Inspection on 12/06/09 for Evergreen House

This inspection was carried out on 12th June 2009.

CQC found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Evergreen House 16/06/08

Evergreen House 11/01/08

Evergreen House 26/06/06

Evergreen House 08/11/05

Evergreen House 29/06/05

Evergreen House 02/11/04

Evergreen House 27/07/04

Evergreen House 07/03/04

Similar services:

Maple Lodge

Heathlands

Aston Court Nursing Home

Breme

Ravenhurst

Bank House

Inspirations

Ashcroft Hollow Nursing Home

Extracts from inspection reports are licensed from CQC, this page was updated on 12/10/2009.

Key inspection report Care homes for older people Name: Address: Evergreen House Lichfield Road Tamworth Staffordshire B79 7SF     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Keith Jones     Date: 1 2 0 6 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 35 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 35 Information about the care home Name of care home: Address: Evergreen House Lichfield Road Tamworth Staffordshire B79 7SF 0182750675 0182750120 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Jayantical James Bhikhashai Patel,Mrs Kailash Jayantical Patel Name of registered manager (if applicable) Miss Claire Nutter Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Age: Dementia (DE) age 55 and above. Physical disability (PD) age 55 and above. The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 9 Old age, not falling within any other category (OP) 28 Physical disability (PD) 10 Date of last inspection 9 0 10 Over 65 0 28 0 Care Homes for Older People Page 4 of 35 Brief description of the care home Evergreen House is located in Tamworth, Staffordshire. It is situated in a residential area and is accessible via public transport and is close to local amenities. The service provides care to older people, some of whom may have a physical disability or dementia care needs. The three storey-detached building provides accommodation for twenty-eight people on the ground and first floor level, comprising of sixteen single and six shared bedrooms. Although en- suite facilities are not provided bathrooms and toilet areas are situated close to bedrooms and communal areas. The ground floor offers a separate dining area, compact lounge, and a large conservatory that is utilised as a lounge. All areas are equipped with essential furnishings and fitments to promote the comfort of people who use the service. A passenger lift enables people to access all floors. Ramped access is provided at the rear of the property only. Ample car parking is available at the front of the building secure gardens to the rear. The full range of charges were not detailed in the services Statement of Purpose, or Service User Guide documents, the reader may wish to contact the service to obtain this information. Care Homes for Older People Page 5 of 35 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: We conducted this unannounced inspection with the Acting Care Manager, and senior care staff on duty, whose input contributed to this report. Our inspection of the Home allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 26 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with personal care needs. To do this we looked at (case tracked) three peoples files from admission referral to the present time, and three staff files were examined. We also looked at other information such as complaints, incidents, events and other professional reports. We took the opportunity to speak with a number of people who are using this service, relatives and members of staff, who took an active role in our inspection process, their input contributed to the subsequent report. We acknowledged receipt of the Annual Care Homes for Older People Page 6 of 35 Quality Assurance Assessment (AQAA), and nine survey forms returned that we sent out to people who use the service some weeks before the inspection. We inspected a sample review of administrative procedures, practices and records, confirming satisfactory practice and management. There followed an inspection report feedback, involving the Acting Care Manager, in which we offered an evaluation of the inspection, indicating those requirements and recommendations resulting from the inspection. Care Homes for Older People Page 7 of 35 What the care home does well: What has improved since the last inspection? There is recognition that a more person centred care approach has been generated, and a greater involvement by people who use the service and their relatives. We were informed that a greater emphasis in receiving peoples opinion has resulted in an awareness of expectation and concerns, including the insufficiency in providing meaningful activities and social interaction. There is some evidence of managers having taken on board the views and the importance of socialisation, however there remains much to develop, especially in providing time and resources to people with dementia care needs. We have also acknowledged a much improved report and monitoring system, again with more improvements still to be achieved. During the past year we recognized the efforts to manage and maintain the general level of decor and furnishings, although insufficient to meet an increasing wear and Care Homes for Older People Page 8 of 35 tear, and in addressing the needs of people with a higher dependency of care. We have recognized an improvement in the recruitment and induction of new staff, with a more robust process and management approach. Establishing a person centred basis of working has identified the importance of the staff induction programme, relative to the needs of people using the service, although inadequate staffing levels and maintaining a sound training scheme remains a challenge. There have been a recognizable improvement in meaningful training for staff, and a much improved staff morale. What they could do better: If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. Care Homes for Older People Page 9 of 35 You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 35 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 35 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The needs of people are appropriately assessed before they are offered a place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We examined the services recently revised Statement of Purpose and found that it provided an informative description of Evergreens aims, objectives, and the way it operated, although it was readily available for general distribution. We acknowledged that the informative Service User Guide is presented to all enquirers, and that information concerning fees payable were not included, but is produced in large print as and when necessary. We also advised that the Guide be updated to reflect changes that have occurred recently, and that an audio and pictorial version would help people to make an informed choice. It is stated in the AQAA, and we recognised that the Statement of Purpose represents the basis on which the home operates upon, offering those people who may use the Care Homes for Older People Page 12 of 35 Evidence: service, and their relatives, the opportunity to make an informed choice about where to live. A comment we received from a relative who completed a survey before the inspection: Mum stayed at Evergreen for three weeks prior to becoming a resident. Our examination of three peoples care records and plans, indicated that each person had an individualised pre admission assessment, the amount of information recorded was adequate in forming an appraisal of that persons needs and capabilities, assessing the social background, and were consistent with dating and ownership of the assessor. We identified that the Acting Care Manager or her deputy, at the point of referral, conducts the pre-admission assessment. We found through our discussions with relatives and people using the service, that their involvement was taken into account, and that they felt included. We advised that each record showed the attention to details of individuality to allow the formulation of a care support plan, based on assessed, individual needs. A relative we talked to on the day informed us: My daughter looked around for me and she said it was a good place with good people. From our examination of care files we found that the assessor determines the suitability of the application in view of the facilities available, and at the capacity of the home, to manage the person and any special needs. We are satisfied that people are informed of those facilities, but have indicated that this process would be enhanced with a more detailed personal and social assessment report. A plan of care based on personal needs and daily living processes is then produced from the assessment information obtained. From our discussions it was evident that people are able to visit and assess the quality, facilities and suitability of the Home at any reasonable time, to meet with staff and management. No intermediate care took place in the home. Care Homes for Older People Page 13 of 35 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples needs are addressed through the care planning process, generally meeting principles of respect, dignity and privacy. Medicine administration systems and practice are safe. Evidence: We found that care records, through case tracking, showed that this standard is adequately met, maintaining a satisfactory quality process of assessment. The pre admission assessment represented the foundation for an organised care planning process, in association with Social Services reports if available. Each persons health, personal and social care needs are assessed in an individual plan of care, including those peoples, and relatives views, to reflect their changing needs, reinforced through a daily report. However we found a single instance when a recent admission for respite care had not had a plan organized for three days, to which a formal process of care was dependant upon pre admission information. There were no other cases involved in delayed care planning. There were also inconsistencies in the review process requiring the establishing of a monthly review of risk assessments and Care Homes for Older People Page 14 of 35 Evidence: care planning process. Three individuals care files were examined in detail, each demonstrated essential information on the individual, their life style and needs, events and contacts, procedures and actions monitored on a daily basis and reviewed. We noted the process of instigating separate care plans for specific issues, including temporary plans for events that have arisen, such as chest infections and falls. There were adequate risk assessments completed in areas such as manual handling, falls, nutrition, personal hygiene, and continence. The process has also established a degree of social awareness for each person, which has proved to be useful in enhancing understanding of personal needs, but could be developed more in line with improved socialization and activities based plans. We had evidence that physical, psychological and special needs are assessed and documented, along with a satisfactory monitoring process, such as nutritional screening, weighing, hearing and sight tests as appropriate. The General Practitioner (GP) of choice service is supportive; through which arrangements are made to provide professional support. Case tracking confirmed to us that specialist support and advice are sought as needed, with access to a local Doctor, Dentist, and Chiropodist. Comments we received from several people using the service and visitors: We have found that every member of staff have been very helpful to both of us, and have made a wonderful difference to mums outlook on life. She appears to have lost all the problems she had whilst living on her own. Medical care, if mom required a doctor they are always very proactive. Moms room is always clean and tidy, and Mom is kept clean. Care for X, when I leave I have peace of mind that she is well looked after, having cared for her at home for six years. Staff are very helpful. There was a clear appreciation of the openness and opportunity to contribute. Carers were seen to generally interact with people who use the service with understanding and friendly compassion, people were seen to be supervised in the lounge areas. In the progress of meeting people who use the service it was acknowledged that their general appearance indicated that their health and personal care was attentive and effective. Care Homes for Older People Page 15 of 35 Evidence: Risk assessments were carried out on an individual basis, and now reviewed on a regular basis. Included in the care records were applications of established monitoring systems, following a process of recognition and evaluation. There were several people on high dependency care whose care plans, assessments, and reviews were well maintained, although the bedside care monitoring charts needed to be kept up to date, and completed on the set regime of care, and signed by staff on a 24 hour basis, to reflect, and evidence the observed standards. Records of Medical and District Nurses interventions confirmed their dependency needs, although no one was assessed as requiring nursing care. All of those people have been reviewed with family members, with an understanding that their continuing dependant needs will be met by the service. Continence is assessed on admission and promoted within the plan of care and saw that peoples nutritional needs, and weights were frequently reviewed. Care staff maintain all aspects of peoples personal care, overseen by the care management on a daily basis. We observed courteous interaction between people and staff, based on a level of confidence of mutual trust and respect. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their lifestyle, complimentary regarding the quality of their lives and the care they were receiving at Evergreen. We observed that the system of daily monitoring that continues to be subject to the capacity of individual staff members, with a dual system of report and tick box. We also noted that when events need recording, a senior member of staff or manager have it recorded in the weekly report summary, and review the care plan. The situation is much improved from the last inspection, although dependent on diligent management intervention. Staff training should continue to improve their written report skills. Comments and discussions with people confirmed their acceptance and confidence in the overall standard of care and service given: They take care of mum very well, as she is bed bound. The food is very good and the rooms are nice and clean. My mother has been here only three weeks, but within this time mum has received very good care. All the staff are caring, understanding and respect mums privacy. One visiting husband who visits everyday stated that he was very happy with the care that his wife is receiving in the home, that she is treated with respect and dignity, and that his wife is always clean and well presented. Another visitor told us that: The standard of care given was the most important thing. Care Homes for Older People Page 16 of 35 Evidence: We examined the administration of medicines, which adheres to procedures to maximise protection to people. The storage in a chain secured medicine trolley, within a corridor is adequate but poorly sited. We saw that medicines were being administered effectively, with no breaks in continuity. We advised that bottles of medicines were used that an opened date be written on the bottle. We found the receipt of drugs, storage, accountability, and disposal of unused medicines was audit trailed, accurate and appropriate. There were no people self-medicating at the time of inspection. The medicines fridge was secured and used appropriately, although poorly sited and requiring a daily temperature recording. Controlled drug arrangements were satisfactory. Self medication and risk assessment policies were seen to be satisfactory, with no one in at the time who wished to participate in the scheme. We confirmed that only suitably qualified staff administer medication, all have received updated training in the Safe Handling of Medications. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service. visitors and staff, and that relatives have freedom of visiting, which emphasised the importance of maintaining social contact. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. In our discussions with people who use the service and staff it was recognised that diverse needs were accommodated within the planning of care, with dietary, religious and personal matters identified, along with the diverse physical needs. Cross referencing accidents and events with care plans showed a connection of appraisal, although no regeneration of plans or risks assessments were noted. We were impressed with the confidence and closeness within the Home and the mutual respect that prevailed. Our discussion with visitors on the day was a fruitful exchange, with all being very complimentary of care. Care Homes for Older People Page 17 of 35 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Peoples rights to live a meaningful life are promoted, and people are offered opportunities to exercise choice and control over their lives. People are offered a healthy, well balanced diet. Evidence: We found the daily routine to be flexible and non institutionalised, offering choices for meal times, personal and social activities, including recognition of varied religious needs. Our discussions with people who use the service and staff, identified a relaxed and informal atmosphere in which the peoples needs were respected, with the security that there are familiar events to the day they could relate