This inspection was carried out on 13th October 2005.
CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.
The inspector made no statutory requirements on the home as a result of this inspection
and there were no outstanding actions from the previous inspection report.
CARE HOMES FOR OLDER PEOPLE
East Green House East Green House The Green West Auckland Co Durham DL14 9HH Lead Inspector
John Trainor Unannounced Inspection 13th October 2005 10:40 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 East Green House DS0000031692.V254287.R01.S.doc Version 5.0 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. East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service East Green House Address East Green House The Green West Auckland Co Durham DL14 9HH 01388 832218 01388 832218 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) Durham County Council Mrs Christina Barnett Care Home 39 Category(ies) of Old age, not falling within any other category registration, with number (39), Physical disability (8) of places East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 25th January 2005 Brief Description of the Service: East Green House is registered for 31 Older Persons not falling within any other category and 8 persons with a physical disability (PD)(E). It is a well-established Local Authority home situated in the West Auckland community with its amenities and good road and public transport links to Bishop Auckland, Durham and Darlington. All bedrooms are single occupancy and are equipped and furnished to a satisfactory standard. The home provides a range of individual/separate lounges on both the ground floor and the first floor, offering a wide choice for service users including smoking and non smoking. A shaft/vertical lift is provided between ground and first floor as well as stairs for the more able. The home provides long term and respite/short stay services and dedicated accommodation is provided, together with specialised facilities, equipment and staff to deliver short term intensive rehabilitation and enable service users to return home (Intermediate Care). There is an attractive, well-tended garden to the rear of the home with seating and good access for the people who live there. East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection was unannounced and lasted 6 hours, during which there was a tour of the environment and several people who live at the home were asked their views on what it was like to live there. Three people had their care reviewed in detail to see how good the home was at providing for peoples needs. The homes representative on the day of inspection was the registered manager Christina Barnett. What the service does well: What has improved since the last inspection? What they could do better:
A system for ensuring electrical equipment is checked regularly and safe needed to be implemented to ensure the safety of the people living in the home. Further improvement was needed to some of the toilet areas to make them more pleasant for people to use. A review of the medication policy and recording practice was necessary to make sure people were not prescribed drugs they did not need and staff were recording in the monitored dosage sheets in line with recognised good practice. The frequency of fire safety training needed to increase in order to ensure all staff were trained in line with current guidance on fire safety issues. East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 6 Record keeping needed to improve to avoid the keeping of communal record files and ensure each person resident had a working care file which held all of their personal care records including risk assessment and risk management plans. The home was given instructions to improve these matters and make things better for people. 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. East Green House DS0000031692.V254287.R01.S.doc Version 5.0 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 East Green House DS0000031692.V254287.R01.S.doc Version 5.0 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 and 6. People could be assured their needs were assessed and the home was able to meet their needs before they made a choice to move into the home. EVIDENCE: Care management assessments were evident on care files and the home manager assessed people before confirming in writing their needs could be met. Rehabilitative care was provided in conjunction with community rehabilitation teams and occupational therapists to maximise peoples potential when deciding if they should return home. East Green House DS0000031692.V254287.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Though people had their health care needs met and recorded in a plan of care improvements to the record keeping process would enhance the continuity of care for people. EVIDENCE: People had access to both primary and secondary health services as evidenced in their care files. Hoists and equipment were available and maintained safely Staff received medication training. Medication fridge temperatures were recorded daily. Medication in the main home was stored safely though it is advised medication should not be stored in the manner currently practiced on the intermediate care unit and the secure medication room in the main home be used. East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 10 Recording on the medication sheets was not always completed in line with good practice with medication being prescribed by a G.P. and not given by staff with no record on the dispensation sheet. MARS sheets were filled in by hand with no signatures of who had completed them. Medication continued to be printed on the Mars sheets even when the person no longer needed them and though staff did not dispense these medications when they were not needed the sheets continued to show them as prescribed. It was recommended a review of the system be done with the local pharmacist to ensure a safer method of practice which removes any room for error. It was also recommended the provider reviews it’s policy on PRN medication as the current position, in practice, where G.P.’s are prescribing paracetemol four times per day just in case and staff are omitting them still leaves staff making the decision on whether the medication is needed and is worse than having a clear PRN policy for staff. Daily record sheets and moving and handling risk assessment/management plans were kept in a communal file instead of in the individual care file which meant when recording on peoples daily care staff do not refer to the plan of care. It was recommended that records are kept in the person’s individual care file to make the care plan a working document staff access every day and ensure continuity of care regardless of who is providing it. East Green House DS0000031692.V254287.