CARE HOMES FOR OLDER PEOPLE
College Green Rest Home 14 College Road Crosby Liverpool, Merseyside L23 0RW Lead Inspector
Trish Thomas Unannounced 15th July 2005 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 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. College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 3 SERVICE INFORMATION
Name of service College Green Rest Home Address 14 College Road Crosby Liverpool Merseyside L23 0RW 0151 928 2760 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr. S and Mrs. M Prance Mrs. Pauline Ginnever Care Home 21 Category(ies) of DE - Dementia registration, with number of places College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 4 SERVICE INFORMATION
Conditions of registration: 1. Service users to include up to 21 DE(E) 2. A variation for 1 named out of category service user under pensionable age. This variation is applicable only to the named service user, should the named service user leave the Home or become of pensionable age, the variation will cease to apply. 3. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the CSCI. Date of last inspection 29th November 2004 Brief Description of the Service: College Green is a care home for 21 older people who are assessed with dementia. The home is owned by Mrs. S. & Mrs. M. Prance. The registered manager of College Green is Mrs. Pauline Ginnever. The home is situated in a quiet residential area of Crosby, opposite a park and close to bus routes and local shops and restaurants. College Green is a converted Victorian family house with a front car park and a secluded rear garden. The home provides twenty-four hour care, accommodation, meals and laundry. Referrals are made primarily by Social Services Departments subject to mental health assessment and, as the home does not provide nursing care, referrals are made to relevant mental health, general health and paramedical services. College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The manager of College Green, Mrs. Pauline Ginnever, was on leave at the time of this inspection and her deputy, Mrs. Janet Davies, was in charge. The inspection was carried out during the morning and lunch period and early afternoon. Three staff members were spoken with, records were inspected, and the interior and exterior of the building were visited. The residents of College Green looked well cared for and comfortable in the company of staff on duty. As all residents are assessed with dementia, the primary sources of evidence as to their life in the home, were by direct observation, reading care plans and by discussion with staff. One resident who commented said that she had settled in and had no complaints. She said she was comfortable and the food was satisfactory. She spoke mainly of her past experiences before living in College Green. Care plans were in place for all twenty residents. The format appeared suitable for addressing residents’ needs and the majority were well maintained. Shortfalls were noted regarding the care plan and health needs of one resident and requirements are made under Regulations 12 and 15. Management of prescribed medication was satisfactory at the time of inspection. College Green has an activities programme. There was no evidence that the home has provided supervised outings recently, a recommendation is made accordingly under Standard 12. The home has one lounge/dining area, which provides adequate communal space for twenty-one residents. Staff carry out domestic duties in the lounge area when residents are eating their meal. A recommendation is made under Standard 15 that this should cease. As residents of the home have dementia, the manager has taken satisfactory action to protect them from abuse, by establishing related policies and procedures and staff training. There is an ongoing maintenance programme and decoration of the interior is ongoing. A recommendation is made regarding the exterior paintwork, particularly at the rear of the premises and requirements made as to suitable maintenance of the rear garden, where some risks to health and safety were observed. Good staffing levels are consistently maintained in accordance with the roster, and ancillary staff employed. The home maintains health and safety records and the majority were satisfactory. Requirements are made where shortfalls were noted. What the service does well:
Mrs. Ginnever is a qualified manager who has many years of experience in the care of people who have dementia. There has been a nil staff turnover since the last inspection, which has provided the continuity of care necessary for people who have dementia. The residents appear to be benefiting from the familiarity of their surroundings and contact with staff, who are known to them.
