CARE HOMES FOR OLDER PEOPLE
College Green Rest Home 14 College Road Crosby Liverpool Merseyside L23 0RW Lead Inspector
Mrs Trish Thomas Key Unannounced Inspection 24th April 2007 10:00 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 College Green Rest Home DS0000005385.V336888.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. College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service College Green Rest Home Address 14 College Road Crosby Liverpool Merseyside L23 0RW 0151 928 2760 0151 9491252 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) Mr Ian Simon Prance Mrs Margaret Prance Mrs Pauline Ginnever Care Home 21 Category(ies) of Dementia - over 65 years of age (21) registration, with number of places College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. Service users to include up to 21 DE(E). 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. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. 6th July 2006 3. Date of last inspection 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. As the home does not provide nursing care, referrals are made to relevant mental health, general health and paramedical services for residents as needed. College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The methods used in this inspection were, discussion with and observation of residents in the lounge, discussion with the manager, Mrs. Pauline Ginnever and staff. Records compiled in the home regarding care practice, health & safety and staffing were read and a tour of the building was carried out. What the service does well: What has improved since the last inspection?
All but one of the requirements from the last inspection have been met, and that relating to removal of unwanted items from the grounds is repeated in this report with extended time limits given. College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 6 Requirements which were made during the last visit, with regards to the wedging of fire doors, (which causes a risk in case of fire) were being met during this visit. None of the fire doors were seen to be wedged, open at this time. Wheelchairs have footrests in place to avoid discomfort or risk of injury to residents. The training records show that staff had received training in protection of vulnerable adults, to ensure they are aware of the indicators of abuse and the procedures to be followed if abuse is suspected. Training in infection control is now being provided for staff to avoid risk of cross infection when staff are providing care, laundry duty and entering the kitchen. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 8 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. Prospective residents have had their needs assessed and are given the information they need to ensure that College Green can meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 3 and 4. College Green does not provide intermediate care and is not assessed against standard 6. College Green has a service user guide, which is provided to prospective residents (and their representatives before admission) to the home. The guide provides information about College Green, the service provided and principles of care. The guide is available in large print for ease of reference. College Green is registered for dementia (elderly) and residents’ pre-admission assessments (which were read), refer to their mental state and levels of understanding. Physical, social, health and personal care needs have also been assessed and the outcomes form the basis of each individual’s care plan
College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 9 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): Quality in this outcome area is good. Residents’ privacy and dignity is respected in College Green and they receive the care and support they need. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 7,8,9,10. All residents of College Green have a care plan. Care plans follow a standard format based on assessment, action plans and reviews. Two care plans were checked against the outcomes of their assessment and there were action plans in place to meet assessed needs. Risk assessments were in place where risks to safety and welfare had been identified, (for example, with regards to mobility and the environment) and care plans had been reviewed, at least monthly.