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14 and 15. People were supported to continue with their expected lifestyle making choices about how they would like to live their lives. EVIDENCE: Some people consulted went out to the local club for a drink as they liked to do this. Staff were designated on a daily basis to ensure some activity took place in the home. One person was very proud of their gardening achievements. Contact with family and friends was supported and encouraged. People said the food was very good and it looked and smelled appetising. The cook was aware of special dietary needs for people. East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 12 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 and 18 People could be assured their views would be heard and responded to and that measures were in place to protect them from abuse. EVIDENCE: There was a copy of the multi agency strategy on adult abuse, which the home adheres to. Staff spoken to were aware of no secrets and the policy on suspected abuse. The home had a complaints procedure and leaflet explaining this for people resident in the home and their relatives. This included an insert on how to contact the Commission for Social Care Inspection if they wished to. East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 13 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 and 26. Though the home was clean and tidy, people could not be confident all aspects of the home were maintained safely. EVIDENCE: People had no complaints about the environment. The home was clean and tidy, some progress had been made to improving the toilet areas as pointed out in the previous report though there were some which still needed improvement. The portable appliances in the home had not been tested for their safety since 2003 and the home was required to have this done and provide evidence to the Commission for Social Care Inspection. East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 14 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 and 30. People could be confident the staff at the home were able to meet their needs. EVIDENCE: People living at the home said the staff were kind and considerate and met their needs competently and sensitively. Staff were deployed in sufficient numbers to meet the needs of the people resident. Staff files examined showed that the staff received training and were supervised regularly in line with the recommendations in the National Minimum Standards. Recruitment processes were robust and ensured staff were checked to minimise risks to people living in the home. East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 15 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, and 38. Though most aspects of the home were managed competently more attention was needed to ensuring the home was maintained safely. EVIDENCE: The manager had successfully passed her NVQ4 in management. Health and safety files were maintained and checks completed to ensure safety though the hard wiring certificate was not available in the home and had to be forwarded from the central office. Risk assessments were completed and risk management strategies in place. Gas safety certificate was in place and up to date as was appropriate insurance. Hoists and lifts were being maintained safely.
East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 16 Staff were appropriately supervised though supervisors needed to ensure their recording of these sessions is more robust. Portable Appliance Testing had not been carried out in the home and the home was required to do this to ensure the safety of those people resident. East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 17 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 3 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 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 3 17 X 18 3 1 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 3 X 3 X X X X 1 East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 18 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 OP9 Regulation 13 (2) Requirement Timescale for action 31/12/05 2 OP19 16 3 OP19OP38 13 (4(a&c)) 4 OP38 23 (4(d)) The registered manager must review current medication recording practice to remove the recording anomalies identified in this report and reduce the risk of accidental administration of medication people do not need. WCs identified during inspection 31/12/05 to be refurbished to provide a more domestic style environment. (Previous timescale of 25/04/05 not met.) The electrical hard wiring and 21/10/05 PAT test certificates were not available for inspection and must be made available to the Commission for Social Care Inspection before 21st October 2005 to evidence the safety of the installation and equipment. The registered provider must 31/12/05 ensure all staff receive fire safety training appropriate to the policy for the home with refreshers 6 monthly for staff who work days and 3 monthly for staff who work nights. East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 19 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 OP7 Good Practice Recommendations It is recommended that all care records pertinent to the delivery of care to an individual be stored in the individual care file this includes the daily record and moving and handling risk assessments. This will enable the care plan to be a working document and encourage consistency of care among all staff. It is recommended there is a review of PRN medication policies and practices to ensure an outcome for the individual which is safe and provides clear guidance for staff. Where staff are handwriting instructions on MARS sheets these should be signed and countersigned by a fellow staff member to ensure they are an accurate reflection of the G.P.’s prescribing advice. 2 OP9 East Green House DS0000031692.V254287.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Darlington Area Office No. 1 Hopetown Studios Brinkburn Road Darlington DL3 6DS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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