Care Home: The Elms Nursing Home

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What the care home does well Service users benefit from a full assessment of their needs and either they or their representatives are encouraged to look around the home before they decide to move in. Friends and relatives are welcome to visit the home and can do so at any reasonable time. They are given regular opportunities to have their say about the services provided by the home. Service users are protected by robust procedures for recruiting new staff, designed to protect them from any potential for harm. There are good staff training programmes in place, ensuring all staff receive mandatory training and more specialist training where necessary. Survey respondents said the food was very good and the catering team provided them with plenty of choice and often asked for feedback about the things they liked best. The overall cleanliness of the home is of a good standard. The last quality assurance exercise undertaken by the home evidenced that people were 100% satisfied with this aspect of the service. What has improved since the last inspection? There have been significant improvements made since the last inspection in line with the three statutory requirements and six good practice recommendations made. Staffing levels have been reviewed and the Provider has increased the staffing establishment to ensure service users assessed needs are met. Regular reviews of staffing levels are now in place. Some new personnel roles have supplemented the staff team since the last inspection. A part - time activity coordinator has been employed, which increases the home`s diversional staff to two. The second activity coordinator is a volunteer. Activities within the home have also become more person centered. This ensures service users have access to stimulating and meaningful activities that meet their individual needs and expectations. The Elms now have a dedicated reception area and full time reception staff. The reception area is bright, welcoming, and responsive to peoples needs and provides information about the home and the service it provides. The home employs a multi-cultural workforce. At the last inspection staff were not all able to evidence they had the necessary verbal skills and cultural understanding to deliver the services and care which the home offered to provide. The home was commendably quick to respond and act upon this issue. Registered General Nurses have completed a 10 week English language and cultural awareness training programme in order to address the difficulties in communication raised. A similar training programme is to be rolled out to health care assistants and other staff that have direct contact with service users, to ensure their needs are fully understood and met in future. The standard of care planning has improved and more developmental work in this area is planned. Minor shortfalls in medication storage requirements have been addressed, which ensures that vulnerable service users are not put at risk and the home adheres closely to good practice guidance. The home`s Statement of Purpose and a Service User Guide have both been reviewed since the last inspection and content is now more user friendly. The home has been re-accredited to the Investors in People Award. This is a national quality standard which sets a level of good practice for improving an organisations performance through its people. What the care home could do better: The service evidenced a firm commitment and an increased awareness of their accountability for continuously improving the quality of the care and service delivery at The Elms during this inspection. It was clear that the provider and the management team have carefully considered past criticism and complaints from external agencies and the points raised in the previous inspection reports. The new manager acknowledges that there is still further work to be done and improvements to be made. They are however aware of the actions they need to take and have developed a clear service improvement plan to ensure that good outcomes for service users are sustained and their experiences of The Elms improved. Key inspection report Care homes for older people Name: Address: The Elms Nursing Home The Whitepost Health Care Centre Ranelagh Road Redhill Surrey RH1 6YY     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marion Weller     Date: 0 6 1 0 2 0 0 9 This is a review of 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. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 31 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 Homes for Older People 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. 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 Care Homes for Older People Page 3 of 31 Information about the care home Name of care home: Address: The Elms Nursing Home The Whitepost Health Care Centre Ranelagh Road Redhill Surrey RH1 6YY 01737764664 01737780710 zelinaramdhan@whiteposthealthcare.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Dr P J David,Mrs S P David Name of registered manager (if applicable) Type of registration: Number of places registered: care home 49 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: The maximum number of service users to be accommodated is 49. The registered person may provide the following category of service only: Care home nursing - (N) to service users of the following gender: Either Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - (OP) Dementia - (DE) Physical disability - (PD) Date of last inspection Brief description of the care home The Elms is a registered care home providing nursing care for up to 49 residents. The home is situated on the site of the old East Surrey Hospital at the top of Whitepost Hill and is on the same site as an independent health care service separated from The Care Homes for Older People Page 4 of 31 2 0 1 0 2 0 0 8 49 0 49 Over 65 0 49 0 Brief description of the care home Elms by internal doors and also owned and