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 July 2006 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.V295368.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.V295368.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 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.V295368.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, at all times, employ a suitably qualified and experienced Manager who is registered with the CSCI. 06/01/06 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.V295368.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 the inspection were, discussion with residents, direct observation, discussion with three visitors to the home, the manager, Mrs. Pauline Ginnever, three members of care staff and the administrator. Records maintained in the home regarding care practice, medication, health & safety and staffing were read. A tour of the premises and building was carried out. A number of questionnaires completed by residents’ representatives were read and reference made to the pre-inspection questionnaire, which had been completed by the manager. What the service does well: What has improved since the last inspection?
Requirements from the last inspection have been met. Some recommendations are repeated in this report. The maintenance programme is ongoing, two bedrooms have recently been decorated, painting of the exterior woodwork has commenced and two freezers have been replaced in the kitchen.
College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 Page 6 90 of staff have achieved NVQ Level 2 or above and the mandatory training is ongoing. 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. College Green Rest Home DS0000005385.V295368.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.V295368.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3 New residents are admitted only on the basis of a full assessment undertaken by people trained to do so and to which the resident/representative and all relevant professionals have been party. EVIDENCE: The care files of five residents were checked for mental health and home’s assessments and those files were satisfactorily maintained. Community Care Review minutes held on the files showed the names of the resident, their representatives, and home’s staff being present and their comments noted by the social worker chairing the review. Referrals through the Local Authority were accompanied by social work assessments of mental capacity and behaviour, physical health, social and personal care needs. The psychogeriatrician has assessed the residents and there are ongoing referrals to mental health services as changes in a resident’s condition or behaviour is observed during residency in College Green. The residents’ care plans had been reviewed at least at four weekly intervals and residents and their
College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 Page 9 representatives attend a social work review prior to the placement at College Green being made permanent. College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 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): 7,8,9,10 The registered person promotes and maintains residents’ health and wellbeing through the home’s assessment and care planning procedures. Residents’ dignity/diversity has not been fully recognized and respected in some instances. EVIDENCE: The care plans were tracked and both followed a standard format. For both, the action plans were addressing the resident’s needs identified in assessments, or the outcomes of monthly reviews. Reference was made to the pre-inspection questionnaire, which states the names of all G.P.s who attend residents of College Green. Case tracking provided evidence that residents have access to their G.P., mental health professional, social workers and paramedical services such as opticians, chiropodists, dental and emergency services. College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 Page 11 The home has a procedure for managing residents’ prescribed medication. Drugs are stored in a locked trolley and there is a returns and audit trail of unused medication. Medication administration records were well maintained. The comments of the visitors of one resident were discussed with the Mrs. Ginnever (Manager). Residents’ dignity must be maintained by ensuring they have a supply of their own individual clothes, which fit, and are returned to their rooms when laundered. The family should be consulted as to who will take responsibility for choosing the clothes along with the resident. I visited the laundry, which is well organised, and there is a system in place aimed at returning laundered clothes to the owners’ bedrooms. A family said some of their relative’s clothes have gone missing. It is advised that staff receive training in equal opportunities/diversity. The daughter of another resident who was visiting said that the home, staff and care are fantastic and they look after her mother “very well.” College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 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): 12,13,14,15 The routines of the home are aimed at meeting the residents’ social and cultural needs and residents receive a varied and wholesome diet. There is scope for further development in providing regular and structured activities for all residents, in accordance with individual capacity and preference. EVIDENCE: Reference was made to the pre-inspection questionnaire where the manager quotes a range of activities available to residents