to. We recommend that a more detailed profiling of peoples lives be obtained at admission assessment, as a basis for individualised social care, offering choice and support. We recognise the principle that activities are a key element in the socialisation approach to care, with visitors encouraged to be involved in a partnership style with care staff. The home does not have an activity coordinator, and on talking with the Acting Care Manager it was apparent that there is a recognition to enhance the socialization role, with the allocation of a carers time to activities. During the course Care Homes for Older People Page 18 of 35 Evidence: of the inspection we saw staff interact with people in a positive and polite manner at times, although we also observed in the lounge areas limited distraction or entertainment for people using the service. We acknowledge resources are available to provide ad hoc entertainers, and a person to come in three times a month. We feel that there is insufficient attention drawn to offer a therapeutic service for people with dementia, and for people who have greater dependency needs. It remains our recommendation that creative ways of providing activities such as adapted equipment for those with disabilities; life story work and seeking individual interests would enhance life for people living in Evergreen House. This would be consistent with a Person Centred Care approach as stated in the Statement of Purpose. We also recognised that people would like the opportunity to enjoy outside activities in a potentially very attractive garden and patio area, well suited for the task. Comments we received from surveys issued to people who use the service before the inspection: They could do more activities and spend time with us. The cares spend too much time outside, and not enough with us. There is a major shortage of activities in the home, I dont know if this is cost, or staff shortages to supervise anything, although she doesnt like to come out of her room, and likes her own company. There are a lot of residents that like to do activities or have a good old sing song with someone brought in for the music. Could arrange more activities and outings. Better quality of food and some entertainment for residents. It is stated in the Statement of Purpose that personal choice and relative self determination are respected in policy and action. Throughout the inspection we found this to be true. Those individuals rooms inspected showed an influence of personalisation in the inclusion of belongings, some furniture and general decor, although attention was drawn to addressing the personal needs of people with dementia, in the furnishing of bedrooms. Our inspection of the Home demonstrated a degree of expressed individuality in most of the bedrooms inspected. Relatives and friends are encouraged to maintain social links as part of the planning of care. An Anglican service is provided on a monthly basis, and a local Baptist minister has sessions. A Roman Catholic priest attends on request, and a Church of England communion is given every fourth Tuesday. No other religious or spiritual needs were Care Homes for Older People Page 19 of 35 Evidence: presented at this time. We found that the standards of catering offered a good quality service, to which those people we spoke with were very complimentary of all aspects of quality. We recommended that the cook institute a menu on a four weekly cycle, whilst recognizing that present arrangements offered a wholesome, varied and suitable choice. We observed a very pleasant lunch served during inspection, with choices available between fish and chips and chicken casserole. A menu for the day was inspected and seen to offer a wide choice of meals throughout the day, served in comfortable and clean dining rooms. The quality and quantity of the food offered on the day was observed to be of a good standard. People interviewed confirmed that that the quantity and quality food provided was good: The food here is always good and tasty, always hot, and the staff are very helpful. Very good standard of cooking and choice available. Its always set out so nice. Although one survey comment received from a relative offered: We think it would be a good idea to have a menu of at least two choices of meal, because if they can cook something mom does not like, there is not much she can do about it. We saw that staff offered discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of people living in the home. We confirmed that the cook knew each person using the service, and some of the relatives. We discussed diversity with the cook, who indicated an awareness in meeting individual needs; there were no special (cultural) needs at the time. Individual preferences were recorded in assessment and conveyed to the catering staff, who met with, and discussed their requirements. Care Homes for Older People Page 20 of 35 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: We examined the complaints policy (reviewed 27.05.08) and found it appropriate and up to date. There were a few minor concerns, which we feel would be better dealt with through a record of Concerns, Complaints and Safeguarding, to record peoples concerns in a meaningful and effective manner. From our talks with people who use the service, and staff, it was evident that any small matters were handled immediately, discretely and to the satisfaction of all concerned. All people had received information on the procedure to complain, including reference to us. This process was evidenced through the Service User Guide, on examination and case tracking and discussion. We identified that there had been two complaints received by the Registered Provider, both seen to have been dealt with in a responsible manner. We have been aware of two safeguarding issues raised concerning people who are living in the home, with a satisfactory outcome from the action taken. Comments we received