Inspection on 19/10/07 for Green Close

This inspection was carried out on 19th October 2007.

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

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Green Close 16/10/08

Green Close 20/11/06

Green Close 30/01/06

Green Close 09/08/05

Green Close 25/01/05

Green Close 24/05/04

Green Close 22/10/03

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

CARE HOMES FOR OLDER PEOPLE Green Close Drakes Avenue Sidford Sidmouth Devon EX10 9JU Lead Inspector Dee McEvoy Unannounced Inspection 19th October 2007 09:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Green Close DS0000039212.V344552.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. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Green Close Address Drakes Avenue Sidford Sidmouth Devon EX10 9JU 01395 515050 01395 512815 kath.hawkins@devon.gov.uk http/www.devon.gov.uk/adoption.htm Devon County Council 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) Position Vacant Care Home 23 Category(ies) of Old age, not falling within any other category registration, with number (23), Physical disability (23), Physical disability of places over 65 years of age (23) Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category PD Physical Disability must be over the age of 50 years 20th November 2006 Date of last inspection Brief Description of the Service: Green Close is a Care home providing accommodation and personal care people over the age of 50. It is situated a short distance from the village centre of Sidford on the outskirts of Sidmouth. The home provides intermediate care for people in East Devon. The home has four short stay beds and eighteen rehabilitation beds. The home does not admit people on a long stay basis. Referrals to this service are received from Health and Social Care professionals. The home is dedicated to helping people who may be ready to leave hospital but are unable to return home without further rehabilitation. The home can also care for those people who are struggling to remain at home. The rehabilitation service offers people a stay of up to six weeks, during which intensive therapy is provided by health and social care professionals. People are assessed throughout their stay and their needs are addressed so as to ensure a safe and appropriate discharge, tailored to meet their needs. The accommodation is on three floors, with a passenger lift between each floor. All bedrooms are single occupancy and equipped with wash hand basins, TV, and nurse call points. The access throughout the home is level, and the home has a good level of equipment to assist mobility including handrails, grab rails, and assisted bathrooms. There is a lounge and dining room on each floor. Outside there are lawns and flowerbeds and a pleasant courtyard with plenty of seating. Parking is limited, although there is parking in the surrounding streets. The home also provides a venue for Age Concern Day Care on the top floor. Information received from the home indicates that there is no charge for those people admitted for Intermediate Care service. Those needing respite care are financially assessed and charged accordingly. Services that people pay for independently include newspapers and magazines, hairdressing, continence aids and medical requisites, toiletries, chiropody, confectionery and stationery. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. As part of this key inspection the manager completed an Annual Quality Assurance Assessment (AQAA), which contained general information about the home and the people living and working there. With the information provided, CSCI surveys were sent to people receiving care at the home, their relatives, staff and outside professionals, prior to our unannounced site visit. Completed surveys were received from 9 people who had used the service; 7 relatives and 14 staff and 2 health and social care professionals expressing their views about the service provided at the home. Their comments and views have been included in this report and helped us to make a judgement about the service provided. We spent 9.5 hours at the service. There were 15 people receiving care at the home at this time. To help us understand the experiences of people at this home, we looked closely at the care planned and delivered to three people. This included one person admitted to the home for short stay respite care and two people admitted for rehabilitative care, with the aim of helping them to regain their independence so that they can return to their own home. Most people at the home were seen or spoken with during the course of our visit and seven people were spoken with in depth to hear about their experience of living at the home. Time was also spent observing the care and attention given to people by staff. During our visit we met and spoke with three health professionals and two care managers. Seven staff, including the manager and care and ancillary staff were also spoken with, individually or in a small group. A tour of the premises was made and we inspected a number of records including assessments and care plans and records relating to medication, recruitment and health and safety. Finally the outcome of the inspection was discussed with the registered manager What the service does well: This home provides an effective and valued rehabilitation care service. People admitted to the home for rehabilitative care are well supported and encouraged to regain independence and return home where possible. Many people using the service told us how valuable it had been to them in enabling them to regain confidence and skills. Comments included, “A helpful step on from hospital”, “I have really improved since being here”, and “The care and support has been very good”. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 6 Relatives too praised the service for it’s support to people, relative’s comments included, “Provides an essential service in taking people from acute hospitals & preparing them for their return to independence (in most cases)” “To provide support to enable people to live independently or find suitable care”, “It is essential that the rehab services provided at Green Close are maintained” and “Overall I feel Green Close does a great job and deserves more funding”. Professionals recognised the value of the service at Green Close, their comments included, “The feedback from people and their families has always been positive”, “They support people to achieve their maximum potential to be able to return home” and “A very professional but approachable service, striving to achieve good outcomes for people”. When asked what the home does best, one wrote, “To give people a feeling of being stronger in themselves and to have a more positive attitude to returning home”. Good information is available to people who are considering using the services at the home, which helps them make a decision about whether the home will suit their needs. People referred to the home through health or social services have a comprehensive assessment of their needs completed by someone who is suitable trained. The home provides access to specialist health professionals such as Occupational therapist and physiotherapist, who work closely with other health professionals to ensure that people’s health care needs and rehabilitation needs are well met. People told us that staff respect their privacy and dignity and that they were treated “as you would like to be treated”. During our visit staff were friendly and helpful in their approach to people’s needs and requests. People told us they were happy with the visiting arrangements at the home, and relatives said they could visit when they wanted to, and that the home usually keeps them informed of important events affecting their relative. On the whole people enjoyed the food, particularly the main meal, although a limited an alternative is currently available. The chef and manager have ideas for improvement, including new menus, which they hope to implement soon. People using the service said they knew how to make a complaint and this information is contained in the home’s Statement of Purpose. However, nearly half of relatives responding with CSCI surveys said they did not know how to make a complaint. People living at the home are protected from abuse or harm with the systems in place for dealing with any concerns. Good arrangements are in place to ensure that people’s valuables and money are protected. The home has lots of good equipment to aid people with their independence. One person told us, “They have given me some new equipment which has been wonderful”. The home is accessible, with handrails and other adaptations. There are separate areas within the home to encourage independence and recuperation, such as a Physio treatment room and small kitchen. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 7 The number of staff on duty and the skills and experience of the staff meet people’s needs. People told us they receive care and support in a timely way and that staff were available when needed. During our visit the routines seemed flexible and care was delivered in an unhurried manner. Many people praised the attitude of staff, saying, “Staff are wonderful, nothing is too much trouble” and “They are cheerful and ready to help”. Staff at the home have been recruited properly to ensure that people are protected from unsuitable workers. What has improved since the last inspection? What they could do better: The home has been asked to provide people with terms and conditions of their stay to ensure they are aware of their rights and responsibilities. The home must improve the information contained in care plans to ensure that people receive the personal care they need in a way that they prefer. Some attention is needed to ensure that medication within the home is managed safely. The home has been asked to improve the storage of medicines requiring refrigeration to ensure that it is kept safely and as per the manufacturer’s instructions. They should also ensure that unwanted medication is returned to the pharmacy. People told us they would like more activities to be organised at the home. Two people told us they get bored, particularly during the afternoon. Relatives also felt that activities could be improved, and felt that this would be beneficial to people at the home. Currently information about people’s interests and hobbies is not consistently recorded to help plan activities at the home. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 8 The general décor at the home is in need of attention in order to maintain a pleasant environment for people. Some carpets are stained and some communal areas, such as the dining room on the first floor would benefit from redecoration. People using the service, professionals and staff felt that the home was looking tired and “shabby” in places. There is a lock missing on one of the bathroom doors, which reduces people’s privacy and dignity. There are no accurate staff training records at the home, which makes it difficult to assess the training given to staff and where training is needed. The manager has been asked to develop an overview of training so that needs can be identified and staff enabled to keep up to date with training. Currently not all staff are receiving supervision, which is necessary to monitor people’s performance and discuss any training and development needs of staff. The home has appointed a new manager since the last inspection, but in order to ensure the home is consistently well managed, an application to register with the commission should be submitted as soon as possible. The home does consult with people about the quality of the care and supported given to them during their stay. Formal analysis of the results of surveys had not been done to form a report about the quality of the services provided. This information would be useful to people considering using the service, and other interested parties such as commissioners of the service, relatives, professionals and CSCI. At the last two inspections requirements were made to ensure all staff received the necessary fire safety training in order to protect people and ensure staff know how to react in the event of fire. Evidence that all staff had received fire training was not available at the time of this inspection. Training records were not available and one staff member told us they had not attended the necessary training, although they had been in post for sometime. Other aspects of health and safety at the home need attention to ensure that people remain safe. The home has not completed or put into practice the fire risk assessment. The home has been asked to ensure that all staff are aware of their responsibilities and actions as per fire risk assessment. Some staff have not had up-dated manual handling training, to ensure practice is a safe. The home must ensure that the environment is safe by ensuring that all systems, such as gas and electrical systems, are safe and regularly serviced. Certificates of maintenance and servicing of these systems should be available to verify that they are safe. No portable appliance testing has been conducted for over a year, which could put people at risk. 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 Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 9 contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Green Close DS0000039212.V344552.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 Green Close DS0000039212.V344552.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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Good information is available to people about the service so that they know what to expect and overall people benefit from a good assessment process, which ensures that the home can meet their needs. People admitted for rehabilitation are successfully supported to regain their independence and to return home where possible. EVIDENCE: The home has good written information about the services it provides, although two of the seven people responding with CSCI surveys felt they did not have enough information about the home before they moved in. This is mainly due to the nature of the service. Relatives felt they “usually” received enough information but one commented that information was “sometimes slow to filter through”. People admitted for short stay or intermediate care may not see information about the home until they arrive. A copy of the Statement of Purpose is kept in people’s room and the reception area. CSCI reports are Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 12 available on request but the manager will look into the possibility of ensuring that they are made freely available in reception. The majority of people responding with CSCI surveys told us they did not have contracts or terms and condition of their stay. During our visit we looked at three ‘individual service contracts” in people’s care files. These had not been completed in respect of the individual with information such as the room to be occupied. None had been signed by people to indicate that they were aware of the terms of their stay, which would ensure that were aware of their rights and responsibilities. All referrals to the home come via social services or health care professionals. We spoke with two care managers who felt that assessment arrangements generally ensured that accurate information was gathered and that the right service was planned and given to people. Two therapists working at the home said that assessments “usually” contained enough information about individual needs and that they would contact the referrer should they need clarification. Assessment information received from referring professionals was looked at. Two contained some detailed information about people’s needs; a third was less detailed. