Care Home: The Elms

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What the care home does well Detailed information about people that live in the home is available to staff so that they can ensure the care needs are being met. The information on each person`s care needs is kept in five separate files to make sure they receive all the care that they need and staff know what to do to meet people`s care needs. Staff communicate well with relatives and healthcare professionals to ensure the needs of the people who live in the home are identified and met. The care needs of the people who live at the home are monitored regularly to make sure the care they are getting is still effective. The complaints procedure for the home is readily available for the people who live there, their relatives and others, so they can be confident their concerns and complaints will be listened to. Staff receive good leadership and direction to help them make sure that the needs of the people who live at the home are met in the way they prefer.The home, and particularly the garden that is in the centre of the home, is well maintained so that people who live there are in safe, comfortable and clean surroundings. CLS, the organisation that runs the home, has provided a range of policies and procedures so that staff have the guidance they need to make sure that the people who live at the home stay safe and well. The activities co-ordinator organises a range of activities, both in the home and in the community, so people who live there can choose which activities they wish to take part in. What has improved since the last inspection? The improvements to garden have made it a more relaxing and comfortable area for the people who live in the home. The use of the smaller communal lounges as dining areas has made the large dining area less crowded and more relaxed during meal times. The programme of re-decoration within the home has ensured it looks well maintained at all times. What the care home could do better: Staff should ensure the meals remain hot when being taken to the smaller lounges. The assessment documentation for all new people who come to live in the home should be available on their care files. CARE HOMES FOR OLDER PEOPLE The Elms Elm Drive Crewe Cheshire CW1 4EH Lead Inspector Mr Val Flannery Key Unannounced Inspection 23 June 2008 08:15 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 The Elms DS0000006515.V363578.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. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Elms Address Elm Drive Crewe Cheshire CW1 4EH 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) 01270 584236 01270 250636 www.clsgroup.org.uk CLS Care Services Limited Jayne Murphy Care Home 40 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (1), Old age, of places not falling within any other category (39) The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 40 service users to include: * No more than 39 service in the category of OP (Old age, not falling within any other category) * No more than 1 service user in the category of MD(E) (Mental disorder, excluding learning disability or dementia) 18th July 2006 Date of last inspection Brief Description of the Service: The Elms provides care and accommodation for forty older people. Located on a residential estate in Crewe, the home is close to shops, a pub and is on the bus route to the town centre. A passenger lift and stairway allow for access between the ground and first floor of the two-storey building. All the bedrooms are single and have handwashing facilities. There are sufficient bathrooms and toilets to meet residents’ needs. Communal lounges are located on both floors and there is a large dining room plus people can eat in the communal lounges if they wish. For those residents with mobility problems, the home provides bath hoists, wheelchairs, grab rails and other mobility/lifting aids. Staff are on duty twenty-four hours a day to provide care to the residents. The current weekly fees range from £343.34 to £400.00. Further details about fees are available from the manager. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 stars. This means the people who use this service experience good quality outcomes. This unannounced visit took place on the 23 June 2008. The visit lasted 8.5 hours in total and was carried out by one inspector. Feedback about the findings of this visit was given to two of the care team leaders on the 23 June 2008 The visit was just one part of the inspection. Before then the manager was asked to complete a questionnaire to provide up to date information about service offered by the home. Other information received by CSCI since the service was last visited was also reviewed. During the visit various records and the premises were looked at. People who live in the home were spoken with. Relatives and staff were also spoken with during the visit and they gave their views about the service. These are included throughout the report. What the service does well: Detailed information about people that live in the home is available to staff so that they can ensure the care needs are being met. The information on each person’s care needs is kept in five separate files to make sure they receive all the care that they need and staff know what to do to meet people’s care needs. Staff communicate well with relatives and healthcare professionals to ensure the needs of the people who live in the home are identified and met. The care needs of the people who live at the home are monitored regularly to make sure the care they are getting is still effective. The complaints procedure for the home is readily available for the people who live there, their relatives and others, so they can be confident their concerns and complaints will be listened to. Staff receive good leadership and direction to help them make sure that the needs of the people who live at the home are met in the way they prefer. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 6 The home, and particularly the garden that is in the centre of the home, is well maintained so that people who live there are in safe, comfortable and clean surroundings. CLS, the organisation that runs the home, has provided a range of policies and procedures so that staff have the guidance they need to make sure that the people who live at the home stay safe and well. The activities co-ordinator organises a range of activities, both in the home and in the community, so people who live there can choose which activities they wish to take part in. What has improved since the last inspection? What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 7 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 The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. An assessment of need is undertaken before people come to live in the home to ensure their care needs are identified and can be met at the home. EVIDENCE: The care files for three of the people who live in the home were seen during the inspection. These showed that assessments of need are carried out by staff from the home or provided by other professionals including healthcare professionals. The assessment included details on the person’s mobility and history of falls, their ability to care for themselves, their current medication and their likes and dislikes. This information helps determine if the person’s needs can be met at the home. It is also used to develop plans on how the home can meet these needs. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 9 Two of the people spoken with said they had not visited the home but that they knew about it because they have lived in the area all their lives. One of the relatives spoken with said they had visited the home on their father’s behalf and had discussed their findings with him. Both of the relatives spoken with said they, or another family representative, were present when the initial assessment of need were carried out and that their views and the views of the person moving into the home were sought and listened to. A copy of the statement of purpose and service user’s guide to the home are kept in the bedrooms. The home does not offer an intermediate care service. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Care plans reflect the care to be provided for people who live in the home, so their needs are been met. Staff maintain the dignity and privacy of the people who live in the home so they are treated with respect. EVIDENCE: The care records/files for three of the people who live in the home were seen during the inspection. These showed they are consulted about the care and support they receive. For example, the plans of care showed the level of help they required with moving about the home, getting dressed/undressed and using the bathrooms and toilets. Staff were seen supporting and encouraging people to be as independent as possible with these tasks of daily living. Staff were seen respecting the privacy of the people who live in the home by knocking on bedroom doors, ensuring doors to bathroom/toilets were closed and discussing private and personal issues in the office or in people’s private rooms. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 11 Records were seen that showed that by doctors, nurses and other healthcare professionals visit people who live in the home according to their needs. For example, a person who lives in the home asked a visit from a doctor. Following a phone call from staff to the person’s surgery, a doctor was seen visiting him in the afternoon. He visited the person in their bedroom. A district nurse was also seen visiting people who live in the home. She also saw the people in the privacy of their bedrooms. A list of staff training was provided by the home. This showed that staff receive training on a range of health care matters including diabetic training, palliative care training, first aid and NVQ in health and social care. The record of medication administered by staff to people who live in the home was seen during the inspection. The record was signed by staff and it showed that people receive their medication as prescribed. Satisfactory arrangements were seen for staff who administer medication to the people who live in the home. One of the care team leaders said a person living in the home administers her own inhaler. Medication is kept in a locked trolley which is stored in a locked cupboard when not in use. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 12 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): 12, 13, 14 and 15 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. The routines within the home allow for the people who live there to have individual choices and wishes so they are able to exercise control over their lives. EVIDENCE: Two relatives were spoken with during the inspection. They said they are able to maintain contact with their relative in the home and that they can visit at any time. They also said they are made very welcome by the staff and are kept informed of incidents/other that may effect their relative. During the inspection one relative was seen taking her father out to a local shop in a wheelchair. Others were seen visiting the home and meeting with their relatives either in their bedrooms or in the communal lounges. One person who lives in the home was seen leaving the home to catch a bus to go shopping. The people spoken with during the visit said they are able to choose how they live their daily lives. For example, when they get up and go to bed, where in the home they wish to spend their leisure time, where and when they have The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 13 their meals, where they meet with their visitors and whether they join in the organised activities. The mealtime seen during the visit was relaxed and unrushed. The people who live in the home can choose where to have their meal- either in the large dining room or in one of the smaller lounges located around the home. One person chose to have her meal after the others had eaten. She was able to choose what she wished to have for her meal. Staff were seen helping people with their meal. This was done in a quiet and sensitive manner. People living in the home are offered a choice for their meals. One person told us, ‘you could not get better food anywhere’. Another person is a vegan and the cook provides suitable food for him. The menus seen showed that choices are offered and that an alternative will be provided if the person wishes. One person said since the two new cooks were appointed the food can be cold when it reached the smaller lounges. This was reported back to the seniors on duty at the end of the inspection. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. The home has a complaints procedure that is readily available so people feel that their concerns are being listened to. Staff have an understanding about safeguarding adults so people who live in the home are protected from harm and abuse. EVIDENCE: A copy of the complaints procedure was on display in the entrance area of the home and in the bedrooms. It included details on how to contact the Commission for Social Care Inspection. The record of comments and compliments (includes complaints) folder was on display in the entrance area to the home. There were no complaints recorded. The senior members of staff spoken with during the inspection said no complaints had been received by the home. Three of the people who live in the home, two relatives and four staff said they were aware of the complaints procedure and how raise issues of concern. CLS have a procedure on safeguarding adults. A copy of this is kept in the home. The two senior staff spoken with said that no referrals had been made from the home under adult protection procedures. The information provided by the home showed that all staff have received a brochure on ‘Recognising and reporting abuse’. Refresher training on Protecting Vulnerable Adults from The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 15 Abuse (POVA) is planned for the 15 and 18 August 2008. A copy of the government guidelines ‘No Secrets’ is also available in the home. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 21, 22, 23, 24, 25 and 26 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. The home is well maintained and free from hazards so people live in comfortable and safe surroundings. EVIDENCE: The home is located in a residential area of Crewe. It is close to shops, pub and the bus route to the town centre. On the day of the visit the home was clean, bright and free from unpleasant smells. The people who live in the home and the relatives spoken with said the home is always like that and that the ‘girls work very hard to keep it clean and fresh’. Communal lounges are provided on both floors. These are close to residents’ bedrooms and were seen being used by residents during the visit. There is a The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 17 large dining room on the ground floor next to the kitchen. People can also choose to eat in the smaller lounges that are located around the home. All the bedrooms are single; the rooms seen contained residents’ personal possessions - for example, pieces of furniture, televisions and family photographs. Lockable cupboards are provided in the residents’ bedrooms. Bathrooms and toilets are located around the home and within reach of bedrooms and communal areas. Hoists, bath-lifting aids, grab rails and wheelchairs are provided for residents with mobility problems. Care call points are located in bedrooms, bathrooms, toilets and communal areas. Access between the ground and first floor is via the passenger or stairway. The garden in the centre of the home has been improved and developed. People spoken with during the visit said it gives them a very pleasant outside area to sit and relax in. The people spoken with during the inspection said they could choose to be in the communal areas with other residents or be by themselves in their bedrooms. During the visit the maintenance assistants were seen carrying out general repairs to the home and were redecorating a bedroom. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Staff receive the training to ensure they have the necessary skills so that the care needs of the people who live in the home are being met. EVIDENCE: The staffing rota seen on the day of the inspection showed that there is normally one care team leader and three care assistants on duty during the day, afternoon and evening. There are also domestic and kitchen staff and a cook on duty during the day. There is one care team leader and one care assistant on duty during the night. The training record supplied by the home showed that all staff have access to NVQ training in care or in cleaning, as appropriate to their role. At least 50 of care staff have achieved NVQ Level 2 or above. The record also showed that staff have access to a range of training courses including first aid, fire safety, food safety, moving and handling, equality and diversity, continence promotion, skin viability and diabetic training. Two staff personnel records were seen on the day of the inspection. The information in the files included application forms, two references, criminal record bureau checks and an induction checklist. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 19 A number of people who live in the home and two relatives were spoken with during the visit about the staff. The people who live in the home said staff were ‘kind, caring, helpful and overworked’. The relatives said they that no staff behave in a way that had caused them to worry or make complaints. They said staff are ‘welcoming and friendly’ and that ‘they have a lot to put up with’. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 People who use services experience good care in this outcome area. We have made this judgement using available evidence, including a visit to the service. Staff are receiving the leadership that will ensure they have the necessary skills to support the people living in the home live their lives as they wish. The routines of the home appear to suit the people who live there so the home is being run in their best interests. EVIDENCE: Since the last inspection, on the 18 July 2007, the manager for the home has transferred to another CLS home. The person replacing her has worked for CLS in a management capacity for some years and has been manager for another home in the group. She has completed her NVQ Level 4 in management and Registered Managers Award and has attended training The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 21 required for the day-to-day running of the home included a weeklong course on caring for people with dementia. The people spoken with during the inspection, including those who live in the home, relatives and staff, said the high standards put in place by the previous manager would continue to be developed by the new manager. The home seeks the views of the people who live there and their relatives. This is done by holding meetings, during reviews and by the use of questionnaires. According to the staff spoken with during the visit the overall feedback is included in a report. However, a copy of this report was not available during the visit. Two of the people who live in the home said staff often ask them if they are ok and like living in the home. One of the care team leaders spoken with during the inspection said the people who live in the home and/or their relatives are expected to manage their personal finances. CLS will offer assistance to people in managing their finances if required. CLS Care Services has developed a range of policies and procedures on health and safety and safe working practices. This includes training of staff in first aid, moving and handling and food hygiene. During the visit a sample of records were seen that showed equipment is tested and services. For example, fire safety equipment is serviced annually, as is the passenger lift, hoists and other lifting equipment. The fire alarms are tested weekly, the emergency lights are tested monthly and evacuation drills and staff training are carried out as required. The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations The Elms DS0000006515.V363578.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection North West Region CSCI Preston Unit 1 Tustin Court Port Way Preston PR2 2YQ 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. 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