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Inspection on 13/09/07 for Carr Green Nursing Home

Also see our care home review for Carr Green Nursing Home for more information

This inspection was carried out on 13th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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.

What follows are excerpts from this inspection report. For more information read the full report on the next tab.

What the care home does well

The staff are friendly and they make visitors feel very welcome. Visitors are welcome to call and have a look at the accommodation at any time. People are always assessed before they move into the home to make sure that all of their needs can be met and it is the right place for them. Everyone looks well cared for. Relatives felt that the staff kept them well informed about any accidents or concerns about health issues. One person said "not only have they telephoned me in the middle of the night, staff from the home have visited my relative in hospital". People told us they enjoyed the meals. The home is appropriately staffed throughout the day and night to meet the needs of people who live there. These are some of the comments people made in the surveys they sent to us: "they do a very good job" "the level of care is above my expectations" "they care and provide a homely atmosphere" "staff are caring and hardworking" "the care of all residents is usually good. In fact if it wasn`t for the dedication of the long serving staff, I do feel the service wouldn`t exist"

What has improved since the last inspection?

The medication system is being managed properly, people are getting their medication at the right times. The bedrooms that have been redecorated look much brighter. Redecorating the corridors will improve the look of the home. The staff recruitment process is much better. All staff are checked before they start work at the home to make sure they are suitable.

What the care home could do better:

