CARE HOMES FOR OLDER PEOPLE
Genesis Care Home 76 Wimborne Road Bournemouth Dorset BH3 7AS Lead Inspector
Debra Jones Unannounced Inspection 26th June 2006 10:45 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 Genesis Care Home DS0000003942.V303255.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. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Genesis Care Home Address 76 Wimborne Road Bournemouth Dorset BH3 7AS 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) 01202 515713 01202 762880 Genesis Care Homes Limited Miss Andrea Louise Mangold Care Home 13 Category(ies) of Dementia - over 65 years of age (13), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (13) Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 15th March 2006 Brief Description of the Service: Genesis Care Home is a large, detached house, situated in the Winton area of Bournemouth. The home has ramped access and is a level walk away from nearby local shops, cafes and restaurants, churches and public houses etc. Local buses are available nearby to other parts of Bournemouth as well as Poole, Christchurch and beyond. Visitor parking for several vehicles is available at the front of the home and also on nearby streets. The front garden is mostly laid to lawn with flower borders and there is a more secluded garden with seating available to the rear of the property. The home is registered to accommodate up to thirteen older people with a mental disorder and/or dementia, within two double and nine single bedrooms. Accommodation is arranged on the ground and first floors, with a stair lift available to assist access between floors. Three rooms have en-suite facilities and there are sufficient communal bathrooms and WCs available on each floor. A comfortable lounge/dining room and adjoining sun lounge are available to residents. Twenty-four hour personal care is provided. Laundering of clothing etc is carried out on the premises. Activities are arranged on a daily basis and an inter-denominational religious service is held at Genesis every month. All meals are prepared and cooked within the home. Genesis is owned by Mrs Gene Mangold, trading as Genesis Care Homes Ltd and managed by her daughter, Miss Andrea Mangold. The Borough of Poole Social Services retains a block contract and makes the majority of placements at Genesis Care Home. Current fees range between £472 and £575 per week. A chiropodist visits the home every couple of months and charges residents “10 each visit. A hairdresser also visits and sees all residents two weekly. She charges on average of £14 each visit. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over 7 hours over two days. Day one was on 26th June 2006 and day two was on 29th June 2006. This was the first of the two anticipated visits of the year. The requirements and recommendations made at the last inspection were followed up. Some progress had been made. The Inspectors looked around the building and a number of records and related documentation were inspected. Gene Mangold the registered person for the home, and staff on duty assisted with the inspection. The Inspector sat and chatted with residents in the lounge in order to get a feel for what it is like to live at Genesis. Prior to the inspection the home gave out comment cards on behalf of the Commission to people living in, and interested in the service so that they could give feedback about their experience of the home. Four cards were returned from residents. Comments lead us to believe that their relatives assisted them to complete the forms. Comments included:‘my aunt is extremely happy in the home. The staff are exceptionally caring, kind and approachable. My aunt feels safe and secure in the home. She has put on weight and is so well looked after. She couldn’t be anywhere better. I am very impressed.’ ‘very caring and polite staff.’ On the first day of inspection due to concerns raised with the police nurses body mapped residents and care managers reviewed their care. Both considered that the home was looking after the residents well. Immigration officers interviewed staff and found that their residency and working arrangements were as they should be. Due to the high number of people in the home on the first day and the lack of availability of the manager for both days of inspection it was not easy for the registered person to find and explain all the paperwork requested during the course of the inspection. The management of the home are co-operating with the police in respect of a complaint made to them. What the service does well:
All residents have their needs before they are offered places at the home. Once accepted all receive contracts / statements of terms and conditions to make it clear what the resident can expect from the home and what the home expects from the resident.
Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 6 Residents get support from a range of health professionals working in the community. Administration of medicines was clearly recorded and audit trails indicated that medicines were given as prescribed and recorded appropriately. Staff were observed throughout the inspection to be treating residents with courtesy, patience and kindness. The home offers person centred activities, which focus on each resident, and their individual needs. Information about each residents past life, hobbies and interests etc is recorded and this usually involves input from relatives and friends. Some activities take place spontaneously and some group activities are arranged. Residents are encouraged to exercise as much control over their lives as possible and helped to make decisions about what they do each day. Visiting times at Genesis are unrestricted and visitors are made welcome. Residents are able to see their visitors in the lounge/dining room or their own bedrooms as they wish. Meals are served in the dining area of the lounge. A two weekly menu is in operation at the home. Meals are said to be based around the known likes and dislikes of residents. Information about residents’ likes and dislikes is gathered when they move to the home. One resident talked of how she enjoyed the meals. The home has a complaints procedure to reassure anyone wanting to complain to the home that they will investigate and respond to their concerns in a timely and appropriate way. The home has the space and facilities needed for the number of residents accommodated there. Bedrooms are comfortably furnished and contain the residents own personal items. The communal space comprises a lounge/dining room with a small adjoining conservatory. This room can be closed off from the rest of the lounge/dining room by means of a sliding door, providing additional space for activities or sometimes as a quiet room. Residents also have access to a rear garden, which is enclosed. There are paved areas where residents can walk. Patio tables and chairs are available and some residents enjoy sitting outside when the weather permits. There are a good number of staff on duty at any time available to care for residents living in this home. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 7 The home seeks the views of residents, relatives, health professionals, care managers etc, as a means of making any suggestions for improvements and ensuring the home is run in the best interests of residents. It is the policy of the home not to have any involvement in the personal finances of residents. Therefore, all residents who are unable or do not wish to handle their own affairs, have a relative or other representative to deal with their finances etc. The home never handles residents monies but pays for services such as chiropody and hairdressing and then invoices relatives or representatives for payment every month. Records confirm that equipment used in the home is regularly checked and maintained to ensure its safety. This includes proper maintenance of the fire warning system, emergency lighting and fire fighting equipment. Staff also receive regular training in fire prevention to ensure that they are fully equipped to deal with a fire should it occur. What has improved since the last inspection? What they could do better:
The home’s own statement of terms and condition is not the same as the authority who places there in respect of trial periods. This potentially confusing difference should be addressed. Every resident has a care plan, which should set out in detail the individuals care needs and how these are to be met. Plans need to be expanded to include all the areas of need that the home has identified and that care workers need to respond to. Assessments and plans also need to be regularly updated as needs change. Daily notes could do with being more descriptive in respect of events outside of the ordinary. All aspects of recording could do with improvement to show where residents become in need of health interventions and the follow through after medical advice has been sought.
Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 8 Residents should have access to the full range of toiletries any of us would expect, including shampoo. Allergies to medicines need to be recorded accurately on the MAR chart and the maximum and minimum temperature of the medicines fridge should be monitored. There should be confirmation from the district nurse who trained and assessed the competence of staff to give insulin and check blood sugar levels for individual residents. To ensure that residents are being treated with respect and dignity an audit of the home needs to take place to ensure that it is clean and that furnishings and furniture are in good repair. Part of the kitchen is currently being used as office space. This is not considered best practice by the Commission. There was evidence that cigarette smoking had been taking place in the kitchen. More care must be taken with regard to stock rotation, to ensure out of date items are not served to residents. Generally food needs to be stored and used appropriately. The Adult Protection policy has also been re-written but needs a further small addition. The home needs to resolve the problems they are having with their neighbours in respect of the impact that the redevelopment of the next door site is having on the home and the residents e.g. security and enjoyment of the outdoor areas. The laundry area was not clean and the sink in the corner of the sluice / laundry room was cracked and leaking. There were no towels or paper towels for staff to use once they had washed their hands in this area. The home has a laundry policy that is not reflecting the national minimum standards, practice in the home and advice from the Health Protection Unit. Genesis Care Home is not meeting the target of having 50 trained staff with National Vocational Qualifications (NVQ) level 2. The NVQ is a means of confirming an individual’s competence in actual work and a method for the manager to ensure that the care home has appropriately competent staff to deliver care. The home has a thorough recruitment procedure based on equal opportunities, to ensure the protection of residents. This policy needs to be adhered to at all times to ensure that only suitable people who have been through thorough pre employment checks work at the home. Information required by law must also be kept in respect of employment such as how many hours the person is to work every week. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 9 Examination of training files shows a variety of essential training has taken place. However, some training took place a while ago and is in need of updating. All care staff should also receive training in dementia care, dealing with challenging behaviour etc., to ensure they have the skills and knowledge necessary to care for the residents living in this home. The manager is experienced in working with older people with dementia, but has still not achieved completion of the National Vocational Qualification (NVQ) level 4 in management and care, to ensure she has the necessary qualifications to carry out her responsibilities in full. Accidents and incidents are being recorded but records are not being held in accordance with data protection legislation. Some residents are having more accidents and falls than others and the home should analyse the accident reports and take steps to minimise future accidents and inform care plans to protect residents. Data product sheets are held on file in respect of cleaning products but there are not product sheets for all the products currently in use. The home also needs to be more careful about keeping hazardous substances locked away to protect residents. The lagging jackets to the tanks in the airing cupboard on the first floor must be replaced / renewed to cover the hot surfaces that are currently exposed. 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. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 10 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 Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 11 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): 2 & 3. Standard 6 does not apply. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All residents have contracts / statement of terms and conditions so that they understand the conditions of their stay at the home. Pre-admission assessments are carried out to ensure that only those whose needs can be met by the home are offered places there. EVIDENCE: Residents at this home either receive contracts from the placing authority or directly from the home if they are privately funded. At the last inspection it was noted that there are differences between the homes own terms and conditions and that of the Borough of Poole, e.g., a trial period of four weeks for privately funded residents and six weeks for Borough of Poole funded residents. The Registered Person said that this had been addressed but none that had been issued since the change had been made could be located on the day of inspection.
Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 12 The Borough of Poole Social Services has a block contract arrangement with Genesis Care Home and makes the majority of placements in the home. They provide the home with copies of their assessments and one such assessment was seen for the resident moving to the home that afternoon. It was clear from their file that they had also been visited by a representative of the home the day before the inspection visit to ensure that their needs could be met at Genesis care home. Another file was reviewed for a resident who had been at the home a little longer. The local authority had also placed this resident. A copy of the social services assessment was on file but not dated as to when the home received it. It is suggested that the home dates all assessments / correspondence in respect of residents coming to the home to evidence when they become aware of information. An assessment carried out by the home was also on file. Mrs Mangold told the inspector that a standard letter is sent to residents confirming that their needs will be met along with other useful leaflets. Three out of the four residents who returned comment cards to the Commission prior to the inspection said that they had enough information before they moved in to the home so they could decide if it was the right place for them. All four said that they had received a contract. One relative commented ‘I was encouraged to inspect the home to make sure I felt it was suitable for my aunt.’ Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 13 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Whilst a care planning system is in place it is not robust enough to ensure that staff have sufficient information to meet the needs of residents or to demonstrate that all the needs of residents assessed by the home have been met. A range of community health professionals meet the health needs of residents. The home has systems in place for handling and administering resident’s medication so that they are given as prescribed and correctly recorded but recording of allergies and authorisation for staff to give insulin could be improved to protect residents. Residents are treated respectfully and care is offered in a way that protects the resident’s right to privacy and dignity, however more respect needs to be shown by ensuring that residents have access to all the toiletries they need and in providing a clean and well maintained environment for them to live in. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 14 EVIDENCE: Each resident has a file that contains a range of assessments and information about the persons needs. A care plan is also in place and daily records relate to the care that workers deliver as outlined in this plan. However the care plan does not address how the needs of residents gathered in all the assessments are to be met e.g. there is an oral care assessment yet oral care is not mentioned in the care plan and so daily notes do not evidence any oral care being given. Also care plans are not updated /amended where risks are identified in assessments or through accident analysis. One file reviewed had a risk assessment dated 2003, which had not been updated despite the person having had a number of falls that were recorded in the accident book. Plans often refer to ‘monitoring’, but how this monitoring takes place or what the monitoring outcomes are is not clear. One resident whose file was reviewed is a diabetic. Her plan did not contain sufficient detail in this area of care to properly promote her health and well-being. Files looked at did not include manual handling assessments and care plans did not include a section on medication. Whilst there was some evidence to show that the plans looked at had been updated this was not at the desired regularity. The registered person outlined the toiletries that are supplied to each resident in the home and which should have been in each room i.e. crème bath – used for face and body washes, talcum powder, deodorant / body spray, tooth brush and toothpaste, razors and shaving lotion (where appropriate) and shampoo. Not all rooms contained these items. In the case of shampoo no residents’ rooms visited contained any. The communal bathroom on the ground floor had two bottles marked with the names of the residents they belonged to. The cupboard that contained a decent supply of toiletries for care workers to replenish residents’ rooms with, but no shampoo was found here either. On the first day of inspection a number of care managers from the Borough of Poole were carrying out reviews. Their feedback to inspectors on completion of this work was that they felt that residents were well cared for by the home. They had also been in touch with eight relatives who also expressed satisfaction. When asked ‘do you get the care and support you need?’ all four of the residents who returned comment cards replied ‘always’. The three care plans examined showed that professional advice is sought and visits by the GP, District Nurse, dentist etc are recorded. However as daily notes are written in numbered codes relating to sections of the care plan and very little description is recorded about how the resident has spent their day or how they are it is hard to evidence why GPs or District Nurses are involved in the care of residents. It is also hard to establish how timely the intervention of the community services has been in relation to when care staff first become concerned about the health of residents. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 15 A chiropodist visits every two months at a cost to residents of £10 a visit. Records confirmed this. On the first day of inspection nurses were carrying out a body mapping exercise to check that residents were being well looked after. Their conclusion was that they were and that any marks on the residents were consistent with the recorded accidents and daily notes. The four residents who returned comment cards said that they ‘always’ received the medical support they needed. The home has a medication policy. Medicines were stored securely. The maximum and minimum temperatures of the fridge used to store medicines were not recorded. Actual temperatures recorded were in the correct range and the Commission Pharmacist showed the senior carer on duty how to use the maximum and minimum thermometer. The Commission Pharmacist also checked residents’ medicines with their Medication Administration Record (MAR) charts. The directions on the MAR charts agreed with the labelled medicines. One resident had an allergy to penicillin recorded on their assessment but ‘none known’ on their MAR chart. Another resident’s allergy status was not recorded on their MAR chart. When a choice of dose was prescribed staff did not record the dose they gave. Audit trails for medicines in the monitored dosage blister packs and in manufacturer’s packs agreed with the records indicating that medicines were given as prescribed and recorded. The quantities of medicines received were recorded. Changes to medication were clearly recorded on the MAR chart and in the records of contact with health professionals. The care plans of residents with diabetes included details of the frequency of monitoring and usual range of blood sugar levels but not what to do in the case of high or low levels. One resident’s sugar levels were only recorded for 16 out of 23 weeks, with no records for February 2006. There were records of GPs reviewing 5 resident’s medication recently. The Pharmacist was told that all staff who give medicines have done a medication course and she saw evidence for three of them. The senior carer said that new staff were trained to give insulin as part of their induction but there was nothing to confirm this. Three staff had a form in their file stating that they had been trained to do this signed by them and the manager but not by the district nurse who delegated this task. The home had patient information leaflets on medicines for staff to refer to. Staff were observed to be treating residents in a respectful manner and were discreet in the carrying out of personal care tasks. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 16 Rooms that are shared have screens in them to further safeguard privacy and dignity. Wardrobes and drawers are kept in a tidy manner. Some clothes are marked with the residents’ names though many are not which could result in confusion or residents wearing each other’s clothes especially given that all clothes are laundered together. It is suggested that all clothes are named. Inspectors were told that staff know the residents’ clothes as do the residents themselves. Being well cared for and treated with respect extends to living in a clean and well-maintained environment. Sadly this was not the case throughout the home. For example some rooms visited had beds that had been made despite sheets being soiled, pillows and cases that were stained, pillows that would no longer to comfortable to use, a bed cover was seen that had a hole in it, stained furniture, wardrobes / cupboards without handles, dirty and dust lampshades. Windows were also very dirty inside and out, this being in the main due to the demolition of the building next door. An orientation sign in the hallway giving personal information about a particular resident was discussed with the registered provider. The appropriateness of this information being available to all residents and visitors to the home was debated along with the need to review it e.g. to see if another way to convey this information to the resident when needed might be found. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 17 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home satisfies recreational needs and a range of social activities provides variation and interest for the residents. Visitors are made welcome at the home and can come whenever it suits them and the residents. Residents are helped to have a choice over how they live their lives at the home. A balanced and varied selection of food is available, that meets residents’ tastes, choices and special dietary needs and is served in pleasant surroundings. However, more care must be taken to ensure smoking is banned from the kitchen, out of date food items are not available to residents and that food is generally appropriately stored once in use. EVIDENCE: The home looks to provide person centred activities, which focus on each resident and their individual needs. To assist in this, information about each residents past life, hobbies and interests etc is recorded often contributed by family and friends. Group activities are organised such as armchair football
Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 18 and skittles, singing and a weekly movement to music session. During the inspection on the first day residents were seen enjoying picture book colouring, watching TV, reading magazines and talking with each other. A calm, easy going atmosphere was observed in the lounge and residents interested in talking with the inspector confirmed their well being. On the second day of inspection residents were sitting out in the garden with staff before coming inside for morning coffee. Of the four residents who returned comment cards 1 said that they it was ‘always’ the case that there are activities arranged by the home that they can take part in; 2 said that this was true ‘usually’, and one said ‘sometimes’. Daily care notes evidence the involvement of residents in activities. Since the last inspection a visitors book has been introduced. This showed the number and range of visitors to the home. The book also has room for visitors to make comments. Recent comments were very positive e.g. relatives having enjoyable visits with their family members and being made to feel welcome at the home. Residents are able to see their visitors in the lounge/dining room or their own bedrooms as they wish. Where able residents are encouraged to exercise as much control over their lives as possible and to make decisions about what they do each day, what they wear, what they want to eat and drink and when they get up or go to bed. Meals are served in the dining area of the lounge. Lunch on the first day of inspection (Monday) was minced beef with mushrooms and peppers. Served with roast potatoes, peas and carrots. One resident chose to have quiche as an alternative to this meal. The main course was followed by stewed apple. Supper had been prepared by mid morning and was sitting on the counter beside the fridge, covered with foil. On the second day of inspection (Thursday) lunch was shepherds pie – a dish of mince, onion and mushrooms covered with potato and carrots. One resident had a plain fish alternative. A two weekly menu is in operation at the home. Meals are said to be based around the known likes and dislikes of residents. Information about residents likes and dislikes is gathered when they move to the home. One resident talked of how she enjoyed the meals. Prior to the inspection four comment cards were received by the Commission from residents. Three of the four said that they ‘always’ liked the food and the other that they liked the food ‘usually.’ Care workers take it in turn to do the cooking and recipe sheets show that meals are simple to prepare. All have up to date food hygiene certificates. No staff have been trained in nutrition and it is suggested that staff undertake this training. Some information about this subject is available in the home and Mrs Mangold said that nurse trained staff would have covered nutrition as part of their training.
Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 19 Part of the kitchen is currently being used as office space. This is not considered best practice by the Commission. As at the last inspection there was evidence to show that cigarette smoking was still taking place in this room. At the last inspection food with ‘best before’ dates that had passed were found in the kitchen. This time most food was found to be in date and correctly stored but a worrying number of items were found where packets had been opened, were not dated when the packet had been open and contents had not been decanted. Some foodstuffs had passed their use by and best before dates. In addition foods were found stored in the cupboard that should have been in the fridge and eaten within a certain time. The two freezers were also inspected. A good range of food was found. On the second day of inspection there was a greater quantity and variety of fruit and vegetables on the premises. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 20 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. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home has a complaints procedure, which reassures those who complain that their concerns will be taken seriously, fully investigated, and appropriate action taken. The Adult Protection policy has also been re-written but needs a further small addition. EVIDENCE: The home has a satisfactory complaints procedure. Since the last inspection no complaints have been received by the home or by the Commission. The Commission is informed that a complaint has been made to the police and this may have adult protection implications. The management of the home are cooperating with the police in respect of this complaint. The comment cards sent to residents asked the question ‘Do you know who to speak to when you are not happy?’ Four residents sent back cards. Three residents answered ‘always’ to this question and one said ‘usually’. In respect of knowing how to make a complaint three said ‘always’ and one said ‘usually’. At the last inspection it was noted that the Adult Protection policy was in need of minor amendment i.e. that the policy should also make reference to the
Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 21 Public Interest Disclosure Act. The policy seen on file did not contain this reference. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 22 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, 20, 21, 23, 14, 25 & 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents have access to pleasant indoor and outdoor communal facilities although this is currently compromised by the demolition next door. Generally the premises are in a good state of repair but some actions need to be taken to bring it up to the standard it should be. Actions have been taken to make the bathrooms safer for residents. Bedrooms are of sufficient size and are adequately furnished and individually personalised to suit residents. The home although not as clean as it could be has no unpleasant smells. The home provides sufficient bathrooms and WCs to meet the needs of residents. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 23 EVIDENCE: The front garden is attractively laid to lawn with flowerbeds. The rear garden is enclosed and offers more seclusion, also some shade from mature trees. There are paved areas where residents can walk around. Patio tables and chairs are available and residents were sitting sit outside on the sunny second day of inspection. The home has been in discussion with neighbours over the upkeep of their fencing. The building next door is now being demolished and the fencing problem has not been resolved. The current state of some fencing means that the rear garden is not secure and residents can only access the garden when supervised by staff to ensure they cannot wander off. The demolition is also having an adverse effect on the home in respect of dirt and dust. Windows are dirty and this makes the bedrooms in particular gloomy and dark. The communal space comprises a lounge/dining room with a small adjoining conservatory. This room can be closed off from the rest of the lounge/dining room by means of a sliding door, providing additional space for activities or sometimes as a quiet room. Bedrooms are basically furnished and contain the residents own personal items where they have chosen to bring them into the home. Some rooms are carpeted but others have floor coverings that are more suited to the needs of the individual. (see comments in section above – ‘health and personal care’ in respect of cleanliness and upkeep of rooms). Three single bedrooms have en-suite facilities. Commodes are also in use in some bedrooms. There are two communal bathrooms and three separate WCs situated on the ground and first floors. (The ground floor bathroom has an assisted bath). At previous inspections it was noted that the ground floor communal bathroom had been redecorated and Miss Mangold had added pictures, decorated tiles and mobiles etc, in order to make bathing a more welcoming and pleasurable experience for residents. Miss Mangold has said that she has similar plans for the first floor bathroom, but this work has still not been completed. Previous inspection reports have highlighted the lack of heating in bathrooms/WCs. The only heating in bathrooms comes from heated towel rails, which have potentially dangerously hot surfaces. The towel rail in the bathroom on the first floor has now been disabled and a fan heater has been fitted. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 24 All four residents that returned comment cards said that the home is ‘always’ fresh and clean. Inspectors were told that an external laundry service is used for the laundering of sheets, pillowcases, duvets and towels etc, with all personal items are laundered within the home. When inspectors visited the laundry area a duvet was in the washing machine. The laundry area was not clean and the sink in the corner of the sluice / laundry room was cracked and leaking. There were no towels or paper towels for staff to use once they had washed their hands in this area. The home has a laundry policy that is in need of updating to reflect the national minimum standards, practice in the home and to be in line with advice from the Health Protection Unit. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 25 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. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The numbers of staff on duty at any time are sufficient to meet the current needs of residents. Genesis care Home is not meeting the target of having 50 trained staff with National Vocational Qualifications (NVQ) level 2, the benchmark standard for ensuring that residents are in safe hands at all times. The home has a recruitment policy in place which needs to be followed at all times to ensure the protection of residents from unsuitable people potentially working at the home. Staff training is carried out but not all staff currently have had the necessary training appropriate to the work they perform in caring for the residents. EVIDENCE: The staffing roster includes the full names and work titles of all staff. This roster shows who is on duty and when, along with who is in charge at any time. Rosters are amended with any changes and so serve as a record of what was actually worked. The level of staff cover at the home remains at the high level noted at previous inspections. Staffing rosters confirm that four care staff are on duty throughout the day, two working from 8 a.m. until 6 p.m. and two from 8 a.m. until 7 p.m. Two night care staff are on duty from 7 p.m. until 8 a.m. In
Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 26 addition, a domestic assistant carries out cleaning duties from 9 a.m. until 12 p.m. on a daily basis. Care staff share responsibility for cooking, laundry and other domestic tasks. In the hallway there are photographs of staff to aid recognition. Residents were asked are the staff available when you need them? All four who responded with comment cards to the Commission said that this was the case ‘always.’ At present, only one member of staff has National Vocational Qualifications (NVQ) level 2, although the registered person is working towards more care staff commencing training for this qualification later this year. Most staff at the home have nursing qualifications from abroad. For most of them working at Genesis will be the first experience they will have had of working in a residential home. The home has a thorough recruitment procedure based on equal opportunities, to ensure the protection of residents. At the last inspection it was pointed out that this procedure needed updating to reflect the changes brought about by the introduction of the Protection of Vulnerable Adults (POVA) list held by the Department of Health. This has been done. All staff files were examined and these showed the home to be aware of the required information that needs to be in place, e.g. proof of identity, references, work history, details of qualifications CRB disclosures etc. However it was not clear from all files the date that the person started work at the home and how many hours they are employed for and not all files contained full employment histories. Some were not clear about the capacity that people were employed in. Other files showed that staff had started working at the home before their Criminal Record Bureau (CRB) disclosures or Protection Vulnerable Adult (POVA) checks had been received at the home. Since the last inspection two new members of staff have started working at the home; one as a care worker and one as a domestic. The only papers for the domestic was a reference and the home’s completed induction / orientation programme. The