CARE HOMES FOR OLDER PEOPLE
College Green Rest Home 14 College Road Crosby Liverpool Merseyside L23 0RW Lead Inspector
Mrs Trish Thomas Unannounced Inspection 6th January 2006 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 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.V277064.R01.S.doc Version 5.1 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 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.V277064.R01.S.doc Version 5.1 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, at all times, employ a suitably qualified and experienced Manager who is registered with the CSCI. 15/07/05 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 Mr. 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 front car park and a secluded rear garden. The home provides twenty-four hour care, accommodation, meals and laundry. Admissions to the home are made primarily through Social Services Departments and are subject to a mental health assessment. College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The methods used in this un announced inspection were, discussion with residents, the manager, Mrs. Ginnever and staff. Records compiled in the home were read, in relation to care practice, medication, staffing and health & safety. The lounge, medication area, kitchen and laundry were visited. What the service does well: What has improved since the last inspection?
Requirements from the last inspection in relation to legionella prevention, fire drills and instruction, have been addressed. A shed has been provided for garden tools and the hazards observed in the rear garden have been removed. Staff no longer carry out cleaning duties in areas where residents are eating their meals. Non-slip flooring has been fitted in some bathrooms as part of an ongoing programme.
College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 Page 6 What they could do better:
The manager must ensure that in instances where a resident may refuse the services of a G.P., this is recorded on the care plan and a risk assessment carried out and a review arranged with the relevant authorities. The manager must ensure that care plans are reviewed to fully reflect the means of meeting residents’ health needs, that refusals to accept medical treatment, and resulting action by the home, are recorded. These requirements are given in response to a matter, which arose during the last inspection (July 05) and have been queried in the provider’s response. Whilst the requirements would not apply in all instances, the home must have a system to ensure that their duty of care, is seen to be carried out, where residents may refuse medical treatment, due to dementia. The manager must not employ a person to work in the care home without having obtained, in respect of that person, information and documents referred to in paragraphs 1-7 schedule 2 Care Home Regulations. The documents referred to as not having been obtained, are two satisfactory written references and up to date CRB clearance. In meeting the requirement, the manager will ensure that residents are protected by the home’s recruitment procedure. The manager must ensure that fire systems tests in the home are carried out weekly. The manager must produce an up to date gas certificate and arrange for hot water outlets in baths and showers to be tested weekly and maintained at 43 degrees. In meeting the health & safety requirements, the manager will ensure, so far as is reasonably practicable the health, safety and welfare of residents and staff. The manager should consult with residents (representatives) and arrange outings and structured in-house activities accordingly. In meeting the recommendation, the manager will ensure that residents find the lifestyle experienced in the home matches their expectations and preferences and satisfies their mental health, cultural, religious and recreational interests and needs. The manager should prioritise attention to the exterior paintwork in the home’s maintenance plan. In meeting the recommendation, the manager will ensure that residents live in a well-maintained environment. The manager should consider provision of a dishwasher for the home. As care staff do the washing up after some meals, provision of a dishwasher would give them more time with residents and protect the home against the risk of cross infection.
College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 Page 7 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 DS0000005385.V277064.R01.S.doc Version 5.1 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 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 the following standard(s): 3 All admissions to College Green are subject to mental health assessments, in accordance with the registered category of the home, (dementia elderly). In addition, social work assessments on file include details of physical and personal care needs. EVIDENCE: Reference was made to mental health assessments, home’s assessments and community care review records. The files of three residents were read and contained mental health assessments undertaken prior to admission by relevant professionals, and there was also evidence of ongoing review of care plans post admission. In some instances, social services had arranged community care reviews, which had been attended by the residents and their representatives, social workers and senior staff from the home. College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 Page 10 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 the following standard(s): 7,8,9 In general, care plans appeared to address the needs, which were identified in residents’ individual assessments. Following the provider’s response to the last inspection report (15/7/05), which queries requirements (under Regulations 12 (1)(a) and 15 (1)(2) regarding duty of medical care for residents who may refuse treatment, those requirements repeated in this inspection, with extended time limits given. The home has a system in place for managing residents’ prescribed medication and staff who administer medication receive training. EVIDENCE: The format of care plans was seen to provide systems for in-house assessment and review and care planning for personal care and the needs of residents who have dementia. All residents are registered with a G.P. on permanent admission to the home. There is no procedure in evidence within the care planning process, to ensure that the home’s duty of care is discharged for residents who, due to dementia, may refuse medical treatment.