operated by the same provider. The home is within walking distance of Redhill, which provides access to shops, public transport and a range of social and leisure facilities. The home has a large garden to the rear of the premises. All floors that accommodate service users are accessible by stairs and a passenger lift. The Elms is privately owned and run by the Whitepost Health Care Group who run other similar establishments in the South East. There are limited parking facilities to the front of the premises. The weekly fees are from £550 £750 per week. Please contact the manager for more detailed information. Care Homes for Older People Page 5 of 31 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The Elms Nursing Home last had a Key Inspection on the 20th October 2008. Three statutory requirements were awarded and six good practice recommendations were made as a result of the site visit. The home was subsequently assessed to be a one star - adequate service. This Key Inspection was undertaken on the 6th October 2009. The inspector was in the home from 11:00 am until 16:30 pm and was accompanied for part of the time by an Expert by Experience from Help the Aged. Experts by Experience provide an additional source of evidence. They pay particular attention to people who use the service to establish their experiences of living in the home. The Expert by Experience produces a report of their findings following the inspection which is used to inform the inspectors own report and to support judgements made. On the day of the site visit to The Elms, the Expert by Experience spent time talking with service users in a communal area, spoke with one of the homes activities coordinators, the appointed manager, the Care Homes for Older People Page 6 of 31 providers director of operations and some staff members, in addition observed the lunch period in one of the homes dining rooms. During the site visit the inspector spoke with the appointed manager, a senior staff nurse, the providers director of operations and some other staff members. The inspector was shown around the communal areas of the home and was invited to view individual bedroom accommodation. In addition, some service user records and other documents were inspected. The inspection report takes into account all the information obtained about the service since the previous site visit. This includes any formal notifications, phone calls and letters received and any information concerning complaints or allegations. The appointed manager was asked to complete the homes Annual Quality Assurance Assessment (AQAA) prior to the inspection. The completed AQAA document was received by us within the timescale given. The AQAA is a self assessment that focuses on how well outcomes are being met for people using the service. It also gives some numerical information about the service. The completed document gave us clear and detailed information which provided a good picture of what was happening in the service and their plans for further development. Prior to the site visit we sent surveys to people receiving services at The Elms, members of the staff group and in addition, we surveyed a number of health and social care professionals involved with the service, to gather their views. A total of 19 completed surveys were returned to us. Comments taken from surveys have been used throughout the report. Some details have also been taken from the homes most recent quality assurance exercise, dated March 2009 which asked relatives of service users for their levels of satisfaction with the home.. Care Homes for Older People Page 7 of 31 What the care home does well: What has improved since the last inspection? There have been significant improvements made since the last inspection in line with the three statutory requirements and six good practice recommendations made. Staffing levels have been reviewed and the Provider has increased the staffing establishment to ensure service users assessed needs are met. Regular reviews of staffing levels are now in place. Some new personnel roles have supplemented the staff team since the last inspection. A part - time activity coordinator has been employed, which increases the homes diversional staff to two. The second activity coordinator is a volunteer. Activities within the home have also become more person centered. This ensures service users have access to stimulating and meaningful activities that meet their individual needs and expectations. The Elms now have a dedicated reception area and full time reception staff. The reception area is bright, welcoming, and responsive to peoples needs and provides information about the home and the service it provides. The home employs a multi-cultural workforce. At the last inspection staff were not all able to evidence they had the necessary verbal skills and cultural understanding to deliver the services and care which the home offered to provide. The home was commendably quick to respond and act upon this issue. Registered General Nurses have completed a 10 week English language and cultural awareness training programme in order to address the difficulties in communication raised. A similar training programme is to be rolled out to health care assistants and other staff that have direct contact with service users, to ensure their needs are fully understood and met in future. Care Homes for Older People Page 8 of 31 The standard of care planning has improved and more developmental work in this area is planned. Minor shortfalls in medication storage requirements have been addressed, which ensures that vulnerable service users are not put at risk and the home adheres closely to good practice guidance. The homes Statement of Purpose and a Service User Guide have both been reviewed since the last inspection and content is now more user friendly. The home has been re-accredited to the Investors in People Award. This is a national quality standard which sets a level of good practice for improving an organisations performance through its