Inspection on 26/10/06 for Genesis Care Home

This inspection was carried out on 26th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Genesis Care Home 28/06/07

Genesis Care Home 10/10/05

Genesis Care Home 17/05/05

Genesis Care Home 17/11/04

Extracts from inspection reports are licensed from CQC, this page was updated on 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Genesis Care Home 197 Peter Street Macclesfield SK11 8ES Lead Inspector Judith Morton Unannounced Inspection 09:55a 26 October 2006 th 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 DS0000062417.V296724.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 DS0000062417.V296724.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Genesis Care Home Address 197 Peter Street Macclesfield SK11 8ES 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) 01625 421623 Winnie Care (Macclesfield) Ltd Beverley Powell Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42), Physical disability (5) of places Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. This home is registered for a maximum of 42 service users to include: * Up to 42 service users in the category of OP (old age not falling within any other category) * Up to 5 service users in the category of PD (physical disability) over the age of 55 years The registered provider must, at all times, employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection 10th October 2005 2. Date of last inspection Brief Description of the Service: Genesis Care Home is a purpose built home in Macclesfield that opened in February 2004. Care is provided for people aged 65 and over, including short term respite care. The home is a three-storey building and residents’ rooms are situated on all floors. The 39 bedrooms all have en-suite facilities and have been furnished to a high standard. All bedrooms have a television and telephone point. Each floor has a lounge and dining area. Access between floors is by a passenger lift or one of the staircases. The home has an adequate number of toilets and bathrooms suitable for the residents. . There are gardens and patio areas for residents to use during warmer weather. There is easy access for wheelchair users by the front entrance and throughout the home. Aids to help service users move about as independently as possible are fitted throughout the home and include bath hoists, grab rails and an emergency call bell system. The home has staff on duty twenty-four hours a day The financial manager from the company’s head office said that the scale of charges for Genesis Care Home is £343.43 to £455.00 per week. Newspapers, toiletries, hairdressing and private chiropody are not included in the weekly charge. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced visit, part of the first inspection for this service, took place on 26 October 2006 and lasted five and a half hours. This visit was just one part of the inspection. Other information received by CSCI about the home was also looked at. Before the visit, the previous manager was asked to complete a questionnaire to provide up to date information about the services provided. CSCI questionnaires were given to residents; their families, health and social care professionals to find out their views about the home. Comments from forms that were sent back to CSCI have been included in the report. The previous registered manager has left since the last inspection. The new manager for the home was on duty and assisted the inspector with the visit. The previous registered manager had provided before she left. During the visit, various records were looked at as well as the house itself. Four staff members and eight residents were spoken with and their views about the home are also included in the report. What the service does well: What has improved since the last inspection? A new form has been devised so that staff can record what type of activity was offered to the residents and whether they joined in or refused. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 6 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 3 & 5 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. Good information about the service is provided and thorough assessments are done to make sure that residents’ needs can be met at the home. EVIDENCE: There is a statement of purpose and service user guide available for the home. They are in larger print, making it easier for residents with visual impairments to read. The content is good, using plain language and including enough information to enable the residents to make a choice about whether their needs could be met at the home. There were copies of the service user guide in the residents’ bedrooms. Four residents’ care files were checked. There was a good, detailed preadmission assessment document on each of the files checked. This covered all aspects of the prospective resident’s life. The front sheet of the care file contained identifying information about the resident, their contacts, date of birth etc. However, not all the sections were Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 9 completed and the forms did not identify whether the residents wanted to follow their religion whilst living at the home. Residents’ health needs were assessed before they move into the home and continued to be assessed once they were living there. Any medication they were on and a detailed medical history were recorded. There was also a residents’ choice form which described the residents’ preferences, such as, what time to get up, where to have breakfast, what drink they preferred, what time they liked to go to bed. The benefit of having a detailed life history, including interests and hobbies, on each resident at the front of their file was discussed with the manager. This would help staff get to know the resident and what they liked to do. Residents spoken with and those who completed the questionnaires said that they had been to visit Genesis for a look around, see their proposed bedroom and to meet the staff and residents before deciding on whether to move there. On the day of the site visit a prospective resident was being shown around the home with a view to moving in. