Inspection on 27/11/07 for Alma Green Care Home

This inspection was carried out on 27th November 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Alma Green Care Home 23/01/07

Alma Green Care Home 13/03/06

Similar services:

Chirnside House

Keer Sands Residential Home

Ruskin Lodge

Bushell House

Langrigg House

Parkside

Dystlegh Grange

Thornton Lodge

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Alma Green Care Home Alma Green Hall Green Upholland Skelmersdale West Lancashire WN8 0PA Lead Inspector Denise Upton Unannounced Inspection 27th November 2007 09:30 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 Alma Green Care Home DS0000062739.V350491.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. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Alma Green Care Home Address Alma Green Hall Green Upholland Skelmersdale West Lancashire WN8 0PA 01695 622504 01695 622504 MBOWKER5@AOL.COM 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) Cranford Care Homes Limited Mrs Joanne Bowker Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The home is registered for a maximum of 29 service users of the category of OP (Old age, not falling within any other category. Staffing must be provided to meet the dependency needs of the service users at all times and will comply with any guidelines which may be issued through the Commission for Social Care Inspection regarding staffing levels in Care Homes. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Rooms 8 and 9 may only be used as a bedroom for single occupancy or for shared occupancy in the case of married couples or like partnerships where both parties have expressed the wish to share. 23rd January 2007 3. 4. Date of last inspection Brief Description of the Service: Alma Green is located in the small village of Up Holland, which is part of the town of Skelmersdale. There is easy access to local community services such as shops, library, pharmacy, post office and local bus routes. The home is registered to provide 24 hour personal care for up to twenty-nine older adults of either sex, over the age of sixty-five. Alma Green is purpose built and privately owned by Cranford Care Homes Limited. Responsibility for the day-to-day running of the home is that of the registered manager, Joanne Bowker. The home is arranged over two floors accessed by a passenger lift. There are twenty-five single bedrooms and two double rooms suitable for anyone choosing to share bedroom accommodation. All have en-suite facilities. Five small communal sitting rooms are available, one of which is a designated smoking lounge. Information is available to prospective residents in a Service User’s Guide. This tells prospective residents about the home and the services and facilities provided. The residential care fees at Alma Green in November 2007 ranged from £391 50 per week to £392.00 per week. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced site visit took place during the course of a mid-week day and in total spanned a period of approximately nine and a half hours. The twenty-one core standards of the thirty-eight standards identified in the National Minimum Standards-Care Homes For Older People were assessed along with an additional standard. This included a re-assessment of the requirements and recommendations identified in the last inspection report. The inspector spoke with the registered manager, a senior carer and a care assistant. In addition, individual discussion took place with three people living at the home and two relatives who were visiting. Several other residents were also briefly spoken with throughout the day in communal areas of the home. A number of records were also examined and a tour of the building took place that included communal areas of the home, the laundry and kitchen and some bedroom accommodation. Information was also gained from the Annual Quality Assurance Assessment (AQAA) completed by the registered manager. In addition, a number of residents, relatives/friends and members of staff also completed a Commission for Social Care Inspection survey form that helped to form an opinion as to whether resident’s needs and requirements were being met. This key inspection focused on the outcomes for people living at the home and involved gathering information about the service from a wide range of sources over a period of time. What the service does well: Detailed information had been gathered prior to admission, which collectively provided a clear picture of individuals so that the home was confident that assessed needs could be adequately met by the staff team. The health care needs of people living at the home were being well met, by the involvement of a wide range of external professionals, who visited people within the privacy of their own accommodation. Practices adopted by the home demonstrated that medications were managed appropriately to ensure that those living at the home were adequately safeguarded in relation to safe medication techniques. People visiting the home were made to feel welcome at all times and those living at Alma Green were treated with respect and dignity and their privacy consistently maintained. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 6 The management team and staff work well together to ensure that the needs of the residents individually and collectively are met. Comments received from relatives and residents confirmed that they were happy with the care provided. One relative said, “ My mother never complains about the staff or the home. A number of staff go out of their way to help my mum bring fruit and such in when I cannot get through during the week” Residents described the staff group as “brilliant”, “staff are very friendly, I am very pleased living here” and “all staff are lovely, kind and helpful”. Observation of care practices throughout the day confirmed residents are treated with respect and dignity. The atmosphere in the home was very relaxed and friendly, promoting a caring environment in which residents can undertake their daily lives. The home was found to be clean, tidy, pleasant smelling and well maintained with nicely decorated communal areas and bedrooms and good quality furnishings throughout, which provided a comfortable and homely