people. What they could do better: 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. Care Homes for Older People Page 9 of 31 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 10 of 31 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective service users can be confident that their individual needs and aspirations will be comprehensively assessed prior to them moving in to ensure those needs can be met. A minor review of documents designed to inform and guide prospective service users and their relatives will ensure they have all the information they need. Evidence: The Elms Nursing Home has developed a written Statement of Purpose and a Service User Guide. Both documents have been reviewed since the last site visit and content is now more user friendly. It was discussed that the service user guide would benefit from further minor review to ensue it reflects the new managers details and the correct contact details for the CQC. In addition, the Service User Guide should be dated to satisfy people they are reading the most up to date version. The manager stated the work to do this was in hand. The homes AQAA records the managers plans to produce information documents about the service in other relevant languages and in alternative formats, such as audio or pictorial versions to ensure information about Care Homes for Older People Page 11 of 31 Evidence: the service is available to suit all levels of service user capacity. The manager visits prospective service users prior to admission to make a decision as to whether the home can meet the persons needs. Information is obtained from other parties, including health care professionals to assist in assessment decisions. Two pre admissions assessments were inspected and found to be sufficiently detailed and comprehensive. The manager records in her AQAA.....Our pre-admission assessments are both efficient and thorough. Our service is extremely responsive to all referrals. A full detailed needs assessment is completed and we actively encourage prospective clients and / or their relatives to come and view the home. All needs are assessed in line with our Statement of Purpose. We have enquiry feedback forms for potential clients and families who visit the home to use; this enables people to comment on our service and also to state their reasons for choosing or not choosing to use The Elms. In this way we can adapt and improve the service based on constructive criticism. The last inspection report records that the homes reception area was unmanned and the negative impact this had on people accessing the service. This situation has now significantly improved and evidence was seen of a staffed and inviting area where people are welcomed and appropriately assisted. The homes AQAA records......As a direct result of listening to people who use our service we have introduced a new role of a full time receptionist and created a dedicated reception area. We have also made the reception area more user-friendly by ensuring that advice leaflets, information about the home and news is all freely available for visitors to see and to take away. During the previous inspection it was noted that staff had the clinical knowledge and practical skills to care for individuals admitted to the home and were observed to be very hard working, but that numerous concerns had been raised with the inspector about the inability of some staff members to communicate effectively with service users and to understand their cultural needs and preferences. A statutory requirement was awarded for the home to address this issue to the benefit of service users. This requirement has been now been met. RGNs employed have all since completed a 10 week English language and cultural awareness training programme run by a local college in order to address the difficulties in communication. This specific staff training programme continues to roll out to other staff and has been of real benefit to people living at The Elms. A survey respondent records....Things have improved, its nice to have somebody to talk to, thats important for me. Intermediate Care is not provided at The Elms. Care Homes for Older People Page 12 of 31 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this 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 has been substantial progress made to ensure that service users health, personal and social care needs are met and more improvements are planned. The home supports people with their medication needs in a safe way. Peoples right to privacy is being respected and the support they get from staff is given in a way that maintains their dignity. Evidence: Each service user has a care plan. Three were looked at in detail. It was clear that significant time and investment by staff at all levels has gone into developing and further improving the homes care planning system since the last inspection. Care plans were seen to be more comprehensive and were clearly based on the service users pre admission assessment. They provided the detail necessary to inform and direct staff about how they should meet the individuals health, personal and social care needs. Care plans had been regularly reviewed and changes to peoples care needs were evidenced as a result of review. Risk assessments were in place where Care Homes for Older People Page 13 of 31 Evidence: necessary and identified potential and actual risks to service users. They provided clear instruction to staff about strategies to reduce or eliminate hazards with any potential to harm. Daily records were being maintained, which on this inspection better evidenced what the home was doing for service users. The manager records in the homes AQAA.....A weekly ward round has been introduced which involves the Nurse in Charge, Manager and Director in order to assess the changing needs of each service user. This has benefited service users and has improved the quality of care planning and communication among service users, next of kin, staff and management. Two surveys from health