and staff responsibilities. I looked at the medication, administration records and discussed staff training in relation to medication. All staff who give medication have had adequate training and discussion with one staff showed she had a good understanding of her responsibilities. There was a requirement made at the last inspection for the home to ensure that all staff responsible for giving medication observe safe practices in opening medication, and in signing the medication sheets. This has now been done and the medication sheets I examined were being properly signed. There was a community pharmacist visit in June 2009 and this showed medication to be generally well managed. Of the residents who take medication none have as yet been assessed regarding their abilities or wishes to self medicate at any level. The home must ensure that all residents who take medication are assessed in accordance with the provider’s medication policy and that a record of this is maintained on their care plans. (Refer to Requirement YA20) Overall health and personal care and medication for residents is well managed. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a complaints procedure in place, and staff do record complaints brought to their attention and action taken to address them. Procedures and training on safeguarding vulnerable adults are in place to help protect people living in the home EVIDENCE: The home has a good complaints policy in place that was last reviewed in 2009. There is a good relationship between the staff and residents, and the staff spoken to showed a good awareness of how to deal with complaints. There have been no complaints since the last inspection. Currently the system for recording complaints means that any complaint received will be written into a complaints book which is available to all staff, although the provider’s complaints policy has a system for having complaints recorded on loose leaf forms which are then given to the manager. It is recommended that the home use this system and ensure that any complaints received are given to the manager in confidence and that they then record these in a confidential complaints book to be kept in a locked cabinet. This is in order to maintain confidentiality and to foster confidence in the complaints system. (Refer to Recommendation YA22) Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 19 There have been no adult protection issues since the last inspection. Copies of the organisations procedures and social service procedures are available in the home, and these were last reviewed in May 2007. All staff working in the home had received training in relation to safeguarding adults as part of the staff induction and there are regular training updates in relation to this area. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 24,27 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The environment is safe, comfortable, homely and clean but improvement is needed in the provision of equipment for personal care EVIDENCE: Accommodation is provided in a purpose built ground floor home, designed to meet the needs of people using wheelchairs. All residents have their own bedroom. The area is served by public transport and has a selection of shops and local amenities. Currently there are three residents and one vacancy. The home is generally in very good condition and has good natural lighting, is spacious and is comfortable for use of wheelchairs. The garden is well maintained and is also wheelchair accessible. All resident accommodation is on one level. There are separate private flats situated on upper floors, however residents of Elwis house have sole use of the small garden. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 21 Each resident has their own bedroom and share the toilets, shower and bathroom. There is a kitchen diner and a large lounge. There is an office which is also used as the staff sleeping in room. There is a small but well equipped laundry and staff stated that the equipment meets the needs of the people accommodated. Health and safety and fire safety is well managed with appropriate equipment in place and management checks being done. However on the day of inspection the water temperature in the bathroom and shower room were not regulated to a safe temperature and following the inspection the homes manager confirmed that arrangements were being made to have this addressed. The home must ensure that the water temperature in bathrooms/shower-rooms be regulated to a safe temperature of 43degrees Celsius. (Refer to Requirement YA42) Generally good bathing facilities are available to residents with a shower-room and bathroom and one resident’s bedroom has ensuite facilities. A parker bath, which is the preferred and assessed means of bathing for one resident, needs replacing or repairing as it has not been working for the past 2 months. Although the home has tried to sort this out they have now been told the necessary part is not available. (Refer to Requirement YA27) I toured the premises and viewed resident’s bedrooms and these were homely and well maintained. The home was very clean and free from unwanted odours. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 32,34,35 and 36 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are competent and experienced but are not yet adequately qualified to provide the service. There is now better evidence to show that recruitment and employment is well managed but all staff have not been appropriately CRB checked prior to employment. Staff training has improved but some key training is still needed to meet residents care needs. EVIDENCE: There were two requirements made at the last inspection for the home to ensure that staff receive appropriate medication training and that staff be suitably trained to undertake their work. These requirements were met in principle but there is further work needed to improve staff training and qualifications. I examined four staff recruitment, induction, and training and supervision files and found the following: Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 23 1. Only one of the care staff have NVQ qualifications