environment for people to live in. The home was well managed providing a good service for those living at the home and the safety of both residents and staff was promoted and protected. What has improved since the last inspection? What they could do better: The registered manager and staff are keen to provide a high quality service at Alma Green and try hard to ensure that the needs of residents are well met. However there are a number of things that could be improved. One to one staff supervision should take place more frequently. This would enable the manager to target individual staff’s needs, check out understanding Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 7 and provide staff with opportunity to discuss areas of importance specific to themselves. Although staff training is given high priority at Alma Green care staff have not undertaken food hygiene training. This should be undertaken by all staff that prepare, cook or serve food. Questionnaires are made available to residents and their relatives so they can have their say about the running of the home and the service provided. It has been suggested that a further questionnaire could be made available to other people who visit the home such as doctors, nurses, optician and hairdresser so that their views and opinions could be considered. 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. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 8 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 Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 9 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 Quality in this outcome area is good. The admission and assessment procedures were clear to ensure the care needs of residents could be met when living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Prior to residents being admitted to the home an assessment of their strengths and needs is undertaken to ensure that these can be met by the service provided. The care plan records of three residents were looked at in detail and were all found to contain full assessment information, which included the healthcare, social, religious and cultural needs of each individual. There was also evidence to confirm that the prospective resident or their representative had received written confirmation that the home could meet their assessed needs. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 10 It was noted in the records of one resident there was detailed information from other professionals involved in their care, which supported their admission to the home. This information was used as part of the overall assessment therefore ensuring that their individual needs and requirements could be met. Prospective resident and their relatives are encouraged to visit the home prior to admission in order to meet staff and existing residents and to assess the accommodation for themselves. This helps prospective residents to get a feel for the home and enable any worries or concerns that they may have to be discussed. One staff member spoken with confirmed that staff had access to the assessment information and could clearly describe the care needs of residents. From discussions with residents and relatives, observations during the course of the visit and from comments on the Commission for Social Care Inspection surveys, there was good evidence to confirm that people were pleased with the care being provided and felt that their needs were being well met. This home does not provide intermediate care. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 11 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 & 10. Quality in this outcome area is good. There is a consistent care planning system in place to make sure that staff are in the main, provided with the information they need to satisfactorily meet residents needs. The health care needs of residents are well met with evidence of good multi disciplinary working taking place on a regular basis. The medication in this home is well managed promoting good health. Personal support is provided in such a way as to promote and protect resident’s privacy, dignity and independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the development of individual care plans has improved. The care plans evidenced now provide a more detailed account of Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 12 the individual strengths and needs. However, although care plans are more comprehensive, sometimes the detail is missing as to how an objective is to be achieved. The care plan should provide sufficient information to direct staff on what they need to do/the actual assistance required to achieve the stated objective. Whilst there is no suggestion that resident’s individual needs and requirements are not been addressed in practice, a more detailed care plan would help to ensure that a consistent service is provided especially when new staff are employed or agency staff are required. There were a variety of risk assessments in place with some evidence that care plans and risk assessments has been agreed and signed by the resident/relative. However there was some inconsistently with this. Wherever possible, the individual resident should be involved in the development of their care plan and invited to sign the care plan as acknowledgement and agreement to the content. In instances when a resident is unable or unwilling to become involved in care planning this should be recorded on the care plan. Alternatively and with the residents consent, the content of the care plan could be explained to a close relative who could then be asked to sign the care plan. A lot of important information is maintained with regard to each resident by way of the individual care plan, risk assessments, monthly reviews and informative daily records. However the information is somewhat scattered. The significant outcomes of any risk assessments undertaken should be incorporated into the actual care plan. Likewise when important information is written in the daily record that affects any element of the care plan, the amendments made should be clearly identified in the actual care plan. A member of staff spoken with explained that there is always a good verbal handover of information at change of shift. While