College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 6 Visitors are made welcome and there was evidence of consultation with residents’ representatives and access to advocacy services in decision-making. Staff are experienced and trained to NVQ level, they receive mandatory training and updates. The home employs a cook, the kitchen records and environment were well organised, and there were good food stocks, which were appropriately stored. Domestics are also employed and all areas of the home, which were visited, were clean and hygienic at this time. The home has a recruitment procedure and staff files are maintained in good order. There are clear written communication systems in College Green, and a suitable care planning process. The home is situated near to a park, bus routes, shops and restaurants and there is a secluded garden at the back of the home with access through French doors. The home is comfortably furnished and bedrooms are personalised. What has improved since the last inspection? What they could do better:
Residents spend the majority of their time in the home in the communal lounge/dining area. No recommendation is made, but quality of life for residents could be improved by provision of an extra day room/conservatory at a future date. From the comments noted under Standard 7 and 8, with regards to the limited capacity of the residents of College Green and an instance of refusal of the services of a general practitioner. A record must be maintained on the care plan, of each instance of the service being offered/refused and of the remedial action taken by the home in response. A recommendation is made regarding provision of a dishwasher in the home to support the control of infection and to free care staff to their primary role, when ancillary staff are not on duty (in the evenings). Attention is necessary to the exterior of the building regarding the paintwork and the condition of the garden and provision of a tool shed. The hedge clippers were observed leaning with the blades upwards at the side of the ramp, which poses a serious risk to residents. All garden tools must be secured when not in use. Since the last inspection, contact has been made with Environmental Health Officers by the home, and a diagram of the water system of College Green was available at the time of inspection. There was no supporting certification that the storage of water in the home is in accordance with Legionella prevention and the work in obtaining this must be completed, in the interests of the residents.
College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 7 There was no evidence that any day trips had been arranged recently for the residents, or one to one outings to the shops or park. A number of residents were observed as having reasonably good mobility. For the more mobile residents and those prone to agitation, outings should be integrated in their activities programmes. For those who are frail, key workers should arrange frequent one-to-one sessions and trips out by taxi or wheelchair, in accordance with general assessment and risk assessment. 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. College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 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 Standards Statutory Requirements Identified During the Inspection College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 3,4,5 The home was meeting standards 3,4, and 5. All admissions to College Green are subject to mental health assessments, in accordance with the registered category of the home (which is Dementia Elderly). Prospective residents (or their representatives) are supplied with a service user guide and statement of terms of conditions, which are written in plain English, and large print copies are provided if required. Pre-visits are arranged and all admissions are subject to a twenty-eight day trial period. EVIDENCE: Residents care files were inspected and contained mental health professional assessments, which had been carried out prior to admission to College Green. The home has a system in place for ongoing assessment and review of care needs. Mrs. Davies confirmed that residents’ assessment of needs, is ongoing after admission, and are carried out by home’s staff. This is to ensure that the home maintains the facilities and skills to meet any change in need. Mrs. Davies confirmed that referrals are made for Social Services’ reviews and nursing assessments when a change of needs/deterioration in condition requires it. Some of the files, which were read, contained Community Care Reviews arranged by Social Services, attended by the resident, their representatives, social worker and the home manager, Mrs. Ginnever.