care professionals however raised concerns about poor communication between themselves and the homes staff. One respondent records.....They must listen to professionals and always share information relevant to a service users care. Another respondent records when asked what the home could do better? ......Listen to other professionals and treat them as such, not just dismiss what is said. The appointed Manager and the Operations Director acknowledged throughout the inspection that whilst improvements have been made, they are aware that further action is necessary and everyone is working hard to both identify shortfalls and to address them. Such feedback from survey respondents will prove useful to them in achieving this aim. The homes AQAA records in this respect.....We are constantly looking to build on the substantial progress made. We still need to drive up clinical practice for all staff, and this will be achieved through supervision, training and is charted within the framework of the ongoing service improvement plan for the Home. The home continues to use the standex system for care planning which by design is fragmented. It can present as repetitive and unwieldy and makes the retrieval of information difficult and time consuming at inspection and audit. It is therefore difficult to clearly evidence that care plans are provided in a style and format easily accessible to service users and their relatives, as regulation demands. The Director of Operations, who was present throughout the inspection, said that during 2009, the use of the standex system for care planning will be reviewed by senior management. The appointed manager is scheduled to present an alternative format for their consideration. Only registered nurses administer medication to service users and the home has a good record of compliance with the demands of safe medication administration. Some minor shortfalls were evidenced in the last inspection report. Some service users topical medicines were not being correctly stored and this resulted in the homes particularly vulnerable service user group being put at risk. On this visit the situation was seen to be have been addressed. The requirement to correctly store all medicines has been met and will removed from this report. Care Homes for Older People Page 14 of 31 Evidence: There were sufficient staff on duty to meet the needs of service users on the day of the inspection. In line with a statutory requirement made in the last inspection report staffing levels have been reviewed at the home. Care and nursing staff were observed treating people living in the home with respect and maintained their dignity and privacy when observed delivering personal care. Each service user is registered with a general practitioner who visits the home as necessary. Arrangements are in place for services users to access the wider health provision, as their care needs demand. One professional health care respondent records......The service provided is supportive and caring and I would like to recommend The Elms Nursing Home. Care Homes for Older People Page 15 of 31 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Routines of daily living and the activities available to service users have significantly improved over the last year. The home recognises shortfalls in practice when presented and plans to make further changes to ensure the needs and expectations of service users are met. Evidence: Service users are consulted about their social interests and needs as part of the homes initial pre admission assessment. Social needs are recorded on individual care plans together with the individuals likes and dislikes. The current service users religious and cultural needs are catered for. Holy Communion was available for Church of England service users and a priest from St Joseph Catholic Church came to the home every Sunday. The homes AQAA records that a part time Activity Coordinator is employed and is supported by another person who offers help on a volunatry basis in order to promote and offer a variety of diversional and leisure activities for people living in the home. Activities are provided to service users on a one to one basis and also in group settings. The Expert by Experience who accompanied the inspector records in her Care Homes for Older People Page 16 of 31 Evidence: report.... I spent quite a bit of time talking to the homes activities person. She knew all the residents by name and explained what she did on a daily basis. One resident who was mobile she took for walks in the garden when the weather was fine, when wet she walked with them around the corridors. She had made beanbags and played catch to music with three of the residents. They smiled and laughed a lot and enjoyed this game. Several residents are bed bound and I was informed she visited them in their rooms. She told me about a person who comes in on a monthly basis that plays the piano and sings and gets the residents who are interested to join in, this seems a very popular activity and the photos around the wall provided evidence of this. On Tuesday and Thursday each week, a Physiotherapist was present to assist residents and to do exercises. On Tuesdays a hairdresser comes in and on Thursdays, a volunteer from P.A.T. dogs comes, which has proved very popular. There were photos of residents with the dog around the wall. An outing had been arranged to a farm with two of the residents. The Activities coordinator explained that she tried to arrange outings that were not weather dependent. There were now three volunteers, who were relatives of service users who assisted at such events. Further outings had been arranged for October, November and December 2009. Visitors are welcome at anytime and facilities are available for them to access drinks or a meal. Residents are free to entertain visitors in the homes communal areas or in their bedrooms. The menu seen is tailored to the needs of individuals and offers choice. The Expert by Experience reports.....A printed menu is done