this is good practice, the same member of staff went on to say that she relied totally on the verbal information sharing and the written daily records to update her information with regard to the current needs and requirements of residents. This was instead of reading the actual care plan. If staff do not read the directions in current care plans and rely totally on verbal information sharing or what is written in the daily records some important information could be missed. It is recommended that all relevant information be included in the actual care plan that is amended as and when required. This would enable all members of staff to have access to important current details in respect of each resident that they should read for themselves to ensure that every member of the care staff team is provided with the same information. All residents spoken with were however very pleased with the level of care and support provided and spoke very highly with regard to the staff team. One resident and her relative described the care as “first class” and that an “excellent choice” had been made when the decision was taken to live at Alma Green. A recently admitted resident also commented that “I am very pleased Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 13 to be here, I love it. I have been made very welcome and all the staff are very nice”. Residents spoken with felt their privacy and dignity was well respected and that staff were sensitive when they needed help with personal care. Staff had a good overall understanding of the needs of people who lived at the home and were seen to be patient, kind and respectful when interacting with residents. All staff receive training in respect of maintaining privacy and dignity during induction training and National Vocational Qualification (NVQ) training. Through discussion with residents and observation of documentation, there was clear evidence of good multi disciplinary working with health care professionals. It was noted that visits by health care professionals are individually recorded and residents spoken with felt that their health care needs had been fully met whilst they had been living at the home. Observation of practice and examination of care plan records confirmed staff were meeting the diverse needs of residents with specific disabilities and specialised equipment was readily available to assist them with their duties. A relative commented, “I have nothing but praise for the staff and the quality of care provided”. There are good systems in place for the administration of medication. These included good records of medications ordered, received, and returned. Information leaflets on the medications prescribed were kept available for both staff and residents. Dates of opening were recorded on eye drops. The medication administration records of a number of residents were examined and found to be well recorded and accurate. Medication is securely stored. Residents are enabled to self-administer their own prescribed medication within a risk assessment framework. Appropriate storage facilities are provided in individual bedrooms. The medication audit trail is clear. In addition the pharmacist who supplies medication to the home undertakes a periodic drug audit and advises staff on any drug related matters. Staff are also provided with a clear, easy read information sheet that explains what each drug is prescribed for, what the drug looks like and details of any possible side effects. Senior staff that have responsibility for the administration of medication have all completed an extended medication-training course that concluded with a workbook to complete in order to assess competence. This ensured that all staff with responsibility for the administration of medication are competent to undertake the task. One of the secure medication storage areas does not have any natural ventilation that may lead to the temperature rising above the recommended maximum of 25 degrees Celsius. A fan has now been provided that is helping Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 14 to maintain an acceptable temperature in this area. To find a more permanent solution, arrangements have now been made for airflow vents to be fitted that should ensure that the temperature in this area is controlled. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. Improvements have been made to the availability of social activities in order to provide a more socially stimulating environment for people to enjoy. Residents are encouraged to keep in regular contact with family and friends in order to maintain family and friendship links. Dietary needs of residents are well met with a balanced and varied selection of foods served that in the main residents enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The social interests of residents are recorded and residents are provided with a variety of activities to enjoy. The registered manager explained that since the last inspection effort had been put into providing more activities to meet individual needs. One resident commented on a Commission for Social Care survey that “My disability restricts me on a lot of activities available, but to overcome some of them, I now have joined the R.N.I.B. club through Alma Green and now receive talking books which I thoroughly enjoy”. Another Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 16 resident wrote in answer to the question ‘Are there activities arranged by the home that you can take part in’ “Improvements but more activities to stimulate the mind would help” and a third resident wrote, “To have more social activities”. The registered manager is aware of the comments made and it is understood that the range of activities on offer will be reconsidered. However other residents were very satisfied with the activities and entertainment already provided. Although there is a weekly activities programme activities are kept flexible. Board games, bingo, puzzles and a quiz are available, some residents enjoy sing songs and line dancing with staff, pampering and nail sessions are arranged and every evening there is a music session with sherry, lager, wine or lemonade for residents to enjoy. There is also the Lyric which is a room designed as a cinema. A large