from people on the day of inspection: I dont know who to speak to if Im not happy, but the carer listens. Care Homes for Older People Page 21 of 35 Evidence: Usually some one to speak to. Our discussion with the Acting Care Manager confirmed that there is satisfactory evidence of a protocol and response, to anyone reporting any form of abuse, to ensure effective handling of such an incident. The policy and procedure for handling issues of abuse was examined, and found to be appropriate. We examined three staff records to confirm that staff were suitably checked through Criminal Records Bureau (CRB), and Protection of Vulnerable Adult (POVA) disclosure. We found staff received training on abuse at induction, this includes the right to whistle blowing, consistent with the Public Disclosure Act, 1998. Care Homes for Older People Page 22 of 35 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The Home provides a safe, satisfactorily maintained, clean and comfortable environment for the people who live there. Evidence: Evergreen House is located in a residential area of Tamworth, and is accessible via public transport and is close to local amenities. The service provides care to older people, some of whom may have a physical disability or dementia care needs. The three storey, detached building provides accommodation for twenty eight people, comprising of sixteen single and six shared bedrooms. The garden areas with garden furniture, gazebo and sheds were found in various state of repair, although secure. The garden area holds potential for people to enjoy the summer, but needs some attention after a harsh winter. Appropriate risk assessments need to be made to ensure full awareness to safety standards. A perimeter fencing is satisfactorily maintained, and the front garden and driveway offer a pleasant, well tended introduction to the home. We found that internal access was facilitated with suitable fittings of hand and grab rails, in adequate, well lit and airy corridors. We have indicated the need to develop the decor of corridors to reflect a growing need to assist people with dementia in pathway location signs, including corridors with themes and easily recognizable colour Care Homes for Older People Page 23 of 35 Evidence: coordination, linked in with familiar and individulised bedroom doors. There still exists an element of institutionalisation, with instruction notices place in inappropriate areas, to which the Acting Care Manager would seeking alternative ways of display. Wheelchair access was satisfactory throughout all areas of the home, although compromised on one side of the first floor area with storage cupboards, and medicines trolley. On admission the Acting Care Manager or her deputy assesses each individual peoples needs for equipment and necessary adaptations. Efforts had been made to provide a homely atmosphere, and the decor in most areas of home was found to be of an adequate standard, with some evidence of some bedrooms and communal areas looking tired and worn. The home provides two lounge areas and a conservatory, that were pleasantly decorated, providing essential furnishings and items to provide comfortable areas where people were able to interact, or to entertain their guests. A compact, homely dining area was clean and conducive to enjoy a good meal. Bedrooms were generally well maintained to peoples personal preferences although more worn since the last inspection. Nevertheless most bedrooms were personalised, with some displaying peoples own furniture, and most with personal belongings. Some of the original furniture is in continuing need of renewal. It is the policy that on bedrooms becoming vacant that each room is reappraised for redecoration, as confirmed during the Inspection. We found that a number of rooms demonstrated an going problem of storage of equipment, large personal items, dressings and pads, littering rooms and creating unnecessary risks. We have considered that there is a need to enhance personal space for people with dementia, in identifying bedroom doors, fitting items of easy recognition and usage, and installing a personal ownership to their rooms. An effective call system was tested, although some beds were seen without the facility, although empty at the time. A locked facility and lockable bedroom doors are available in each bedroom on request. The locking mechanism to bedroom doors needs to facilitate effective dementia care needs, or allow privacy with easy escape option. However those people we spoke with expressed a sense of belonging and satisfaction in the quality and presentation of their living areas with no one expressing any dissatisfaction. Some comments we have received in the course of inspection: They could move to a more modern building, but be sure to take the staff with you. I like living in Evergreen with the friendly staff and atmosphere. It is always clean and tidy with good meals. Care Homes for Older People Page 24 of 35 Evidence: Toilets were located on both floors and were in close proximity to bedrooms and communal areas. The Acting Care Manager expressed a willingness to meet any reasonable demand for special needs. We found the heating and ventilation to be satisfactory, and lighting was domestic in style. Fire equipment was inspected, and seen to be serviced and up to date. The kitchen was inspected, and found to present a well equipped and organised area. All fridges and freezers were well maintained and checked daily by the kitchen staff. The kitchen was clean and considered secure. We spoke with the cook who confirmed to us that she actively engages with people who use the service to determine their needs and little ways. She was aware of the issues of culture, ethnicity and age diversity, having had experience in dealing with a diverse population. It was agreed to commence a four weekly menu, and display the days meals for peoples information. The laundry was equipped to a