CARE HOMES FOR OLDER PEOPLE Carr Green Nursing Home Carr Green Lane Rastrick Brighouse West Yorkshire HD6 3LT Lead Inspector Lynda Jones Key Unannounced Inspection 13th September 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Carr Green Nursing Home DS0000001046.V346276.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. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Carr Green Nursing Home Address Carr Green Lane Rastrick Brighouse West Yorkshire HD6 3LT 01484 710626 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) Flowertouch Limited Mrs Sandra June Speight Care Home 31 Category(ies) of Dementia - over 65 years of age (3), Old age, registration, with number not falling within any other category (31), of places Terminally ill over 65 years of age (2) Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Can provide accommodation and care for seven named services users - category DE(E) 8th March 2007 Date of last inspection Brief Description of the Service: Carr Green provides both personal and nursing care for 31 older people in what was once a school. The home is located in Rastrick, close to local amenities. There is a small, safe garden area at the side of the home and car parking is available in the grounds. All of the accommodation is on one level and there is level access to the building. There are single and double bedrooms available. None of the bedrooms have en-suite facilities. Bathrooms and toilets are near to the bedrooms. There is one large lounge and a dining room. The kitchen and laundry are in the basement. The fees range from £395 to £485 per week. There is an extra charge for hairdressing, chiropody and personal newspapers. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The last inspection of the home took place on 8 March 2007. We have not made any visits to the home since then. This inspection was carried out to assess the quality of care provided to people living at the home. Two inspectors carried out the inspection over 7.15 hours. We talked to people who live there and to visitors who called in during the day. Discussion also took place with staff on duty. We observed care practice, looked at various records and looked round the home. We gave some feedback to the responsible person (who acts on behalf of the company) who called at the home during the inspection. We gave feedback to the deputy manager at the end of the visit. The manager completed a self assessment form, which provided us with some information about the service. We received this before we did the inspection. We have used some of the information in this report. We sent surveys to a sample of people who live at the home and their relatives, to the local GP practice and to some of the social workers who have contact with the home. We received replies from 6 relatives, 2 GPs and three social workers. We did not receive any responses from people who live at the home. The surveys provide an opportunity for people to share their views on the service with us. Information provided in this way is shared with the home without identifying who has provided it. The comments we received have been used in this report. Since the last inspection there have been two adult protection issues at the home. The investigation into the first one was very poorly managed by the home. The most recent one is still being investigated by the manager. What the service does well: The staff are friendly and they make visitors feel very welcome. Visitors are welcome to call and have a look at the accommodation at any time. People are always assessed before they move into the home to make sure that all of their needs can be met and it is the right place for them. Everyone looks well cared for. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 6 Relatives felt that the staff kept them well informed about any accidents or concerns about health issues. One person said “not only have they telephoned me in the middle of the night, staff from the home have visited my relative in hospital”. People told us they enjoyed the meals. The home is appropriately staffed throughout the day and night to meet the needs of people who live there. These are some of the comments people made in the surveys they sent to us: “they do a very good job” “the level of care is above my expectations” “they care and provide a homely atmosphere” “staff are caring and hardworking” “the care of all residents is usually good. In fact if it wasn’t for the dedication of the long serving staff, I do feel the service wouldn’t exist” What has improved since the last inspection? What they could do better: Information about the home needs to be available so that it can be given to people when they come to look round. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 7 People need to be asked if they would like to be more involved in the care planning process. Daily records need to be improved so that they show what care and support is being provided. Staff must be provided with adult protection training so that they are aware of their responsibility to protect the people they care for and report any poor practice that they see. People living at the home must be treated with patience and respect at all times. Lunchtimes need to be better organised so that people are not waiting for a long time for their meal to be served. There needs to be an annual development plan for the home, a plan for staff development and funding needs to be made available for staff training. The provision of staff training needs to be improved. Staff must be properly trained to carry out their work effectively and safely. In the surveys we asked people how they thought the care home could improve. These are some of the comments we received: “they need to increase the social activities” “some of the staff have been at the home for several years and have made constant efforts to improve the appearance by redecoration – with little support from the owners” “more money for improvements is needed from the owners. Staff have been known to decorate the home themselves on their days off” “it would be nice if everything was brought up to date. Some of the furnishings are very old fashioned” “perhaps some new wallpaper?” 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 Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 8 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 9 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 Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 10 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): 1,3 & 5 (standard 6 does not apply) People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People are assessed before they move in to make sure their needs can be met. People are encouraged to visit to help them decide if the home is right for them. Information about the home needs to be available so that people can take it away with them after making a visit or enquiry. EVIDENCE: Anyone considering moving into the home is welcome to visit, have a look round and talk to other people who live there. Relatives can call at any time if prospective residents are unable to get there. Everyone is assessed before they move in to make sure that their needs can be met at the home. We found evidence of this in the care plans. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 11 A copy of the service user guide and statement of purpose is available in the entrance area. Both of these documents provide some information about the home. Additional copies need to be available so that people can take information away with them. While we were there, two people visited on behalf of their relative who was in hospital, they were planning to visit other homes the same day. The member of staff who showed them round was friendly and welcoming and told them about the service provided, unfortunately there was no information for them to take away to look at later. The home is registered to accommodate 31 people but the statement of purpose states that the home can accommodate 24 people. This discrepancy has arisen because in recent years the double rooms at the home have been used as single rooms, this means that the number of actual places has been reduced. We will discuss this with the owner of the home. The home does not provide intermediate care. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 12 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s health care needs are being met. People are not always being treated with the dignity and respect they are entitled to expect. Medication is generally well managed. EVIDENCE: There is a care plan for everyone living at the home and these are reviewed monthly. At the last inspection in March 07, we asked the manager to make sure that,where possible, people living at the home are involved in their care plans . This gives them the opportunity to say whether the plan suits them and whether it could be improved. Some people are unable to do this because they have dementia, in these instances we asked the manager to ask relatives if they wanted to be included in the reviews. In the self assessment information we were told that people are Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 13 now more involved, but we could see no evidence of this on the documents we looked at. This needs to be looked at again by the manager. In the five surveys returned by relatives, they said they were kept up date with information about things such as hospital appointments and accidents. One person told us “perhaps a regular discussion (should take place) between resident/relative and key worker to look at the level of care being provided; see if there is a need to alter this; discuss any areas of concern and to give positive feedback to staff on the support they provide”. In the surveys, relatives told us that they thought people’s needs were either “always” or “usually” met. They said the home provided the support and care that they expected. The records show details of all contacts with health care providers such as GPs, district nurses, chiropodist, dietician etc. together with the reasons for visits and the outcomes. The GPs who completed comment cards said they thought the home met the care needs of the people living there. They told us they always see people in private, usually in their own rooms. A range of risk assessments are in place, which are reviewed each month. We saw that staff were following the moving and handling plans and using the equipment that was provided. The staff take time to help people with their personal appearance. In the self assessment, the manager told us that people are encouraged as far as possible to choose what they want to wear each day. We saw that everyone was well dressed and had had their hair done. People who live at the home are not always treated with the dignity and respect that they deserve. We were told about an incident where a member of staff behaved inappropriately, demonstrating a lack of respect and disregard for one individual. This person had been trying to attract the attention of staff, to ask for assistance to use the toilet. Visitors to the home had to alert the staff for help. This person was then left waiting for some time in the lounge. A member of staff is reported to have told this person loudly that she was making a fuss, and said that it would not have mattered if this individual wet herself as she was wearing a pad. This incident took place in the lounge in front of other people who live at the home and their visitors. The manager has been asked to investigate this matter. The improvement in the management of medication continues to be maintained. The records that we looked at were good, all records are signed appropriately and people are given their medication at the correct times. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 14 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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People’s social care needs are not being met. The meals are good and the menu is varied, but mealtimes need to better organised so that people are not kept waiting for their meals. EVIDENCE: We looked at four care plans. Each one contained detailed information about life experiences, information about people’s families, hobbies and interests and religious needs. It is not always clear how this information is used to ensure that people have the opportunity to take part in activities that fit in with their interests. For example, we read that one person liked art and craft, TV programmes, playing cards and gardening. However, the daily records told us that this person had “no interest in anything”. We could find no evidence to show that any effort had been made to engage this individual in any activities and there was Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 15 nothing to indicate that this area had been reconsidered at any of the monthly reviews. We were told that one member of staff provides activities “two or three times a week” between 1pm and 4pm. There is no programme of activities, staff told us “we ask people what they want to do, it’s up to them”. While we were there, people were listening to a CD in the lounge and chatting to each other. Staff popped in and out of the lounge during the morning, sometimes stopping to talk, making sure that people had a drink and generally checking to make sure that everyone was comfortable. The staff have different levels of skills in engaging people. Some staff are task focused, they concentrate on the job in hand and don’t really talk to people. Other staff are very good at including people in conversation, asking for their opinions and engaging in good humoured banter with everyone. The management team need to address this as a staff training issue. Relatives are not clear whether any activities take place. One relative told us “they take care of my mother’s physical and limited social needs. She is always nicely dressed”. Other relatives said “there should be more afternoon games” and “I am not sure if they have an activities person as there is seldom anything happening to stimulate or occupy the residents”. It would be useful to discuss the arrangements for activities with relatives at one of the family meetings so that they are clear about what is provided. Staff told us that the company does not provide enough money to cover the cost of entertainment. We were told that the company pays only £45 towards the cost of any entertainment that is arranged. We raised this issue in the last inspection report and asked the person responsible for the home if he would refer this back to the company for review. We were told that a small group of residents enjoyed the occasional glass of sherry when they watched TV; the company do not provide the sherry, it is either paid for by the staff or donated by relatives. As far as we are aware there has been no change to the amount allowed for entertainment and the staff are continuing to raise additional funds themselves. We looked at a sample of daily records. These records are a good source of evidence to show what care and support is being provided. They should help the manager to audit the care that is being provided and should show what is being done to meet each person’s needs. We found the daily records at the home very repetitive, they do not reflect the care and support that is provided. They give very little information about how people are spending their time. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 16 We looked at the records for eight different people for one day. Each one read “all care given as plan states”. We also looked at the daily records for one person over nine days. Each one read “ good diet, in bed”, good diet, sat in lounge”, “good diet, now in room”, “good diet, no problems, now in bed”. There is no information in any of these records about the quality of this person’s life, whether staff talked to him or whether he was invited to join any activities. Meals are served in the dining room, although they can also be served wherever people prefer to sit and eat. The walls are bare in the dining room, the room is large and it is not particularly well lit. Dining tables have cloths on them; they are laid with individual place settings, condiments and the menu for the day is displayed on each table. There is a file in the dining room that provides a reference for staff about individual likes and dislikes and about the type of diet people require, this means that people should always be given a meal that meets their dietary needs. The serving of the midday meal was poor and needs to be better managed. These are some of the things we saw: • • People were left sitting at the table for a long time waiting for their meal to be served. People sitting at the same table did not all get their meals at the same time, which meant that some people were sat for a while watching others eat. We noticed that people who were being assisted to eat by staff were not always told what they were being given. Staff had a conversation across the room about the sort of diet one person required. This is not very respectful. Two people were not offered soup. When we asked about this later no one seemed to know why. A possible explanation is that at least one person could not manage to eat soup from a bowl by himself. We asked why his soup could not be served in a cup? We asked staff to look into this. On a positive note, we saw staff keep going back to one individual who said he didn’t want any lunch. The staff were encouraging in their approach and eventually this person managed to eat some lunch. • • • • Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 17 • The food was hot when it was served and people told us they enjoyed the meals. Carr Green Nursing Home DS0000001046.V346276.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. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People living in the home are not adequately protected from abuse. EVIDENCE: There is a complaints procedure on display in the home. Four out of five relatives who completed surveys said they knew about the procedure, one person said they could not remember what the procedure was. Relatives said they would go straight to the manager if they had any complaints, one person said they would contact social services. People who live at Carr Green are not adequately protected from abuse. The procedures for reporting and investigating suspected abuse are not robust and staff do not have a clear understanding of their responsibilities in this area. In July 2007 we were told about an incident that occurred at the home where where one of the care staff allegedly shouted at a person living there, would not allow the this individual to leave the bathroom and did not use the hoist safely. The matter was inappropriately investigated and poorly managed. We have taken this up with the person who acts on behalf of the company that owns the home. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 19 In September 2007 further concerns were brought to our attention relating to poor practice at the home which is the incident we have already referred to in the Health and Personal Care section of this report, where a member of staff behaved inappropriately, demonstrating a lack of respect for a person living at the home. We were told that other staff witnessed these incidents but as far as we are aware they did not report this to the manager. We have passed on all of the information we have about these matters to the adult protection coordinator for Calderdale and the manager of the home is now conducting an investigation. All staff require further training on adult protection issues so that they are fully aware of their responsibilities in this area. In the self assessment sent to us before the inspection, the manager states that the home’s policy and procedure on protecting people needs to be updated. She also states that staff require additional training in this area. This needs to be arranged as a matter of urgency. Carr Green Nursing Home DS0000001046.V346276.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): 19,20,23,24,26. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. People live in a comfortable environment but work needs to continue on improving the décor and furnishings to improve the overall standard. EVIDENCE: There have been some further improvements to the home since the last inspection, but there is still work to be done to raise the standard of accommodation. The bedrooms are quite large. Many were double rooms that are now being used as singles. Some of the bedrooms have been redecorated and they look much cleaner and brighter. Every bedroom is personalised, many people have their family photos on display and everyone has their own toiletries in their room. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 21 In previous reports we noted that the bedrooms have strip fluorescent lighting in them. This is not the sort of lighting that is usually used in a bedroom, in a domestic setting. We suggested that some consideration should be given to changing the lights when the rooms are upgraded. In some of the bedrooms the strip lights have been already been changed but the new lights are not really suitable alternatives. Three small halogen spotlights have replaced the central light fitting in the room and there is one halogen light over the bed. The central fitting does not provide much light, which means it could be difficult for people with poor sight to see. The over bed light gets very hot when used and this could pose a risk to some people who could burn themselves. When we tried the new lights we found that some of the bulbs were not working, staff told us the bulbs do not last very long and they are constantly having to report this to the handyperson. The use of these lights needs to be reviewed. While we were there the corridors were being redecorated, making these areas look much cleaner and brighter. When we looked round, all parts of the home were clean and odour free. There is a pleasant, well kept outdoor seating area for people to use in the good weather. Carr Green Nursing Home DS0000001046.V346276.