including, “Dance, singing, karaoke, films, television, DVDs, games, art, craft, knitting, sewing, health and beauty, letter writing, reading, books, magazines, daily papers, religious services, exercise, live entertainment.” There were no events taking place at the time of inspection. Two visitors said that they have seen the activities calendar in the hall, but never see any activities being organised when they visit. It was a warm day and a number of residents were seated outside at tables in the garden. Some residents were inside, either dozing or watching television. Mrs. Ginnever said that at times it is difficult to motivate residents who are frail and lack understanding of what is expected of them. A coach trip had been arranged to the Botanical Gardens in Southport for residents escorted by staff. I have made a judgement that more could be achieved on a
College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 Page 13 day to day basis to stimulate and interest the more frail residents, this is on the basis of my own observations and the comments of the visitors. Visitors said they call regularly and there are no undue restrictions on visiting times. They were speaking with staff and residents in a relaxed manner and were offered a drink and given privacy. There is a ramp to the garden and the French doors were open giving residents access to the rear garden, which is secure. One resident said he gets up and goes to bed when he feels like it another said if she chooses to stay in her room her meals are brought up to her. Due to the residents’ reduced capacity and awareness of risk, there are some restrictions on their freedom. The outer doors are locked and the rear garden is secure for residents’ personal safety. Residents spoken with did not comment in depth on the food. The manager said that residents are offered alternatives if they do not want what is on the menu. There is a three weekly rotating menu, which is seasonally reviewed. The food stores were visited and were well stocked. There are regular deliveries of fresh meat, fruit and vegetables, a choice of cold drinks and cereals. 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. It is recommended that diabetic diets are recorded and held on the relevant residents’ care plans, and that the diet and fluid intake of one resident is monitored until such time as her general condition improves. College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 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): 16.18 Staff are aware of the definitions and indicators of abuse but are unclear as to the Local Authority’s procedures to be followed in initiating an investigation, within stated timescales, where abuse is suspected. EVIDENCE: The home has a complaints procedure, which is made available to residents and their representatives on admission to the home. There are also Adult Protection and Whistle Blowing policies. There was one unresolved complaint under investigation at the time of inspection. Staff have received in-house video training in Abuse in the Care Home and it is required that they receive training in Sefton’s Adult Protection Procedures. College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 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 interior of the home is suitable for its purpose being comfortable clean and generally well maintained, however the exterior and grounds require some upgrading. EVIDENCE: A tour of the building was carried out, including visiting the bedrooms of residents whose care plans were tracked. A resident who was occupying her bedroom looked very comfortable and said her bedroom is to her liking. All bedrooms are individual in decoration and layout and highly personalised. There is a lounge dining area with enough dining and easy chairs for twentyone residents. The rear garden is accessible by ramp from French doors and there are shallow steps to the front of the building. The home has an ongoing maintenance programme and two bedrooms have recently been decorated. There was a water leak in the corner of the kitchen, which requires remedial work. The painting of the exterior woodwork is not complete (as
College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 Page 16 recommended as a priority in the last inspection) and the rear garden, in use by residents, was strewn with rubbish and debris from repairs to the building. A new garden shed has been provided since the last inspection for storage of garden tools. The blue carpet in the upstairs toilet is badly stained and needs replacing. The laundry is well organised and has a one-way system to avoid cross contamination. The home employs domestic staff who are trained in health & safety and provided with protective clothing. Cleaning materials were stored in good quantity, secured under COSHH regulations. The building was clean and odour free at the time of inspection. College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 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): 27,28,29,30 Residents’ needs are met by the numbers of staff on duty and NVQ and mandatory training levels are good, some further training is recommended regarding adult protection and infection control. EVIDENCE: Staff rosters were inspected and were satisfactorily maintained. At the time of inspection, there were three care staff and the manager on duty, plus ancillary staff (cook and domestic) and the administrator, for 21 residents. Over 50 of staff have achieved a minimum of NVQ2 and a number of staff are awaiting places on NVQ3 / 4 courses. The home has a robust recruitment procedure and two staff files were inspected and were maintained in accordance with requirements under schedule 2 Care Home Regulations, containing the required identification, references and clearances. Three members of staff were spoken with and said they received regular formal supervision and ongoing mandatory training. They said that the manager and senior staff are supportive. Reference was made to the pre-inspection questionnaire where the manager gives details of staff training/instruction in the last 12 months. Managing Challenging Behaviour, Protection of Vulnerable Adults, Moving and Handling,
College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 Page 18 Emergency First Aid, Health and Safety, Food Hygiene, Fire Prevention (6 monthly for day staff, 3 monthly for night staff), Administration of Medication, Training Care Workers to Safely Administer Medication in the Care Home. Further training is recommended in Diversity/Equal Opportunities, Infection Control. College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 Page 19 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): 31,33,35,38 EVIDENCE: Reference was made to the manager’s c.v. Mrs. Ginnever has fifteen year’s previous experience as deputy manager of another EMI care home and six 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. Mrs. Ginnever has created an organised system for managing care files and takes personal responsibility for reviewing all residents’ care plans on a monthly basis. Quality Assurance Questionnaires Feb 06 were read, these are posted on the residents’ notice board in the hallway : Responses relating to accommodation,
College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 Page 20 bedrooms, staff and meals were mainly positive, scoring 1-3. (1 being highest score). Comments include “Meals are well cooked with alternatives.” “The welcome is excellent. Welcomed by cheerful staff.” “Very happy with the way…………is cared for.” “We as a family are very happy with the care and attention my mother receives at College Green.” The manager states in the pre-inspection questionnaire: “The home has no interest in any resident’s financial affairs and residents have their own appointees with the exception of one who works closely with her advocate.” The administrator and a relative confirmed this as being the case during the inspection. The manager supplied her schedule of staff supervision, which confirms staff’s comments that they receive formal one-to-one supervision sessions on a two monthly basis. Health & Safety Certification was inspected including the following: Electrical Certificate 23/04/04 Gas 16/01/06 Water Maintenance, two tanks replaced. Chubb Fire Alarm Testing Certificate: 21/06/06 Emergency Lights, Fire Alarm System 3/7/06 The following health & safety risks were observed: Fire door in lounge wedged open. An upper window not restrained. A resident was observed in a wheelchair, which had no footrests in place Rubbish and clutter to the side and exterior of the property. College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES
This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from:
4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable
CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 X X X X X X 3 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 3 X 3 X 3 3 X 2 College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 Page 22 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 OP18 Regulation 13(6) Requirement The manager must arrange with Sefton Council for training in the Local Authority Adult Protection Procedures. The manager must arrange for the leak in the kitchen to be repaired. The manager must arrange for the garden to be cleared of rubbish and to be maintained in a condition which is suitable for residents. The manager must arrange for all upper windows to be checked for effective restrainers. The manager must ensure that footrests are in place on residents’ wheelchairs. The manager must ensure that the fire doors are not wedged open. Timescale for action 03/09/06 2. 3. OP19 OP38 13 (4) (c) 13 (4) (c) 03/09/06 03/09/06 4. 5. 6. OP38 OP38 OP38 13 (4) (c) 13 (4) (c) 23 (4) (a) 03/09/06 03/09/06 03/09/06 College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 Page 23 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. Refer to Standard OP12 Good Practice Recommendations The manager should consult with residents (representatives) and arrange outings and structured inhouse activities according to assessment. (From previous inspection). The manager should prioritise attention to the exterior paintwork in the home’s maintenance plan. (From previous inspection). The manager should consider provision of a dishwasher for the home. (From previous inspection). The manager should consult with a resident and his family regarding the purchase of clothing. The manager should arrange for staff to receive training in equal opportunities/diversity. The manager should arrange for diabetic diets to be recorded and held on the individual’s care plan. The manager should arrange for the food and fluid intake of one resident to be recorded. The manager should arrange for the blue carpet in the upstairs toilet to be replaced. The manager should arrange training updates in infection control. 2. OP19 3. 4. 5. 6. 7. 8. 9. OP38 OP10 OP10 OP15 OP15 OP19 OP30 College Green Rest Home DS0000005385.V295368.R01.S.doc Version 5.2 Page 24 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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