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10 & 11 Quality in this outcome area is adequate. This judgement has been made using available evidence and a visit to the service. The care plans were accurate and up to date but risk assessments needed to be reviewed to make sure that residents’ were not being left at risk. EVIDENCE: Each of the care files checked contained a care plan showing how residents’ needs should be met. Key workers had carried out monthly reviews of the plans and checked that they were still appropriate. There were risk assessments in the residents’ files about falls, nutrition, pressure areas, keeping and handling their own medication, moving and handling, having a key to the door and so on. There were also risk assessments specific to the individual, such as going out unaccompanied, having the bedroom door locked at night, and getting into and out of the bath without using any equipment to help them. The risk assessments advised staff how often they were to be reviewed but there was nothing on any of the files to show that this had taken place and that the risk was still manageable. One resident had a risk assessment from Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 11 2005 on their ability to manage their own medicines but it was also recorded that the same resident was at times confused, forgetful and depressed. The activities form in each file was designed to show clearly the date and type of activity and whether or not the resident joined in but some staff were not recording the type of activity. On one file nothing was recorded from 28/09/06, where previously there had been a number of entries made each week. The personal care grid in the files showed clearly when a resident had a bath, hair wash, shave etc and these were being completed appropriately and which member of staff had done this. Residents’ weight was being recorded monthly and information about residents being visited by doctors, nurses and so on was also recorded. There was more detail being recorded about the care given to each resident every day but nothing to show how the residents had felt about their day and the care they’d been given. The entries being made by night staff did not show that regular checks on residents had been carried out and what support they might have needed during the night. It is recommended that steps are taken to improve this recording and to involve residents in commenting about their day so that there is full information about the care being provided to residents round the clock. Residents who could do so looked after their own medicine and had a lockable drawer in their bedroom to store it in. The medicines were stored securely in the home but inconsistencies were found in the medicine administration records where codes had not been used correctly. For example, one resident was prescribed pain relief to be taken every four hours yet the 6pm dose was never given and nothing was recorded to show that it had been refused. All of the residents spoken with were extremely complimentary about the staff. One resident said, “they are lovely, very patient, it can’t be easy for them trying to please all of us”. Another resident said, “they are very patient and kind”. One resident was overheard asking a member of staff to help them down the corridor; the member of staff replied, “of course I can”. When the resident apologised for not being able to hurry, the member of staff said, “that’s ok, I’m not in any hurry”. The residents confirmed that staff always knock on bedroom doors before entering. One resident had a risk assessment for keeping his door locked throughout the night because he does not like to be disturbed. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 & 15 Quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The activities provided, together with the healthy balanced diet being received, ensure the continued physical and mental wellbeing of the residents. EVIDENCE: The residents spoken with said that there were activities for them but they did not always like joining in. “They never force you to do something you don’t want to do”. There was a list of activities displayed on the wall of the lounge, which a member of staff read out to the residents after lunch. The residents from each of the three floors of the home were seen gathering in the large first floor lounge for an activity that afternoon. Although the range of activities offered was wide, there may be others, such as talking books and painting that residents might like as well. It was suggested that steps should be taken to get suggestions from the residents for other activities they might like to do. There was also discussion about other ways of letting residents know what activities were happening, such as enlarged photographs, to help people know what was available. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 13 Residents said they receive visitors regularly, as the visitors’ book confirmed. Some are taken on outings and those who can do so go out to the local pub/shops on their own. Residents can make choices about their food, what they would like to wear, whether to join in activities, where to have their meals and how they wish to spend their time. Residents were seen to move around the home freely and spend time in their room if they wished. Residents said that the food at Genesis is lovely. One said, “you get plenty of food here and it is always nice. They know me now and know what I don’t like so they always put something else on that they know I’ll eat”. Another said, “you get a choice at lunch and dinner and even if you don’t feel like that they will make you something else, like a sandwich”. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. The complaints procedures and adult protection policies were robust so that residents could be confident their concerns would be listened to and they were protected from possible harm. EVIDENCE: The complaints procedure is displayed throughout the home and information about it is included in the statement of purpose. There is also a complaints book for recording any complaint, how it was dealt with, by whom and the outcome. All of the staff who have been working at the home for some time have attended the Protection of Vulnerable Adult training. Some of the newer staff have completed this with their previous employer. There are policies and procedures available to guide staff in the event of them witnessing poor practice. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24, 25 & 26 The quality in this outcome area is adequate. This judgement has been made using available evidence and a visit to the service. Genesis is a warm and comfortable home for the residents but improvements are needed to make sure that they are safe at all times. EVIDENCE: The home continues to be well maintained, clean and comfortable for the residents. Service users live in safe, comfortable bedrooms and are able to have their possessions around them. All bedroom doors have locks that could be overridden by staff in an emergency. A lockable drawer is provided in each bedroom. There are a number of communal rooms, such as lounges and dining rooms in which residents can choose the spend the day. All of the rooms occupied by residents have windows that can be opened for ventilation. The home is centrally heated and thermostatic valves are fitted to the radiators to allow individual control of temperatures in the rooms. All bedrooms radiators are low surface temperature. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 16 A large ramp has been installed from the first floor to the ground floor but it cannot be used until a non slip surface is applied. This was the situation 12 months ago at the last inspection. During the visit, a resident was seen to open the door to leading to the ramp. There was nothing to alert staff that the door had been opened. Steps must be taken so that residents cannot use this door and ramp, except in emergencies, until the non slip surface has been fitted. The home also needs to ensure that nobody can enter the building from any of the doors without staff being aware of who is entering and leaving the building, so that residents are protected at all times. Emergency lighting is provided throughout the home. The home has a laundry which is appropriately staffed and equipped to meet the needs of the service users accommodated. Domestic and laundry staff have received training so they know how to store and handle hazardous materials, such as cleaning fluids, properly. There is a policy to deal with infection control and a copy is kept in the policy and procedures manual. There were no offensive smells in any area of the home on the day of visit. The home was bright and airy, yet warm and comfortable. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 The quality in this outcome area is adequate. This judgement has been made using available evidence and a visit to the service. Although staff are competent and well trained, the gaps in the recruitment procedure leave the residents and staff vulnerable and unprotected. EVIDENCE: The staff rotas showed that there was sufficient staffing available to meet the needs of the residents. The manager said it has been necessary on occasion to use agency members of staff to ensure there is adequate cover for sickness. The induction programme for new staff includes health and safety, fire safety, awareness of how to deal with hazardous substances, and Genesis’ care policies and procedures. The training manager supervises the progress of staff and identifies their future training needs with them. There were also regular staff meetings being held which ensure the staff are kept up to date with practices within the home. The minutes are recorded and kept in the office so that staff can have easy access to them. Five staff files were checked during the visit. They showed that the recruitment procedure for the home had not been followed on two of the files checked. For example, on one file there was only one reference available. Another file showed that the member of staff had started at Genesis on the 24/09/06 yet the Protection of Vulnerable Adult (POVA) check had not been received until 02/10/06 with the Criminal Record Bureau Check being received on 21/10/06. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 18 Additional training is also provided to staff, including care of medicines and care planning workshops. Six of the staff hold National Vocational Qualifications in care Level 2 (NVQ 2) and a further four staff are working towards achieving this qualification. Two staff hold NVQ Level 3, one member of staff is a qualified NVQ assessor. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 33, 35 & 38 The quality in this outcome area is good. This judgement has been made using available evidence and a visit to the service. Although there has been a change of manager, residents continue to feel that the home is run in their best interests. EVIDENCE: There has been a change of manager at Genesis since the last inspection. The new manager had worked at Genesis for almost four weeks at the time of this site visit. She is a qualified nurse who also holds other relevant qualifications for her role. Although the manager was new to Genesis the residents were fully aware of who she was and were seen to freely interact with her during the site visit. The staff were also observed to interact well and those spoken with said they found her approachable. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 20 Residents spoken with were extremely complimentary of all of the staff at Genesis. “The staff are lovely, very caring and can’t do enough for you they have a very difficult job looking after us”. Residents’ meetings are held and the previous manager had encouraged the residents to be more involved in chairing their own meeting. Although there hadn’t been any meetings since the new manager started at the home, she was aware of the importance of giving residents opportunities to voice their opinions. Financial arrangements for the small amounts of money held in the home were satisfactory. Residents’ families help them with their other financial affairs, where necessary. The area manager from the company that owns the home visits it once a month the check that it is running well. A report is made of each visit and a copy is sent to the Commission for Social Care Inspection. However, there is no formal system for obtaining the views of the residents, relatives, staff and people such as GPs on how the home is running. Health and safety training for staff, including fire safety training is all up to date. The environmental health officer visited the home in October 2006. The kitchen staff were completing a new system of recording health and safety, cleaning, food storage, temperature recordings and other checks that they carry out. These were being done satisfactorily. Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 3 X 3 X 3 3 3 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 3 X 3 X X 3 Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard OP7 OP9 Regulation 13(4)(c) 13(2) 17(1)(a) Requirement Risk assessments must be reviewed regularly and updated where necessary. Medication administration records must be completed accurately with appropriate codes being used and all medication given being signed for. Action must be taken to ensure the residents’ safety in that: • a non-slip surface must be applied to the ramp from the first floor so it can be used by the residents • appropriate security measures must be fitted to the door at the top of the ramp and side door to the kitchen • the entrance door to the home must not be left unlocked Thorough recruitment checks must be made on all new staff before they start work at the home in that: • two references must be obtained, one of which should DS0000062417.V296724.R01.S.doc Timescale for action 01/01/07 01/01/07 3 OP19 13(4)(a) & (c) 01/03/07 4 OP29 19(1)(b) 19(4)(c) 01/01/07 Genesis Care Home Version 5.2 Page 23 • be from a previous employer a POVA first check must be obtained RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations The manager should consider adding further information to the assessment as follows: • a brief life history of the resident • information about the resident’s religious practice, nationality, ethnicity and language spoken The manager should take steps to make sure: • the activities form is completed • residents’ views of the care they have received is included in the daily records • the night staff record the checks they have carried out and the support they have given The manager should consider ways of obtaining the residents’ suggestions for new activities The manager should consider methods of seeking the views of residents, relatives, staff and professionals on the way the home is running. 2 OP7 3 4 OP12 OP33 Genesis Care Home DS0000062417.V296724.R01.S.doc Version 5.2 Page 24 Commission for Social Care Inspection Northwich Local Office Unit D Off Rudheath Way Gadbrook Park Northwich CW9 7LT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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