College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 10 For one resident a pressure care plan was in place stating the actions to be taken to support the resident, with visits from district nurses. The records of a community care review were read. A relative said, “I think the carers at College Green do a very good job.” The social worker has written, “(Name of resident) appears relaxed and well presented.” Residents’ diversity is addressed through support for their mental and physical frailty in College Green, and by compiling individual social histories including cultural and religious needs, and making arrangements to support them through links with the community (churches) and family members. All residents are registered with local general practitioners and there are records in their “clinical notes” of medical and paramedical referrals. A health care plan was read, which was to address the needs of a resident who is diabetic. College Green has a procedure for managing residents’ prescribed medication. The storage, recording and auditing systems were satisfactory, and there was certified evidence that staff have received related training. Medication is given to residents from the pharmacy containers, which are blister packs. The medication for two residents was checked and the tablets in stock, and numbers given to residents as recorded on the medication administration sheets, balanced with the number delivered to the home. Information leaflets about medication and possible side effects are contained in residents’ care files for staff guidance. Mrs. Ginnever (manager), said that reviews are arranged through G.P.s if any adverse effects from medication are observed. Residents’ privacy was being respected during the inspection as staff were supporting them discreetly, bedroom and bathroom doors remain closed. College Green has a policy on confidentiality and access to personal files. Residents looked well care for and obvious attention had been paid to their clothing and personal grooming in providing personal care and support. College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 11 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): Quality in this outcome area is good. The lifestyle experienced in the home appears to be meeting residents’ expectations. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 12,13,14,15. College Green has an activities diary (which has recently been reviewed), and is displayed in the hallway. In order to assess residents’ participation in activities, during the visit, time was spent in the lounge with residents and staff after the midday meal. A trolley of drinks and snacks was served to residents and then they took part in a game of bingo. Residents were chatting with one another and with staff, and appeared to be enjoying the social contact. A minority did not take part or had a short concentration span, some participated with enthusiasm and others with assistance from staff. College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 12 There were visitors to the home during the afternoon. They were made welcome by staff and spoke in private with their relatives. Visitors appeared at ease in College Green and one said that it was good to be able to call in regularly. Residents appeared at ease with staff and in each other’s company, they did not comment on the service in detail, but no concerns were expressed. Residents were moving freely through the lounge/dining area and the doors to the garden were open. Subject to risk assessment, residents spend time in their bedrooms if they prefer, in accordance with their levels of understanding and awareness of risk and orientation. The names and contact details of residents’ relatives are recorded in their care files and residents have access to local advocacy services if needed. Mrs. Ginnever confirmed that local ministers visit to administer communion to residents who wish to keep up their religious observances. Residents are offered choices and alternatives at meal times. The menus were read and were satisfactory, providing variety. The main meal is served at around midday with a choice of hot or cold, lighter meal in the evening with a snack at supper. The food stores were visited and were very well stocked, frozen and chilled foods (including meat), being labelled with dates and content. Records maintained in the kitchen were up to date and well organised (including fridge and food temperatures). Mrs. Ginnever said that fresh fruit and vegetables are bought in as needed. College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 13 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): Quality in this outcome area is excellent. Residents’ complaints are listened to and they are protected through staff training and awareness of procedures. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 16,18. A copy of the home’s complaints procedure is given to residents when they move in to College Green, and a copy is posted in the reception area in the hallway, with the service user guide. There has been one complaint about College Green to CSCI since the last visit. This was referred back to the registered providers for investigation. On the information available, it was difficult to reach a definitive outcome. The provider investigation was well managed and supported by a summary of the investigation process, and recommendations for staff guidance in future. The home has policies for protection of vulnerable adults and “whistleblowing”. It is recorded on the training roster that staff have received training in POVA and “whistle-blowing.” Staff have demonstrated commitment to the protection of residents through their awareness of POVA and “whistle-blowing” procedures. A copy of Sefton’s Adult Protection procedures and “No Secrets” are held on the premises.