College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 10 Staff on duty confirmed that prospective residents are welcome to spend time in the home prior to moving in, and all admissions are subject to a twentyeight day trial period. The service user guide, which is given to residents (or their family), on admission, was read, and provides a comprehensive description of the service on offer in the home. College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7,8,9 The home was not meeting standards 7 and 8. Care plans in general appeared to be meeting residents’ needs. In one instance shortfalls were noted with regards to access to health care, and requirements are made under Regulation 12 (1)(a) and Regulation 15(1)(2). The home was meeting Standard 9 with regards to management of prescribed medication. EVIDENCE: Three care plans were read in detail and another was referred to, following discussion with a resident, to check that her health care needs were being addressed. There were shortfalls noted for this resident, regarding a full review of her tissue viability and appropriate medical treatment. The format of care plans was seen to provide systems for internal assessment and review and care planning for personal care and the needs of residents who have dementia. All residents have been registered with a G.P. Prescribed medication was secured in a locked trolley. The home has a written medication procedure. Records of administration were satisfactory at this time and staff who administer medication have received training (Intermediate Certificate in the Safe Handling of Medicines). College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 12 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,15 The home was not meeting Standard 12 with regards to arranged outings for residents. A recommendation is made under this standard that outings be arranged in consultation with residents/their representatives. The staff arrange some social activities and staff numbers are suitable to enable one-to-one with residents. Residents do not go out very often other than with their families. A number of the residents have regular visitors. The home was meeting standard 13 as contact with family and friends is supported by the home and residents have access to advocacy services. The home was not meeting Standard 15. The quality and quantity of meals was to a good standard. A score of 2 is with regards to the environment during mealtimes. A recommendation is made under standard 12 that staff do not carry out domestic duties in the areas where residents are having their meals. EVIDENCE: The home has a social activities calendar, which includes bingo, barbecues and outings to the nearby park and local shops. Newspapers are delivered daily and there are books, a music system and a television in the lounge. Mrs. Davies said there had been a barbecue a few days before the inspection. She said that there had not been any day trips this year, arranged by the home, but some residents go out with their families. There were no activities arranged at the time of inspection. The French doors to the garden were open and some residents were moving freely between the two areas.
College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 13 A number of risks to health and safety were observed in the garden and these are addressed under standard 20. From reading care plans and from the home’s records and policies, it is evident that there is an established communication system with residents’ families. There were details of contact numbers and addresses, for both families and advocacy services. Residents who live in College Green have limited decision-making capacity and there is evidence on record that family representatives have access to care plans. The communal areas of the home consist of one lounge/dining room. The majority of residents have their meals in the dining area, leaving those who are more dependent to remain in the lounge area, eating from small tables, some with assistance from staff. It is daily practice at this time, for staff who are not serving meals, to vacuum the lounge during the meal time when there are fewer residents around. This is not acceptable when residents are eating, as, due to the noise and movement, residents are denied the relaxed atmosphere they need to enjoy their meal. College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 14 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16,17,18 The home was meeting standards 16,17 and 18. Due to residents’ limited capacity to make decisions, there are systems in the home for the involvement of representatives in decision-making and social workers establish power of attorney when necessary, according to the residents’ individual needs. EVIDENCE: The home has an Adult Protection procedure and staff have attended a course entitled Abuse in the Care Home. The home has a series of videotapes for staff use in updating training. The “No Secrets” Document is held on the premises and is accessible to staff. The home has a complaints procedure (which is made available to residents and their representatives) on admission. Since the last inspection there has been one complaint made via CSCI, which was partially upheld and the home has carried out required remedial action. There has been one complaint passed for investigation to the service provider by CSCI, which is awaiting response from the complainant. Information on local advocacy services is posted on the residents’ notice board. The administration manager confirmed that the home does not become involved in residents’ financial affairs and that their savings are not pooled in a home’s account. College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 15 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20 and 26 The home was not meeting Standard 19. Internally, a number of rooms have been decorated since the last inspection. A recommendation is made under Standard 19 regarding the exterior paintwork. The home was not meeting standard 20 regarding the condition of the exterior. A requirement is made under Regulation 23 (2) (o) regarding action required to address the risks observed in the rear garden. The home was meeting standard 26 with regards to the cleanliness of the premises. EVIDENCE: There is an ongoing maintenance programme and a number of rooms have been decorated since the last inspection. Risks were observed in the exterior garden. There appears to be no storage for garden furniture and tools and the hedge clippers had not been put away. Building materials were observed near the fire escape. The fence, which screens the front garden, had gaps and was in need of repair, and the wooden bench was rotting and in time, could pose a risk to residents if it was to collapse. The lawn had been maintained and a table and seating was in place for residents’ use. The ramp from the building has shallow steps and, to minimise the risk of tripping, the levels must be highlighted.