selection of films is available. On the day of the inspection a number of residents were clearly enjoying a Fred Astaire Film during the afternoon. In addition, there is a monthly cinema night when a person visits the home with a large cinema screen and a selection of films. This takes place in one of the larger downstairs rooms to enable all resident to participate if they so wish. Ice cream is provided during the interval. A singing group also visits the home on a regular basis to entertain residents and residents and their families enjoyed a bonfire night hot pot supper. A programme of Christmas activities has been arranged. Two residents spoken with however explained that they did not wish to participate in many activities preferring to spend most of the day in their bedrooms. This was respected. A number of residents also regularly go out with members of their family and a member of staff will escort residents to attend a church service each Sunday at the church next door. A church visitor also visits the home each Sunday to give communion and to conduct a short service for those who wish to participate and a Church minister visits monthly to conduct a full service. As observed, it was clearly evident that residents can entertain visitors of their choice at a time to suit them either in a communal area of the home or individual bedroom accommodation. The relative of a resident spoken with who visits on a very regular basis, stated that he is always made welcome and confirmed his satisfaction with the level of care provided and that he is kept informed about the resident’s well being. Another relative wrote on a Commission for Social Care Inspection survey form that, “With family and friends that come to visit my wife the staff are extremely friendly and polite. They do keep us informed as to what has gone on and what is going on”. All residents wherever possible are encouraged and enabled to retain independence in respect of financial affairs for as long as they wish to and as long as they are able to. However in reality a number of people living at Alma Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 17 Green have assistance from family/friends or an independent advocate. Information regarding local advocacy services is available for residents or their family to access independently. Through discussion with a number of residents and observation of some bedroom accommodation it was clearly evident that residents are encouraged to take personal possessions with them into the home to make their individual bedroom accommodation more homely and comfortable. Residents said they could get up and go to bed when they wanted and could use their own room as and when they like. Some residents chose to stay in their rooms for the majority of the time and ate their meals in their rooms as well. Examination of the menus confirmed that residents were being provided with a varied and well balanced diet and choice was available to them. Meal times were seen to be unhurried and assistance was being given where required. At the time of the inspection the tables were nicely set with condiments, cloth napkins, tablecloths, placemats, and table ornaments. Residents are able to have a drink and snack at any time. This was confirmed through observations during the visit and by the comments of a relative and resident spoken with. The majority of residents spoken with said that they enjoyed the meals provided. One resident said the meals were well cooked and presented and that staff asked her each day for her choice of menu for the following day. Another resident spoken with confirmed that a good variety of foods were served and that staff were careful about her diet as she is diabetic however she would like more salt in her food. A relative commented on a survey form, “Whilst the food is generally acceptable, vegetables are usually over cooked thereby negating much of their nutritional value” but the same person then went on to say, “Of the many homes I have visited, this is undoubtedly one of the very best. There are good systems in place to ensure that the needs and requirements of residents with specific dietary restrictions can be adequately addressed. At present one resident has a specific dietary need due to illness and a specialist nurse has been advising the home in respect of this person’s requirements. During the course of the evening meal it was observed that there was a relaxed and comfortable atmosphere in the dining room with friendly interactions taking place between residents and staff. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. The home has a satisfactory complaints system with evidence that residents feel that their views are listened to and acted upon. Staff have knowledge and understanding of adult protection issues, which helps to protect people who live at the home from abuse. However staff should undertake all elements of the adult protection training. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home has a detailed complaints procedure, which is made available to all residents on their admission. A copy of the procedure was displayed in the reception area of the home and also included in the Service User Guide. If anyone wished to make a complaint there was a form and a box in the reception foyer. Comments received from residents and relatives confirmed that they were aware of how to make a complaint and felt these would be listened to and acted upon. One relative stated” We have never had a problem. If there ever was one, it would be sorted out as soon as possible, nothing is too much trouble for the staff”. Another resident said in response to the question ‘do staff listen and act on what you say’ said, “Everyone is always very helpful”. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 19 A record is kept of any complaints made and the complainant is informed in writing of the outcome of the complaint investigation. One complaint had been received that was thoroughly investigated. The complaint was not upheld. The Commission for Social Care Inspection had not received any formal complaints since the previous visit. Although a record had been maintained of the complaint, the method of investigation was not clear. It is recommended that a form be devised for use when a complaint has been received. This form should provide a clear record of the complaint, method of investigation, outcome of the investigation, any action required as a result of the investigation and the date the complainant was informed of the outcome. It is understood that there is a procedure in place for dealing with allegations of abuse. However at the time of the site visit this could not be located. The members of staff spoken with had an understanding of the procedures to be followed in the event of any allegations or suspicion of abuse or neglect. All residents spoken with said that they felt very safe living at the home. Care staff receive adult protection training through induction training and National Vocational Training (NVQ). However members of staff are also expected to undertake video adult protection training ‘in-house’. Whilst this is good practice, along with the video training are workbooks for staff to complete once they have watched the video. However staff have not been completing the workbooks and therefore there is no formal measure in place to make sure that staff have understood the training provided. It is recommended that staff also have some understanding of the locally agreed protocols for reporting suspect adult abuse to ensure that they do not inadvertently take the wrong course of action. It is also recommended that all staff that undertake the adult protection video training also complete the accompanying workbook. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 20 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 & 26 Quality in this outcome area is good. The standard of the environment within this home is good providing people living there with safe, comfortable and homely surroundings. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents at Alma Green live in comfortable, well maintained and homely accommodation. Bedrooms are comfortably furnished and personalised to reflect the needs and wishes of the occupant. Communal space is varied and welcoming consisting of a number of smaller sitting rooms including a smoking sitting room, that are situated throughout the building and a large combined dining room/lounge. There is a passenger lift for ease of access throughout the building. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 21 All areas were clean, tidy and nicely decorated. There was a homely atmosphere. There were notice boards with pictures of events and information for residents and visitors. A handyman was employed so that minor repairs could be carried out as soon as possible. There are twenty-five single bedrooms and two double bedrooms. There was evidence that residents could bring in small items of their own furniture. All bedroom accommodation was provided with an en-suite facility, which encouraged privacy and independence for residents. All of the bedroom doors had a lock and everyone had a lockable storage space. This also gave residents some control over their privacy. There were sufficient bathrooms on each floor. Hot water temperatures throughout the home were randomly checked and found to deliver water at a safe temperature in line with health and safety guidelines. It was observed during the visit that the home was clean and hygienic ensuring a pleasant environment in which to live. The vast majority of staff had completed infection control training. There was a separate laundry room, which had a suitable washer and a dryer. There was storage space for the clean clothes before they were returned to the residents’ bedrooms. Liquid soap and paper towels were seen in bathrooms and toilets. Plastic aprons and gloves were available for staff and they were seen to use these. This promoted good infection control. Residents and relatives spoken with were all pleased with the communal and private accommodation provided. Residents consistently indicated on the survey forms provided that the home was always fresh and clean and a relative wrote in answer to the question, ‘What do you feel the care home does well’, that “It affords my very elderly father security and comfort while ensuring his dignity is maintained all within a very clean and odour free and exceptionally well managed home”. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. There is a good mix of staff offering consistency of care within the home. The arrangements for the induction and more advanced National Vocational Qualification (NVQ) training in care are good with staff demonstrating a clear understanding of their roles. Induction training is compliant with ‘Skills For Care’ induction training standards and provided to newly appointed care staff within the first six weeks of employment. There is a structured process for the recruitment of staff that includes obtaining satisfactory references and clearances in order to protect people living at the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There was a duty rota on display that gave the name, designation and hours worked by all staff. The staffing levels and skills mix at Alma Green Care Home is determined by the individually assessed needs of residents accommodated. A consistent number of staff is usually on duty throughout the waking day and all night staff have ‘waking watch’ responsibility. There is sufficient ancillary Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 23 staff employed to ensure standards in respect of domestic, catering and general maintenance are maintained. This has enabled a high quality service to be provided that takes into account the social, emotional, and psychological needs of people living at the home in addition to personal care needs. Staff spoken to said they were clear about their role and worked well as a team to ensure the individual and collective needs of residents was met. Comments received from staff prior to the visit indicated that there was sufficient staff on duty at all times. One member of staff wrote, “ Staffing levels at Alma Green are normally four in the morning and four in the afternoon (care staff) depending on absence due to sickness. Staff are called in to cover for shortages”. Another member of staff wrote, “The manager is always approachable and the staff work well as a team, we strive to give our home