care worker had only had one reference, which was not from their last employer and did not relate to care work. Their CRB had been received after they had had their orientation / induction. They had not provided a full employment history. The date they started working was not clear, nor was the number of hours they were to be employed each week. The home is aware that new regulations regarding staff induction are now in place and of the new ‘industry standard’ induction programme devised by Skills for Care www.skillsforcare.org.uk. The registered person said that she was intending for new staff to attend induction courses run by the local authority that meet this standard in Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 27 September 2006. In the meantime staff starting to work at the home receive a documented ‘orientation’ at the home. Ongoing training for staff is delivered through in-house sessions as well as external courses and each member of staff has a training file where copies of certificates etc are kept. Examination of training files shows a variety of training has taken place since the last inspection, e.g., moving and handling, medication and basic food hygiene. One member of staff had attended a course entitled ‘meeting the needs of older people in care homes.’ However, there was not evidence that all staff had had training in essential areas e.g., first aid and basic food hygiene. Nor have all care staff had training in dementia care, dealing with challenging behaviour etc., to ensure they have the skills and knowledge necessary to care for the residents living in this home. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 28 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, 36 & 38. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. The manager is experienced in working with older people with dementia, but has still not achieved completion of National Vocational Qualifications (NVQ) level 4 in management and care, to ensure she has the necessary qualifications to carry out her responsibilities in full. The home is reviewing its performance through a programme of consultations, which include seeking the views of residents, staff, relatives and other visitors to Genesis to ensure the home is run in the best interests of residents. The home is not involved in the financial affairs of residents. A formal staff supervision system is now in place to ensure continuing good practice within the home. Systems are in place to promote the health, safety and welfare of residents but some improvement is necessary to fully ensure the safety of residents.
Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 29 EVIDENCE: The inspection report dated 6 July 2004 states, The registered manager, Miss Mangold, has experience of working with older people with dementia and mental disorder and is currently undertaking her National Vocational Qualifications (NVQ) level 4 in management and care. Miss Mangold has still not achieved her registered managers award – equivalent to NVQ level 4 in management. She has had to make changes in her choice of training course, which has caused delays beyond her control. Once she has completed her Registered Manager’s Award Miss Mangold will need to undertake an NVQ in care at level 4. Quality Assurance questionnaires were sent out in January 2006. The response received was very positive and did not result in the home making any changes to improve the running of the home. Feedback to the Commission from Social Services and Health professionals has also been good. Staff have also been given questionnaires to complete. Responses to these have been more mixed. Whilst there has been some movement to meet the requirements and recommendations made at the last inspection there are still a number of issues outstanding and further requirements and recommendations have been made at this inspection. It is the policy of the home not to have any involvement in the personal finances of residents. All residents have a relative or other representative to deal with their finances etc. The home pays for services such as chiropody and hairdressing and the record kept of what is owed was seen. This amount is then invoiced to relatives or representatives for payment every month. Care staff are now receiving formal supervision at least six times a year. These sessions look at good practice, emphasise the philosophy of care within the home and review the individual career development needs of carers. Policies and procedures are available to guide staff in health and safety issues, Control of Substances Hazardous to Health, infection control, fire safety and moving and handling etc. Records demonstrate that appropriate maintenance and checks of the fire warning system, emergency lighting and fire fighting equipment are taking place to ensure resident safety. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 30 A letter from Dorset Fire and Rescue Service dated 24/3/05 confirms that the fire precautions are being maintained satisfactorily. Records of staff having fire training and drills were seen. Accidents and incidents are being recorded but completed records are being held with uncompleted forms, which is not compliant with data protection. Some residents are having more accidents and falls than others. The home does not analyse the accidents and so it is not as clear as it could be how this information is being used either to take steps to minimise future accidents or to inform care plans to protect residents. Data product sheets are held on file in respect of cleaning products but there are not product sheets for all the products currently in use. Some bleach was found in the kitchen in an open cupboard, along with other cleaning products. In the airing cupboard on the first floor there are two water tanks. These clearly get very hot and you can see where the lagging jackets have melted onto them. The current lagging does not cover the surface of the tanks making the lagging ineffective and meaning that at times those using the cupboard are working near / over very hot surfaces. Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 31 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 1 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 1 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 2 3 3 X 3 3 3 2 STAFFING Standard No Score 27 3 28 1 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 2 X 3 3 X 2 Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 32 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation • Requirement Care plans must contain sufficient information needed to direct care staff to care for the resident person, incorporating the outcomes of all assessments carried out. A section must be included in the care plan on medication. There must be manual handling assessment. Assessments, including risk assessments must be reviewed and updated. Care plans should be kept under review. Residents and staff should have access to all toiletries needed including shampoo. Timescale for action • 1. OP7 15 • • • • 01/09/06 2. OP9 13 (2) The registered person shall make arrangements for the recording, handling, safekeeping, safe administration and disposal of medicines received in the care home including: a) Recording allergies to medicines or ‘none known’ where applicable
DS0000003942.V303255.R01.S.doc 31/07/06 Genesis Care Home Version 5.2 Page 33 accurately on or with the MAR chart. b) Recording the dose given when a choice is prescribed. c) Monitoring and recording the maximum and minimum temperature of the fridge used to store medicines daily. Blood sugar levels must be monitored as stated in the care plan and there should be information on what to do if levels are outside the recommended range. • The home must be audited in respect of cleanliness, the state of repair of the furniture, the fitness of linen in use The result of this audit should be documented. The ongoing appropriateness of individual orientation aids must be reviewed and documented. The registered persons must ensure that satisfactory standards of hygiene are maintained. Cigarette smoking must not take place in the kitchen. The registered persons must ensure that food, which is past its best before date, is not available to residents. (Previous timescale of 1/06/06 not met.) Food must be appropriately stored and
Version 5.2 Page 34 3. OP9 12 and 14 31/07/06 4. OP10 23 and 12 • • 01/09/06 • 5. OP15 16 • 01/09/06 • • Genesis Care Home DS0000003942.V303255.R01.S.doc used as directed and where packets are opened they must be properly secured / decanted. The premises must be kept in a good state of repair externally and internally. All parts of the home must be kept clean. The laundry area must be cleaned and the sink in the corner of the sluice / laundry room repaired / renewed. Towels / paper towels must be provided for use in this area. 7. OP26 16 The laundry policy must be updated to reflect the national minimum standards, practice in the home and to be in line with advice from the Health Protection Unit. 01/09/06 6. OP19 23 01/09/06 8. OP29 The registered persons must ensure that the home adheres to their recruitment policy and that 19(1) staff files contain all the Schedule2 information required by the Care Home Regulations. It is required that an audit of staff training be carried out, to update records and ensure all staff are receiving the training they need. Where necessary, training must be updated, e.g., first aid. (Previous timescale of 30/06/06 not met.) It is required that the manager obtains NVQ level 4 in both management and care. • Data product sheets must be held on in respect of all cleaning products used at 01/09/06 9. OP30 18(1) 01/09/06 10. OP31 18 31/12/06 11. OP38 13 and 23 01/09/06
Page 35 Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 • • the home. Hazardous substances e.g. bleach must be locked away. The lagging jackets to the tanks on the first floor must be renewed. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard OP2 Good Practice Recommendations It is recommended that the homes own terms and conditions and the Borough of Poole contract should have the same time allowed for a trial period. Care plans should be reviewed and updated where appropriate at least monthly. Where daily records are kept they should demonstrate the full range of care given to residents and be descriptive where events occur outside of those predicted. It should be clear why health professionals are involved and what has to be followed through in respect of care following their visits/ interventions. There should be written confirmation from the district nurse who trained and authorised staff to give insulin and check blood sugar levels. It is recommended that the Adult Protection policy also contain reference to the Public Interest Disclosure Act. 1. 2. OP7 3. OP9 4. OP18 Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 36 5. OP28 A minimum of 50 of care staff employed by the home should have NVQ level 2 or equivalent. The standard in respect of quality assurance cannot be met until the home progresses action within agreed timescales to implement requirements identified in Commission reports. Accident and incident records should be stored in accordance with data protection legislation. The home should undertake accident analyses and use information to minimise future accidents and inform care plans to protect residents. 6. OP33 7. OP38 Genesis Care Home DS0000003942.V303255.R01.S.doc Version 5.2 Page 37 Commission for Social Care Inspection Poole Office Unit 4 New Fields Business Park Stinsford Road Poole BH17 0NF National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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