College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 The home was meeting standards 27 and 29. There has been a nil staff turnover since the last inspection. The staff group has many years of experience in residential dementia care. Good levels of care assistants and ancillary staff are on duty in the home. The home has a satisfactory recruitment and selection procedure and staff files were well maintained. EVIDENCE: There is a standardised roster, which states the numbers of care and ancillary staff on duty throughout the day and night. The manager, Mrs.Pauline Ginnever, was on leave and her deputy, Mrs. Davies, was acting in Mrs. Ginnever’s absence. Staff files, which were inspected, were well organised and are secured in a locked filing cabinet. The staff files contained identification, application forms, references and CRB clearances, which was clear evidence of the vetting procedures undertaken by the manager when recruiting staff. Staff have undertaken NVQ and mandatory training and certificates were available. College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 17 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31, 38 The home was meeting standard 31. The manager, Mrs. Ginnever, has appropriate qualifications and experience to manage College Green. The home was not meeting standard 38 as some shortfalls were noted with regards to risk assessments and there was no evidence that staff had undertaken fire drills and fire safety training. Requirements from the last inspection regarding remedial work to kitchen surfaces, have been carried out. Requirements are made in this report under Standard 38.3 Regulation 23(5) as to Legionella prevention. A requirement is given under Standard 38.2 Regulation 23 (4) (d) (e) as to fire drills and training. A requirement is made under Standard 38 Regulation 13 (4) (c) as to risk assessment of the exterior garden. A recommendation is made under Standard 38.2 as to infection control and consideration to provision of a dishwasher in the home. College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 18 EVIDENCE: Reference was made to the manager’s c.v. held at CSCI area office, Crosby. Mrs. Ginnever has thirteen year’s previous experience as deputy manager of another EMI care home and four year’s experience as manager of College Green. Mrs. Ginnever has achieved MCI RSA 4 and undertakes ongoing training in accordance with her care and management roles in the home. Health and safety certification was satisfactory, other than for Legionella prevention. Water temperatures are pre-set at 43 degrees and four fail-safe valves had been recently replaced. College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 19 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 3 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 2
COMPLAINTS AND PROTECTION 2 2 x x x x x 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 3 3 3 x x x x x x 2 College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 20 No Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 8 Regulation 12(1)(a) Requirement The manager must ensure that in instances where a resident refuses the services of the G.P., this is recorded on the care plan, a risk assessment carried out and a review arranged with the relevant authorities. Time limit from the given date. The manager must ensure that care plans are reviewed to fully reflect residents health needs, that refusals to accept medical treatment, and resulting remedial action by the home, are recorded. Time limit from the given date. The manager must arrange for the rear garden to be maintained as follows : Provide a secure storage area for gardening tools. Highlight the levels on the ramp. Remove/repair the rotting bench Repair the side fence (near fire escape) and remove building materials from this area. The manager must ensure that work is completed on providing proof of Legionella prevention. The manager must ensure that regular fire drills and training are carried out and recorded. Timescale for action 16/7/05 2. 7 15 (1)(2) 16/7/05 3. 19 23(2)(o) 30/8/05 4. 5. 38 38 23(5) 23 (4) (d) (e) By 15/9/05 By 30/8/05 College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 21 6. 38 13 (4) c The manager must carry out a risk assessment of the rear garden, including: access/tripping hazards/security and residents access to garden tools By 14/8/05 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. 4. Refer to Standard 12 15 19 38 Good Practice Recommendations The manager should consult with residents(representatives) and arrange day trips according. The manager should instruct staff not to carry out cleaning duties in areas where residents are having their meals. The manager should prioritise attention to the exterior paintwork in the homes maintenance plan. The manager should cosider provision of a dishwasher for the home. College Green Rest Home F53 F03 S5385 College Green V242184 150705 Stage 4.doc Version 1.40 Page 22 Commission for Social Care Inspection Burlington House, South Wing, 2nd Floor Crosby Road North Waterloo, Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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