daily and the residents have a choice for the main course. I noted over the lunch period that one resident did not want their main course and pushed it away, this was noted by the care worker and tomato soup was brought in a cup as an alternative. This particular resident said this was their favourite. Staff who were present in the dining room explained that if a resident did not like the food asked for they were brought something lighter, be it cheese and biscuits or soup. The Chef had worked in the home for 3 years and said he enjoyed his work, changed the menu if a particular dish ended up not being eaten. He was keen to get feedback on the food he provided on a regular basis and told me that he often asked the residents about their preferences. All the residents observed who needed help and support at lunch time had this provided. Another person who had had suffered a stroke asked for their drink to be put into a cup with a lid and this was done immediately. The homes most recent quality assurance exercise evidenced that 92 of survey respondents were happy with the homes catering arrangements. A professional survey respondent said that the new manager had demonstrated a much greater Care Homes for Older People Page 17 of 31 Evidence: interest and understanding in enabling her staff to meet clients nutritional needs and they were hopeful that further improvements would be made and that in addition staff would be given the training they required regarding the importance of good nutrition and nutritional screening. Another survey respondent spoke of the provision of sloppy care. This was further explained and evidenced by saying that sometimes water was put in service users bedrooms for their use, but no glass or a cup provided. In addition, there were times when staff did not ensure that service users were correctly dressed for the environment they were in or that they were intending to go to. The appointed manager and Director of Operations evidenced throughout the site visit their intention to build on the substantial progress made at The Elms over the last year and the inspector is confident that such feedback will be investigated and addressed to service users benefit. Care Homes for Older People Page 18 of 31 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this 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 are systems in place to ensue that residents are protected from abuse and they can be confident that their concerns and complaints will be listened to and acted upon. Evidence: The service has strategies in place to ensure that those who live in the home and those who visit can make their views and complaints known. The homes AQAA records they have received four formal complaints since the last inspection. Two complaints were upheld. Issues raised are investigated and outcomes reported on within the timescale given in the homes complaints procedure. The appointed manager has a raised awareness that the quality of the service provided is the responsibility of the provider and concerns and complaints should be raised with the home in the first instance. The homes written complaints procedure reflects this approach. A recent relatives quality assurance survey undertaken by the provider illustrates that 62 of people surveyed knew about their complaints procedure and 85 of respondents said they would contact the manager in the first instance if they had a concern. Our survey responses show that service users know who to speak to if they are unhappy. One respondent said.....Staff do listen to you and I would say that a good relationship exists between staff and residents here. The homes AQAA records.....Our complaints policy is clear and freely available in reception for people who have concerns to take a copy away. How to Complain notices are displayed around the home. We have introduced a comments and suggestions box which is located in reception. The home is responsive to any complaints raised and we always Care Homes for Older People Page 19 of 31 Evidence: fully co-operate in an open honest and transparent manner. There have been four adult protection alerts and subsequent investigations that the home has been involved in since the last inspection. All of these matters are now closed with no further follow up. The provider and manager continue to approach safeguarding investigations with openness, honesty and a willingness to act immediately on action plans decided upon to secure peoples safety and protection. Regular checks and audits are then put in place to ensure that required improvements are maintained. All staff attend mandatory training in safeguarding vulnerable adults and update sessions are planned on a rolling programme. There home have procedures for the protection of vulnerable adults and for staff to whistle blow - Staff are made aware of both procedures during induction training. Recruitment procedures for new staff are robust. Prior to employment all staff receive Pova First and enhanced CRB checks to fully protect service users from any potential for harm Care Homes for Older People Page 20 of 31 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users have a clean and comfortable environment in which to live that meets their expectations and needs. Evidence: The Elms was originally a cottage hospital and internally the property still resembles this type of layout with long corridors and rooms that lead off on either side of them. Service user accommodation and communal rooms are arranged over three separate floors, accessed by stairs and a passenger lift. This style of provision has a significant impact on the numbers of staff required to effectively manage and provide for the type of specialist care the home offers. In direct response to a statutory requirement to review staffing levels awarded in the last inspection report, the homes establishment staffing numbers have been increased over the last year and evidence shows that the provider took this specific environmental issue into consideration. It