good standard, that red alginate laundry bags were available for handling soiled linen, and that there were appropriate notices regarding chemical handling openly displayed. Peoples belongings were seen to be handled piecemeal, in an organised process, with no evidence of communal usage. Disposable gloves and aprons were seen in use, and liquid soap and paper towels were evident throughout. The home presented a clean and pleasant, mainly odour-free atmosphere, much to the credit of staff. Care Homes for Older People Page 25 of 35 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Further staff training, monitoring and supervision are required to ensure staff have the appropriate skills and knowledge to meet peoples needs. Recruitment processes are inconsistent and need review to ensure protection of the people who use the service from harm and abuse. Evidence: We confirmed that there were 26 people using the service on the day of inspection, of which 24 people were receiving care for dementia. We examined three weeks of duty rotas, and on the day of inspection the staffing levels were: Morning shift 1 Senior Carer and 4 carers (Plus deputy care manager). Afternoon shift 1 Senior Carer and 3 carers Night duty 1 Senior Carer and 1 carer. We recognised that the Acting Care Manager is supernumerary to the staffing roster. Flexible rostering with agreed overtime are used to accommodate shortfall due to sickness and absence, and agency staff are not deployed. Care Homes for Older People Page 26 of 35 Evidence: It was evident throughout the inspection that the demands placed on Evergreen through increased dependency and a higher number of people with dementia care needs, that staffing levels have not been adapted to cope with the demands. We have considered that night duty coverage requires three care staff each night to meet those needs. There is a growing recognition that the arrangements for activities are inadequate, with people getting little in the way of effective supervision, and motivation to socialize and engage, especially in addressing dementia care needs. The catering, maintenance and domestic hours were determined and found to be appropriate for the size of the home and the needs of people. Discussions with the Acting Care Manager confirmed that more than 75 per cent of care staff had receipt of the National Vocational Qualification (NVQ) at level II or III, with two staff members were currently undertaking the training. There was evidence that a training schedule has been established, and that training is undertaken, although records showed that mandatory subjects have not been addressed to ensure that all staff have up to date portfolios of achievement to ensure a level of qualification is offered to maintain quality of standards. We recognized that all the staff interviewed had received dementia awareness training. Those staff we spoke with advised us that they received a good induction programme on starting work at Evergreen. The Provider has established, and continue to pursue improved procedures for interview, selection and appointment of staff. We consider that the process would be enhanced with interview notes and a letter of appointment. An up to date photograph is recommended for inclusion in all staff files. We reinforced the importance of obtaining two references for all applicants. The thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of people. Three staff were interviewed and confirmed our observations. All new staff goes through a satisfactory induction process, that will ensure that they are going to have a solid foundation to work from. All staff have received the General Social Care Council code of conduct, and we advised that the staff record be reviewed in the way information is organised and presented. Discussion with staff demonstrated an inconsistent process of supervised practice, although much improve the managers fail to meet the required six sessions a year. Care Homes for Older People Page 27 of 35 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management team promote the health, safety and welfare of people using the service, and working practices are safe. People who use the service can expect that the home is run in their interests, based on openness and respect. Evidence: The previous Registered Manager had ceased employment, and a new Acting Care Manager has been in post since December 2008, and has worked in the care environment since 1989. She has experience as a carer in a residential home for the elderly, and promoted to Senior Carer before moving to Tamworth to work at Evergreen House as a carer, and laterly as an administrator. Miss Nutter was appointed Acting Care Manager, and has recently been successful in her registration interview with CQC. Miss Nutter currently has an NVQ level 3 in care, and is looking to commence her NVQ level 4 in management and care, she also holds a certificate in Supervisory Management, and a Btec in Infection Control. We recognise the role she Care Homes for Older People Page 28 of 35 Evidence: held as administrator, and advised her to get a replacement in to offer her some support and allow her to develop her key role as Care Manager. We have identified in this report our concerns over a number of issues to which the Acting Care Manager has acknowledged and demonstrated a positive response, and reinforced her commitment in promoting best practice to improve the service delivery. We also discussed the management and direction issues with the Personal Assistant to the Registered Provider, and established the foundation of those concerns, linked to the need to evaluate a resource plan to meet our requirements and recommendations. An random examination of administrative, monitoring, planning and care records showed to us a diligent attitude to effective record keeping. We found them to be generally well maintained in ensuring that the peoples rights and best interests are