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. People who use the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. There are sufficient staff on duty at all times of the day and night to meet people’s needs. Recruitment practices are good. Staff are not provided with the training they need to make sure that they are competent to carry out their jobs. EVIDENCE: When we visited there were 22 people in residence. We talked to staff, looked at a sample of staff rosters and observed practice during the day and we concluded that the home is adequately staffed to meet people’s needs. During the day staff were available in the lounge where people were sitting. They did not always engage with people although they had enough time to do so. This is an area where the management team need to train and encourage staff to improve their skills. Recruitment procedures are good, references are always taken up and checks are always made with the Criminal Records Bureau to ensure that new staff are suitable to work with older people. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 23 According to the self assessment, 51 of the staff either have NVQ (National Vocational Qulaification) level 2 or are working towards this qualification. There has been no improvement in the provision of training for staff. The company does not have a good record of investing in staff and providing funds for staff training purposes. The management team have to use their initiative to find free training for staff so that they have the basic skills to do their work. The training matrix showed that some staff need to renew and update their training in some of the mandatory areas, such as basic food hygiene. This needs to be addressed so that people are properly equipped to carry out their care duties. Some staff told us that they were doing moving and handling training. They said that if the company has to pay for any training, the staff do not get paid to attend. Staff who are not on the duty when staff meetings are held do not get paid to attend staff meetings, they are expected to do this in their own time. The home’s policy on staff training and development states that all staff should get three days paid training each year. Nurses should get five days paid training each year. Staff told us they have never received this entitlement. This is something they need to take up with the company. Errors are still being made with the payment of staff wages. Several staff on duty told us they were very unhappy with the company’s repeated failure to pay them correctly. This has been taken up on behalf of staff by the management team but they have not been able to sort this issue out. This company needs to resolve this urgently to avoid staff demoralisation. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. People who use the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to the service. The home is not well managed and people living at the home are not adequately protected. EVIDENCE: The registered manager is an experienced nurse who has worked with older people for a number of years. She has not yet completed her NVQ level 4 in management. People who live at the home are not adequately protected from abuse. Poor practice is tolerated and is not being reported to the management team promptly. The company are failing to ensure that poor practice is properly investigated and that the home’s disciplinary procedures are being followed. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 25 The management team say they do not have sufficient time to review and update policies and procedures and deal with general management tasks because they are always on shift and they have very little opportunity to work together. At the time of the last inspection the registered manager and the deputy manager were working supernumerary. The company have now reduced this supernumerary time to 10 hours a week for the registered manager with 3 hours a day overlap between the registered manager and the deputy manager. The person who acts on behalf of the company said this was sufficient time to enable the registered manager to complete her management tasks. The registered manager currently chooses to work her hours over 3 days a week and the company have tried to ensure that the deputy manager covers the opposite shifts to ensure that there is always a manager on duty. The company that owns the home does not provide sufficient support to the management team. The registered manager has no control in certain areas, particularly where funding is involved. There is a heavy reliance from the company on ‘staff good will’ to raise money for entertainment and other items that benefit people living in the home. There is no annual development plan for the home, no plan for staff development and no funding available for staff training. The responsible person who acts on behalf of the company is not completing monthly reports on the home. These reports will make sure that he can check that the home is being managed properly, keep a check on the progress being made with redecorating and find out what people think about the service provided. We talked to a member of staff who holds money for some of the people living at the home and we looked at finance records. The records were up to date and accurate and receipts were available for all purchases. Information about the servicing and maintenance of equipment was sent to us with the self assessment, indicating that all of the records were up to date. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 x 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 X 18 1 2 2 X 2 X 2 X 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 X X 1 Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? NO STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15 Requirement People who live at the home or their representatives must be consulted about their care plans. This will give people the opportunity to comment on the care and support provided and say if it could be improved.(This requirement was first made on 8/3/07) People who live at the home must be treated with dignity and respect at all times. Timescale for action 22/11/07 2 OP10 18 25/10/07 3 OP18 13(6) All staff must have adult 22/11/07 protection training so that the people who live there are not put at risk. An up to date 01/11/07 redecoration/refurbishment plan must be provided showing what work still needs to be done in the home together with timescales for completion. Arrangements must be made to 01/11/07 carry out monthly visits to the home and make monthly reports available about the conduct of DS0000001046.V346276.R01.S.doc Version 5.2 Page 28 4 OP19 23 5 OP33 26 Carr Green Nursing Home 6 OP38 13(4) the home. The new lighting that is being installed must be checked to make sure it is safe and suitable for people to use. 25/10/07 Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 29 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. 3 Refer to Standard OP1 OP12 OP15 Good Practice Recommendations Information about the home should be available to give to people when they look round the home. The amount of funding provided towards the cost of entertainment should be reviewed. The mealtime arrangements need to be better managed so that people do not have to sit waiting for their meal for a long time. Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Brighouse Area Team First Floor St Pauls House 23 Park Square Leeds LS1 2ND 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 Carr Green Nursing Home DS0000001046.V346276.R01.S.doc Version 5.2 Page 31 - 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. 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