continues to be a matter for personal conjecture whether this type of layout can be described as homely. No one living in the home or visiting there however raised any issues with us about the homes environment over the last 12 months or during the site visit and therefore for the purposes of this inspection report, it is accepted that the home continues to meet peoples individual and collective needs satisfactorily. There are rear gardens that appear well maintained and can be accessed by residents and visitors as they wish. The manager records in her AQAA of the providers intention Care Homes for Older People Page 21 of 31 Evidence: to design and build a sensory garden for the benefit of service users and their relatives. The inspector has been advised that since the site visit took place work has started on this project. There is a commitment to consistently improve and refurbish all areas of the home on a rolling programme. Since the last inspection a full refurbishment of pre-existing bathing facilities has been completed. A wet room has been created with new toilet facilities and a further new bathroom offers the resource of a profiling bath. There have also been improvements made to a clinical room and the homes reception area has been reconfigured. Some additional storage space is also provided. A large hoist was however seen to be stored in a corridor directly in line with a fire exit and a running man sign. The Operations Director explained that the homes Fire Risk Assessments allow for this. It was discussed that as this information is not on the current fire risk assessment, but is included in some of the homes previous fire risk assessments, this should be further clarified with the Fire Officer to ensure that people living and working at the home are not put at risk. The home was being kept very clean and was largely free from any offensive odours. One area on the first floor evidenced a slightly unpleasant odour. After discussion it was clear that the manager had taken action to resolve this and systems were in place to keep this under control. Infection Control measures and health and safety audits are in place. The homes AQAA records.....Quality assurance surveys sent to service users and relatives illustrate good results in relation to levels of satisfaction with the laundry, cleanliness, privacy and space provided within the Home. Care Homes for Older People Page 22 of 31 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users benefit from staff that receive relevant training and support and are very hard working. People living at the home can be equally be confident that checks have been undertaken to ensure that staff are suitable to care for them. Current staffing is meeting service users needs but levels deployed should continue to be determined according to the assessed needs of the individual service user. Evidence: The staffing numbers on the day of the site visit were observed to meet the needs of the people living in the home. Occupancy is currently reduced to 28 service users. The home is registered for a maximum of 49 people. In response to a statutory requirement awarded in the last inspection report to review staffing levels, the provider has increased the staffing establishment. Regular reviews of staffing levels are now in place and these are continuously monitored by senior staff. The initial staffing review acknowledged the complications caused by the physical layout of the home and the high dependency needs of the service users cared for at The Elms. The manager records in her AQAA.....We have increased staffing establishment, and this is under regular review at Senior Management Team meetings, increased staffing levels improve staff visibility and engagement with residents. This is further evidenced by a decrease in the number of complaints. The inspector found that service users levels of satisfaction had also increased in this area with comments recorded on CQC surveys such as....staff are always quick to help me . And....If I ring the bell they (staff) Care Homes for Older People Page 23 of 31 Evidence: always seem to be around to talk to. Staff surveyed prior to the site visit recorded some ongoing concerns however and said....The number of staff giving care to the residents must be based on the dependency levels of the individual residents, not just on the number of people accommodated. And.....more staff needed on shift to make it even better for residents. And.....sometimes we need more staff. Some new personnel roles have also supplemented the staff team since the last inspection. A full time receptionist post has commanded a very positive response from people involved with the home. This post is currently filled by two staff working part time hours. A new part time activity coordinator has also been employed, which increases the homes diversional staff to two. The second activity coordinator is a volunteer. The home employs a multi-cultural workforce. At the last inspection staff could not evidence they all had the necessary verbal skills and cultural understanding to deliver the services and care which the home offered to provide. The home was quick to respond and act upon this issue. The homes AQAA records.....Registered General Nurses have completed a 10 week English language and cultural awareness training programme run by a local college in order to address the difficulties in communication raised in the previous inspection report. In addition, it was explained that a similar training programme is to be rolled out to health care assistants and other staff that have direct contact with service users, to ensure their needs are fully understood and met in future. The requirement awarded has now been addressed and will be removed from this report. The outcome and effectiveness of this training programme will however need to be audited at completion. Apart from the specific training mentioned above the service recognises the importance of staff training and delivers a full programme that meets statutory