safeguarded, each were examined and found to be up to date. The Acting Care Manager offered evidence of procedures and safe working practices, and that the policy and procedure manual has recently been generally reviewed, and would be of greater help to staff to be updated to meet new situations, especially in light of changes in Mental Capacity, Deprivation of Liberties and Safeguarding regulations. We found that formal staff supervision had been held on an infrequent basis, were had not been kept up to date. It was agreed that a cascaded staff supervision programme would be reviewed to continue to meet a two monthly target. The accident book was seen and found to be in order, with a regular analysis of trends and frequency. Our examination of those records showed an effective follow through of action taken, including a review of care plans if necessary. Accidents occurring to those people we case tracked were seen to be cross checked with care plans, and logged into day report. We would advise that the accident log, following analysis be placed in the persons care file. Through the inspection process we found appropriate risk assessments in place for people using the service, through care planning, review and monitoring, and of the general environment, these are to be reviewed to encompass peoples security and safety, including a full unit inventory of risk. Health and safety notices can be seen throughout the Home, although Chemicals safety notices should be prominent in appropriate areas of use and storage. We were informed through the AQAA, and by the manager that financial arrangements are supervised and administered by the Registered Provider and Acting Care Manager in respect of pocket money, comfort fund and petty cash management. We advised Care Homes for Older People Page 29 of 35 Evidence: that two signatures be on the transaction and dated, and that the Provider does an annual audit of accounts. Care Homes for Older People Page 30 of 35 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 31 of 35 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 That the Care Manager 10/07/2009 generates a comprehensive care plan for all those people admitted to the Home, in a timely manner. To ensure that people receive the expected care foolowing assessment of their nees. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 1 That the Statement of Purpose and Service User Guide be updated to reflect change and that consideration be given to producing the documents in larger print and audio versions, to assist people with poor eyesight to make an informed decision. That the Statement of Purpose be readily available for distribution to relatives or people who wish to know more about Evergreen. That care staff continue to address the issues of a single standard of report writing in care plans and daily reports. 2 2 3 7 Care Homes for Older People Page 32 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 4 7 That the Registered Care Manager institutre an established practice of maintaining observation charts for people on long term high dependency care. That peoples care plans are reviewed on a regular monthly basis to maintain the effectiveness of the care planning process indelivering care to meet peoples needs. That the Care Manager ensures that when bottles of medication are opened that a record of the date of opening be placed on trhe bottle and packaging. That a daily check and record of the medicines fridge be established to ensure that drugs requiring refridgeration are stored at the correct temperature. Review and develop the range of activities and facilities for recreation available to people using the service through the provision of an activity co-ordinator, having regard to the needs of people to recreation and fitness. That a more detailed profiling of peoples lives be obtained at admission assessment, as a basis for individualised social care, offering choice and support. That a four week menu be introduced to ensure a varied choice is offered to people living in the home. A Concerns, Complaints and Allegation book be established to more effectively monitor incidents. That a full unit risk assessment programme be updated, to enable the management to review safety, and appraise facilities on a regular basis. That a progressive programme be initiated to upgrade bedrooms and lounges throughout the home to maintain the expected standard of living environment for people using the service. To consider the environmental arrangements for people with dementia, including provision of easy recognition, dignified identification of bedrooms and facilities to enhance their well being. That the Registered Prover provides adequate care staff on night duty, in raising the nightly cover to three staff. This will ensure a safe provision of staff in meeting the needs of 5 7 6 9 7 9 8 12 9 12 10 11 12 15 16 19 13 24 14 24 15 27 Care Homes for Older People Page 33 of 35 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations people living in the home. 16 29 That satff recruitment procedures are consistent and thorough, in ensuring two references are attained for each applicant, that an interview record and letter of appointment is sent on to successful applicants. That the Registered Provider ensures that all staff receive the required mandatory training to fulfil the aims of the service and meet changing needs of people. That policies and procedures are regularly reviewed in light of changing legislation,and of good practice. That accident logs be kept in the persons care file, and not held in a communal file, to comply with the requirements of the Data Protection Act and ggod practice. That the Registered Provider shall ensure that persons working in the care home are appropriately supervised. 17 30 18 19 33 35 20 36 Care Homes for Older People Page 34 of 35 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. 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