College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 Page 11 The medication storage area was visited and systems discussed with Mrs. Ginnever. The home has a written procedure for the management and administration of residents’ prescribed medication. The storage area was visited and medication was secure, records satisfactorily maintained, and systems for auditing and returns were in order. College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 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 the following standard(s): 12,14 The home has an activities calendar. There were no arranged activities observed during the inspection. There is scope for further use of staff one to one activity sessions with residents, and for individual outings with them. In supporting residents with dementia, a structured activities programme should be adhered to and wherever possible, should include community-based activities. A recommendation from the last inspection is repeated. Residents have access to advocacy services and are entitled to bring a reasonable amount of personal possessions with them when they move into College Green. The home does not become involved in management of residents’ personal finances. EVIDENCE: Discussion took place with the manager and residents. The home has an activities calendar. Two residents could not recall that arranged activities take place on a daily basis. A resident said there had been a party recently. One resident was seen to be busying herself with needlework and drawing, the remaining residents were not occupied. The home has adequate staffing levels to provide one-to-one support for residents when demands on their time allow. It would be possible for individual residents, who are able, to regularly visit local shops, cafes and the park, escorted by staff. College Green has one
College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 Page 13 lounge/dining area, where residents spend their days. The dining area is also used as a smoking area for residents and staff, and is occupied by a number of residents who are non- smokers. The home has a smoking policy and the manager said that residents and staff who smoke, use the garden in fine weather and the dining area, (when meals are not in progress), during cold weather. The cultural/religious needs of residents were discussed with the manager, who said that religious ministers visit the home regularly. Residents are assessed with dementia and do not have capacity to manage their own affairs. There was evidence on residents’ care files of input from advocacy services and ongoing reviews by social workers and mental health consultants. The administrator, Mr. Ryan, said that the home does not have any control over residents’ financial affairs, and that residents’ monies are not pooled or controlled by the home. College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 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 the following standard(s): Standards not assessed. EVIDENCE: College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 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 the following standard(s): 19,26. The home has an ongoing maintenance programme. Improvements were seen in the rear garden, where remedial action had been taken to address the hazards observed during the last inspection. The home was clean and hygienic in the areas, which were visited. EVIDENCE: Since the last inspection, non-slip flooring has been provided in some rooms and this is to be extended to the remainder of bathrooms and toilets. Some of the windows are to be replaced. A shed has been provided in the rear garden for storage of garden tools when not in use. There is an ongoing decoration and replacement programme and the areas of the home, which were visited, were in good decorative order. A recommendation regarding attention to exterior paintwork is repeated in this report. College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 Page 16 The home employs domestic staff, who are provided with protective clothing and training in infection control had been arranged for all staff. The kitchen and laundry were clean and well organised. Cleaning materials are stored and managed under C.O.S.H.H. regulations. College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 Page 17 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 28,29,30 Over 50 of staff have achieved at least NVQ2 and the home provides induction training for newly appointed staff. The home has a recruitment procedure, which is satisfactory. The procedure had not been followed with regards to the vetting of one member of staff. The home provides mandatory training for staff and video training, in accordance with the home’s statement of purpose and registered category. EVIDENCE: The manager confirmed that over 50 of staff have NVQ2 and that some have level 3, awaiting certification. Three members of staff were spoken with and they had received mandatory training updates and supervision. The home has a recruitment procedure and a well-organised system for securing and maintaining staff files. The file of a recently appointed member of staff, who is working in the home, did not contain up to date references or an up to date CRB clearance. The manager confirmed that she arranges updated mandatory training for staff and further instruction is provided by use of a number of training videos held in the home.
College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33,35,38 The home follows a quality assurance system undertaken by an independent assessor. Information was provided by the administrator, who confirmed that the personal allowances of residents are not pooled and that records of transactions are maintained. Health & Safety certificates were in order, other than where requirements are made regarding Landlords Gas Safety Certificate, Fire Alarm Systems Tests and testing and recording of water temperatures. College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 Page 19 EVIDENCE: Records of the most recent independent quality assurance audit in the home, were displayed in the hallway. The administrator confirmed that the home does not take control of residents’ personal finances and any money held, is in the name of the individual or their agent. Details of local advocacy services are available in the home and the manager confirmed that Power of Attorney has been arranged for some residents. A requirement from the last inspection, relating to legionella safety, has been addressed. The home was awaiting certification of the gas engineer’s recent annual inspection. The electric certificate was in date, April 04. The weekly fire systems test had last been carried out on 2/12/05 (these were three weeks overdue at the time of inspection). Water temperature tests (baths/ showers) had not been regularly carried out at weekly intervals. A recommendation from the last inspection regarding provision of a dishwasher is repeated in this report. College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 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 X X 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 X 14 3 15 X COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 2 X X X X X X 3 STAFFING Standard No Score 27 X 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 3 X 3 X X 2 College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 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 OP8 Regulation 12(1)(a) Requirement The manager must ensure that in instances where a resident may refuse the services of a G.P., this is recorded on the care plan and a risk assessment carried out and a review arranged with the relevant authorities. Ongoing as relevant from the date given. Outstanding from the last inspection, extended time limit given. The manager must ensure that care plans are reviewed to fully reflect the means of meeting residents’ health needs, that refusals to accept medical treatment, and resulting action by the home are recorded. Ongoing from the given date. Outstanding from the last inspection, extended time limit given. The manager must not employ a person to work in the care home without having obtained in respect of that person, information and documents referred to in paragraphs 1-7 schedule 2 Care Home
DS0000005385.V277064.R01.S.doc Timescale for action 06/03/06 2. OP7 15(1)(2) 06/03/06 3. OP29 19(1) 07/02/06 College Green Rest Home Version 5.1 Page 22 4. OP38 23(4)(c) 5. 6. OP38 OP38 13 (4) 13 (4) Regulations. Ongoing from the date stated. The manager must ensure that fire systems tests in the home are carried out weekly. Time limit ongoing from the date stated. The manager must produce an up to date gas certificate. The manager must arrange for hot water outlets in baths and showers to be tested weekly and maintained at 43 degrees. 07/01/06 06/02/06 07/01/06 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 OP12 OP19 OP38 Good Practice Recommendations The manager should consult with residents (representatives) and arrange outings and structured inhouse activities accordingly. The manager should prioritise attention to the exterior paintwork in the home’s maintenance plan. The manager should consider provision of a dishwasher for the home. College Green Rest Home DS0000005385.V277064.R01.S.doc Version 5.1 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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