College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 14 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): Quality in this outcome area is adequate. The building is generally in good order and impressions of the home will be improved when the rubbish at the side is removed. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 19,26 College Green is a converted dwelling house situated in a residential area, opposite a park. There are shops, restaurants and bus routes a short walk away from the home. There is off-street parking at the front, and a rear garden, which is accessible from the lounge by ramp. College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 15 There is an ongoing maintenance programme and since the last visit, bedroom 13 has been decorated with new furniture on order, new flooring has been fitted in bathrooms and toilets, bedroom curtains have been replaced and two new freezers purchased for the kitchen. New quilts and pillows have been provided in all bedrooms. Mrs. Ginnever said that the ground floor, including lounge/dining area and hallway are to be decorated and new dining chairs (with sliders) to be provided for residents at the dining tables. The lounge/dining room provides communal space for residents. There is sufficient seating for residents for dining and relaxation. There are French doors to the rear garden, and the doors are left open in warm weather to enable residents to move freely inside and outside of the building. The garden (which is secure from the roadway), was in reasonably good condition at the time of visit as the grass had been cut. There is seating and shade for residents in warm weather. At the side of the building, a quantity of unwanted items was seen, (which looked like building debris), and it is recommended that this be removed to improve the home environment and first impressions of the building. The building was clean in the areas seen during the visit. Domestic staff are employed and provided with protective clothing and secure areas for locking away cleaning materials. There is training and instruction provided in the control of infection, and control of substances hazardous to health. The laundry was clean, spacious and well organised and the equipment was in working order. There are systems for returning laundered items to the owners and separate entrance and exit doors to avoid cross contamination between clean and soiled items. College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 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 consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. The numbers and skill mix of staff are meeting residents’ needs and they are protected by the vetting procedures in place. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 27,28,29,30. Staff rosters show that staffing levels in the home are consistently maintained. Mrs. Ginnever said that the care staff group is stable. A cook has recently been appointed. College Green has exceeded the target of 50 of staff having achieved NVQ qualifications and there is an ongoing training and development plan for staff. Individual plans and proof of training was seen in staff files, examples being, POVA and “Whistle-blowing”, dementia, managing challenging behaviour, medication in the care home, basic food hygiene and infection control. Mrs. Ginnever said that staff will also receive training in person centred planning in the near future. College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 17 College Green has a recruitment procedure, which includes advertising posts, interviewing candidates and taking up references and clearances for those appointed. The files of three members of staff were read, including a recently appointed person, and these gave evidence that the recruitment procedure is followed. Files contained application forms, references, employment dates, proof of CRB, POVA list check, supervision and training and development plans. The most recent appointed staff member had received induction training. College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 18 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): Quality in this outcome area is adequate. The home is well managed but improvements will be necessary to health and safety checks. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Standards 31,33, 35, 38. Mrs. Pauline Ginnever is the registered manager of College Green. Mrs. Ginnever has a management qualification (NVQ4) and seven years of experience in managing College Green and sixteen years of experience previously in a supervisory position, working with people who have dementia.
College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 19 Mrs. Ginnever said that College Green has a quality assurance system and questionnaires are distributed at six monthly intervals to residents and their representatives. The most recent examples were read and comments received on food, accommodation, care and staff were seen. Responses were positive Mrs. Ginnever said that if any negative responses were received, she would arrange for remedial action to be taken. There is also an annual quality assurance review carried out by a firm of consultants. Mrs. Ginnever confirmed that College Green has no interest in any resident’s financial affairs and residents have their own appointees, advocates, or enduring power of attorney if necessary. The charges for College Green are £420.00 - £452.00. Health & safety certificates and the fire book were read. Electrical Certificate 23/4/04 Gas Certificate 16/1/07 Environmental Health Officer 17/4/07 Lift certificate 14/9/06. The lift was called and was in working order. Water temperatures tests, last 26/3/07 (43 degrees). Legionella procedures, taps- monthly, tanks – six monthly. Fire alarm certificate 27/2/07 Last fire systems test, 26/3/07. To ensure that residents are protected in case of fire and that the alarms are working, fire systems tests must be carried out weekly. It will be necessary for water temperature tests to be carried out weekly, to monitor any changes and protect residents from scalds. College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 20 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 3 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 4 17 X 18 4 2 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 4 X 3 X 3 X X 2 College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? Yes 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 OP38 Regulation 13 (4) (c) Requirement To avoid the risk of fire, the grounds must be cleared of unwanted items, and be maintained in a condition, which is suitable for residents. (Repeated from the last inspection, extended time limit given). Fire systems tests in College Green must be carried out weekly to protect residents in case of fire and ensure equipment is working efficiently. Water temperatures in baths and showers must be tested weekly to protect residents from scalds. Timescale for action 24/05/07 2. OP38 23 (4) 24/05/07 3. OP38 13 (4) (c) 24/05/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations College Green Rest Home DS0000005385.V336888.R01.S.doc Version 5.2 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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
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