and this member of staff is soon to transfer. Many care staff are new and the provider needs to ensure that more than 50 are enrolled on an NVQ level 2/3 course and obtain this qualification. (This is equivalent to a minimum of four care staff) (Refer to Requirement YA32) 2. Generally the recruitment and employment documentation available has improved substantially and now clearly shows how staff are recruited and checked before employment. The four staff files examined showed that two care staff started on a POVA First without having had a full CRB – and that there were no apparent robust guidance for them in place regarding not working alone, or about their areas of responsibilities. The staff working Rota reflects that there are always 2 staff/sometimes 3 and the manager around and this goes a little way towards suggesting that these staff did not work alone. One of these staff still doesnt have an enhanced CRB but the provider confirmed they will not allow her to work alone until she gets one. The provider must ensure that all staff have an enhanced CRB check done before starting employment. (Refer to Requirement YA34) 3. There is a raft of appropriate training in place for care staff which addresses the statutory required training such as health and safety, fire safety moving and handling, medication first aid and food hygiene, and in addition staff also have had training about supporting people with learning disabilities. Staff said they feel that training is good and that they now feel more confident in doing their job. However there is a need to provide staff with training in the management of dementia and in management of epilepsy as these areas are included in the assessed needs of some residents. (Refer to Requirement YA35) 4. There is a detailed induction system in place but a number of staff who have been in post for up to 10 months have not yet completed the written induction record. The current acting manager has only been recently appointed and has begun to address this problem. This will take some time and the registered provider and manager must ensure that all of the staff employed have a written and signed record of their induction on file to show they have been fully inducted. (Refer to Requirement YA35) Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 24 5. Staff supervision needs to happen six times a year for all care staff and appraisals need to be scheduled for all care staff. The inspection of four staff records showed that three did not have formal recorded supervision since April 2009. The new manager has already begun the process of getting the staff supervision timetable back on track and has set up a schedule for supervision following the inspection visit. I have some confidence that this matter is now being addressed and therefore no new requirement is to be made. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 25 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 37,39,40 and 42 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has not been well run but steps have been taken to make the necessary improvements. Residents are asked for their views about the quality of care provided and health and safety is well managed with the exception of the regulation of water temperatures. EVIDENCE: The provider said that the home had not been managed well over the past year and took a decision to replace the registered manager. The following areas were not adequately managed, and as a result these standards had fallen below an acceptable level: Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 26 Timely care planning and reviews, reviewing risk assessments, day to day staff supervision and 2 monthly supervision and failing to meet requirements set out in the CSCI/CQC inspection reports. My inspection findings support their assertion. There has been also an oversight in employing staff who have not been adequately CRB checked. (See Requirement Standard 34 of this report) However it was clear also that the new acting manager has done a lot to bring things up to date and that the care planning and staff supervision have now improved. I have some confidence that she is in the process of making the necessary improvements to improve the home’s standards in these areas. There is a new acting manager in place who is experienced in providing support and management in learning disability services. She has an NVQ3 qualification in care and has completed a management course facilitated by the registered provider. The acting manager feels she is getting support from her line manager to sort out the things that need to be improved. She is well informed and was very efficient during the inspection at finding everything and in making sure that the things that need to be improved are talked about and planned. The provider needs to submit an application to have a manager registered with the Care Quality Commission to ensure that their regulatory obligations are met. (Refer to Requirement YA37) There was a requirement made at the last inspection for the registered provider to ensure that monthly audits of the home are carried out and written reports maintained at the home. This requirement was found to have been met at this inspection. A service manager visits the home monthly and checks on a range of care and support issues and has become more hands on in supporting the acting manager. The home compiles quarterly reports for the local authority services commissioners and these reports are detailed and reflect good practice in identifying areas where quality assurance improvements are needed. They show in detail how residents support is progressing and where improvements are needed. There is also an annual health and safety audit carried out by external managers and an annual resident’s survey is also conducted to find out how they feel about the service provided. On the day of inspection the water temperature in the bathroom and shower room were not regulated to a safe temperature and following the inspection the homes manager confirmed that arrangements were being made to have this addressed. The home must ensure that the water temperature in bathrooms/shower-rooms be regulated to a safe temperature of 43degrees Celsius. (Refer to Requirement YA42) There was a requirement made at the last inspection to check with the fire authority regarding the charging of electric wheelchairs. This was a factual error and this should have referred to an electric hoist instead of wheelchairs. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 27 The home has since consulted with the fire authority and risk assessments have been done regarding the use of electric hoists. All other health and safety information is up to date and good health and safety checks are being carried out by the home’s manager and action taken to update risk assessments when necessary. Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 28 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 X 4 X 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 X 26 X 27 2 28 X 29 X 30 3 STAFFING Standard No Score 31 X 32 2 33 X 34 2 35 2 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 X 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 X 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 X 2 X 3 3 X 2 X Version 5.3 Page 29 Elwis House, 1 DS0000025617.V377569.R01.S.doc No Are there any outstanding requirements from the last inspection? 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 YA2 Regulation 14.1 Requirement The registered provider must ensure that residents are only admitted following an assessment of their care needs by a person competent to do so. This is to ensure that residents receive appropriate care and support immediately following admission The registered provider and manager must agree with each resident a written and costed contract/statement of terms and conditions between the home and that resident, including all of the areas prescribed in Standard 5 of the Care Homes Regulations 2000. This is to ensure that residents are aware of their rights The registered provider and manager must ensure that written agreement is reached and recorded with relevant residents, their representatives and social services regarding the use of bedside rails. This is to protect the rights and welfare of these residents The registered provider and DS0000025617.V377569.R01.S.doc Timescale for action 30/11/09 2 YA5 5.1 31/12/09 3 YA6 13.7 30/11/09 4 YA20 13.2 30/11/09 Page 30 Elwis House, 1 Version 5.3 5 YA27 23.2(n) 6 YA32 18.1(c)(i) 7 YA34 19.1 & 13.6 8 YA35 18.1(c)(i) manager must ensure that all residents be assessed regarding their abilities and wishes to manage their own medication and that a record of this is kept on their care plan. This must include whether they agree to the home managing medication on their behalf. This is so that residents are given choice about how their medication is managed and to promote their independence. The registered provider and manager must ensure that bathroom facilities are suitable to the needs of residents and in doing this must ensure that the Parker bath is repaired or replaced so that residents who need it can have a bath The registered provider and manager must demonstrate that plans are in place to ensure that more than 50 of care staff in the home achieves an NVQ level 2/3 qualification. This is so that residents benefit from appropriately trained staff The registered provider and manager must ensure that all care staff are subjected to an enhanced CRB check and that the provider is satisfied prior to their commencement of work with residents. This is to prevent residents from being placed at risk of harm or abuse The registered provider and manager must ensure that management of dementia and management of epilepsy training are included in the homes training schedule for care staff as discussed in this report. This is to ensure that residents receive safe and competent support from staff in these areas DS0000025617.V377569.R01.S.doc 30/11/09 28/01/10 31/10/09 30/11/09 Elwis House, 1 Version 5.3 Page 31 of need. 9 YA35 The registered provider and 31/12/09 manager must ensure that all care staff be fully inducted in accordance with the registered provider’s induction checklist and that a record of each staff induction is maintained for inspection. This is to ensure that residents receive safe and competent support from staff Section 11 The registered provider must 31/12/09 CSA 2000 ensure that an application for registration of a manager for the home is submitted to the Care Quality Commission. This is so that the registered provider meets their regulatory obligations in accordance with the CSA 2000 13.4 The registered provider and 31/10/09 manager must ensure that the homes hot water temperature is regulated to 43 degrees Celsius. This is to protect residents from the risk of injury. 18.1 10 YA37 11 YA42 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 2 Refer to Standard YA1 YA2 Good Practice Recommendations The registered provider and manager should update the Service Users Guide to include reference to the contact details of the Care Quality Commission The registered provider and manager should develop an in house system for carrying out care assessments in order to prevent refusal of admission to residents who do not have one The registered provider and manager should raise the issue of the benefits of lease/purchase of a car for the home at relevant residents next care reviews The registered provider and manager should monitor the DS0000025617.V377569.R01.S.doc Version 5.3 Page 32 3 4 YA6 YA6 Elwis House, 1 5 6 YA7 YA22 implementation of speech and language recommendations for communications systems for one resident as discussed in this report The registered provider and manager should review the level of advocacy support for some residents as discussed in this report The registered provider and manager should implement the registered providers system for recording complaints in order to best protect complainants rights to confidentiality as discussed in this report Elwis House, 1 DS0000025617.V377569.R01.S.doc Version 5.3 Page 33 Care Quality Commission Care Quality Commission Citygate Gallowgate Newcastle Upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. 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