a nice friendly atmosphere”. Comments from residents and relatives were without exception, very positive about the management and staff team at Alma Green. One resident wrote, “Since moving here over two years ago, I have not had the desire to want to move to another home due to me being very happy and content at Alma Green”. Other residents described the staff as “brilliant”, “staff are very friendly, I am very pleased living here” and “the staff are all very good I can press the buzzer at any time and get attention” and “all staff are lovely, kind and helpful”. Positive comments about the staff group were also received from relatives. One person wrote “The staff are extremely friendly, do try their best under the situations/circumstances they find themselves. Many thanks need to be given to all the staff”. Another relative wrote, “I think Joanne (Manager) and her team, do a cracking job, they all work very hard to enable the residents to have a decent quality of life. It must be very hard when like my mother, to live in a home especially when away from friends and family. The girls go out of their way to help my mother and I”. Observations made during the visit confirmed that there was a genuine caring relationship between the staff, residents and their relatives. Training of staff is given high priority at Alma Green and there is a clear commitment to the training and development of all the people working at the home. All care staff are encouraged and enabled to undertake a National Vocational Qualification (NVQ) in care. The vast majority of the care staff team have achieved this recognised qualification at Level 2 that is commendable. The remaining recently recruited members of the care staff will undertake this course of study following completion of formal induction training. In addition, a further number of care staff are either pursuing or have achieved an NVQ award at a more advanced level. This shows that people working at Alma Green are appropriately and sufficiently trained to do the job expected of them. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 24 Since the last inspection improvements have been made to the recruitment of new staff. This is to make sure that people living at the home are protected. Since the last inspection, some new members of staff have been appointed. From observation of two recently appointed staff member’s personnel file, it was evident that the recruitment policy and procedures had been followed. This included an application form, health questionnaire, formal interview, references and a Criminal Records Bureau (CRB) clearance had been obtained prior to the applicant actually taking up post at the home. On commencement of employment at the home all staff are given the General Social Care Council (GSCC) code of practice and conduct. Induction training that is compliant with ‘Skills for Care’ nationally recognised induction training standards for care staff is provided to all new members of the care staff team. This follows the home’s induction training programme that is specific to the needs of Alma Green Care Home. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 25 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, 36 & 38 Quality in this outcome area is good. The home is well managed and run in the best interests of the residents. Health and safety procedures and training protected the welfare of residents and staff. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered Manager at Alma Green is competent and experienced, and has achieved a variety of qualifications including the Registered Managers Award. In addition, the registered manager is a D32/33 internal assessor and has undertaken a variety of further ‘short course’ training to update her skills and knowledge. There are clear lines of accountability within the home and the homeowner. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 26 The registered manager works to continuously improve services and provide an increased quality of life for residents. The manager is resident focused and leads and supports a competent staff team who have been recruited and trained to a good standard. There are clear lines of accountability between the registered manager and the homeowner. There was evidence that the homeowner visits Alma Green on a regular basis and produces a monthly written report on the conduct of the home. However the monthly report could be more detailed. This should include the topics of discussion between the homeowner and residents and the homeowner and members of staff and highlight some of the comments made. There was a clear understanding in the provision of care of the principles of equality and diversity and that residents should receive equal treatment and access the same resources without favouritism of discrimination. It was established that there was a low turn over of staff and those spoken with were happy working at Alma Green, felt that they were well supported and that the manager was very approachable and supportive. Prior to the visit the registered manager completed the AQAA (Annual Quality Assurance Assessment) and was able to show clearly what they did well and how they felt that they could improve the service for the benefit of the residents. Information gathered about the home showed that all the requirements made at the previous inspection had been appropriately addressed, which demonstrated a good standard of service was being provided. Quality assurance systems were in place, which included questionnaires given to residents/relatives to gain information about the service being provided and identify how improvements could be made. Questionnaires are freely available in the foyer area of the home for people to access at any time and surveys are provided for residents formally to complete at least annually. The most recently completed surveys were evidenced. The outcomes of the resident surveys are made known to residents by way of the monthly newsletter and through residents meetings that take place approximately every three months. Relatives are also invited to attend with relevant issues acted upon as soon as possible. Some discussion took place with the registered manager about devising a survey for other stakeholders such as General Practitioners (G.P.), District Nurses, chiropodist, hairdresser or any other person who has an interest in the home. This would also help to inform the internal quality audit. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 27 To supplement the formal process, informal processes are in place that includes informal daily dialogue with residents. This helps to influence change as does the resident meetings and staff meetings. The home had received a RDB quality rating of 4 stars. This is an external quality award that demonstrates the home’s commitment to providing a good quality service. The Annual Quality Assurance Assessment (AQAA) showed that people were supported to manage their own finances if they so wished and were able to do so. Secure facilities are available in all bedroom accommodation for the safe keeping of individual resident’s monies and personal items. However in reality, the families of the people living at the home often assist their relative in this matter. Where a request is made from either a resident or relative for the home to hold small amounts of monies for residents for personal needs, this is only agreed when the resident/relative gives written permission. Clear records are maintained in relation to residents personal allowances and any monies retained by the home for safekeeping. The AQAA questionnaire showed that policies and procedures were in place in relation to the handling and protection of residents’ finances so that appropriate safe guards were put in place however this could not be located at the time of the visit. The registered manager thought that staff had possibly ‘borrowed’ this for training purposes. There was evidence of one to one staff supervision taking place with good written records maintained that had been signed by the supervisor and supervisee. However one to one staff supervision was infrequent. The file of one staff member observed indicated that formal one to one staff supervision had only taken place three times over a thirteen-month period. From discussion with the registered manager, it is understood that annual staff appraisals also take place but this is not necessarily recorded. Formal one to one staff supervision should take place at least six times a year. At minimum one to one supervision should cover all aspects of practice, the philosophy of care in the home and career development needs. This would enable the supervisor to target individual staff’s needs, check out understanding and provide a formal platform for staff to discuss areas of importance specific to themselves. Alma Green ensures safe working practices are maintained through implementation of the home’s policies and procedures and staff training in respect of health and training issues. All members of the care staff team receive mandatory health and safety training covering a variety of topics including moving and handling, fire training, COSHH, infection control and first Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 28 aid training that is updated on a regular basis. However although catering staff have undertaken food hygiene training, care staff have not. It is recommended that all members of staff that prepare, cook, or serve food should receive this training. The AQAA questionnaire showed that systems and equipment at the home had been appropriately serviced to ensure that both residents and staff were adequately safeguarded. This was confirmed by the examination of a random selection of service certificates and reports. A variety of risk assessments had been conducted showing that any hazards had been identified and systems put in place to ensure any risks were eliminated or minimised so that those living at and those working at the home were adequately protected. Comments received from residents/relatives were very positive about the way the home was run. One resident stated, “This is a well managed and caring home” Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 29 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 N/A 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 X X X X X X 3 STAFFING Standard No Score 27 3 28 4 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 2 X 3 Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 30 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. 1. 2 Refer to Standard OP7 OP7 Good Practice Recommendations The directions in the plan of care for staff to follow should provide clear direction of how an objective is to be achieved. All significant information regarding a resident should be incorporated in the actual care plan. Care staff should read the actual care plans rather than just rely on verbal information sharing or written entries in the daily record. Residents or when appropriate their representative, should wherever possible, be involved in the development of their care plan and sign the care plan as acknowledgement of their agreement and understanding. It is recommended that a specific form be devised to record a complaint, the method of investigation, outcome, any action required as the result of the outcome and the date the complainant was informed of the outcome. The missing adult protection policy/procedure should be DS0000062739.V350491.R01.S.doc Version 5.2 Page 31 3. OP7 4. OP16 5. OP18 Alma Green Care Home 6 7. 8. 9 10 OP31 OP33 OP35 OP36 OP38 replaced. Staff that undertake adult protection video training should complete the accompanying workbook and have some understanding of the local protocols as detailed in the “No Secrets In Lancashire” document. The monthly Regulation 26 reports should be more detailed. Consideration could be given to developing a questionnaire for other stakeholders. The missing policy/procedure in respect of resident’s monies and valuables should be replaced. Formal one to one staff supervision should take place at least six times a year and staff appraisals documented. All staff that prepare, cook or serve food should receive food hygiene training. Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway 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. Extracts may not be used or reproduced without the express permission of CSCI Alma Green Care Home DS0000062739.V350491.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!