requirements and the National Minimum Standards. Care staff trained to NVQ Level 2 or 3 exceeds the 50 minimum standard. Training records evidenced 66.67 of care staff are qualified. The service has robust recruitment procedures that are regularly reviewed to ensure good practice is being consistently developed. Three Staff files were inspected. It was found that recruitment procedure is followed in practice and there is accurate and comprehensive recording at all stages of the process to secure the safety of service users. The manager records.....We have overhauled the HR department and increased the staffing complement from one full time HR Officer, to one part time HR Manager and 1 full time HR and Training Coordinator. Our outsourced HR advisory service also remains operational. In this way residents can be assured that all staff members have Care Homes for Older People Page 24 of 31 Evidence: been appropriately recruited, and are fully CRB checked. This ensures patient safety for this vulnerable adult group. Care Homes for Older People Page 25 of 31 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this 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 receiving services benefit from a competent manager who provides clear leadership and whose aim is to consistently improve and develop the service and the outcomes for the people who live there. Evidence: The registered manager in post at the last inspection has now left the homes employ. A new manager appointed by the provider has been in post since 29th June 2009. The appointed manager is currently in the process of making application to register and is going through the CQC fit person process. She has the required nursing qualifications and management experience to support her application and clearly evidenced skills and abilities that will enable her to run the home effectively and meet its stated purpose,aims and objectives. The home operates within a clinical governance framework to further support the managers role. There are clear lines of accountability within the home and with external management. Staff receives regular training, supervision and annual appraisal and they consider Care Homes for Older People Page 26 of 31 Evidence: supervision is useful. One survey respondent said.....I am often offered training at supervision. There have been significant improvements since the last inspection in line with statutory requirements and good practice recommendations made and in relation to the homes own developmental plans. There has been regular Regulation 26 visits made by a representative of the provider organisation, with reports compiled detailing outcomes of the visit and any actions to be taken by the manager or her deputy. The management team has taken positive steps to ensure that systems are now more robust and investment has been made in the staff team to address shortfalls at the last inspection. The manager records in the homes AQAA.....The home has seen a vast and sustained improvement over the last 12 month period and the management and administration can evidence such improvement. It can also show its commitment to achieving a better standard of care and service delivery. The home has shown a high degree of self awareness and has actively taken on board past criticism and complaints from external agencies and the points raised in the previous inspection report. All areas have been acted upon within a short space of time. The home also freely acknowledges that there is still further work to be done and improvements to be made; however we are aware of the improvements necessary. The home has been re-accredited to the Investors in People Award. This is a national quality standard which sets a level of good practice for improving an organisations performance through its people. The home has a quality assurance system and audit processes are in place. The inspector saw the results of a recent quality assurance survey. These are designed to obtain the views of all stakeholders in the service and results are collated to inform planning. Relatives are offered the opportunity to attend service users reviews and relatives meetings are held quarterly where they can make comment about the service. The manager offers regular weekly surgeries. The Expert by Experience records in her report.....The new manager appeared to be enthusiastic and keen and explained that complaints were always dealt with and a lot of hard work had been completed to improve the quality of care for the residents since the last inspection. She also said that this was an ongoing situation and that she realised she could not be complacent, but had to improve all the time. The home maintains allowance money on behalf of service users if requested to do so. This is overseen by the owner organisations finance administrator, who keeps written and computerised records. All debits and credits are recorded, all receipts retained. Care Homes for Older People Page 27 of 31 Evidence: Accounts are audited by a member of the organisations administrative finance staff quarterly. The Manager records in the homes AQAA that all records of maintenance and safety checks are up to date. These were not all inspected on this occasion. In relation to The Mental Capacity Act 2005 and Deprivation of Liberty Safeguards, assessments of capacity and decision making for service users would be undertaken, where it was necessary, in a way that complies with published codes of practice. There is no one living in the home who is currently the subject of a deprivation of liberty authorisation. Care Homes for Older People Page 28 of 31 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 29 of 31 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Care Homes for Older People Page 30 of 31 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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. Care Homes for Older People Page 31 of 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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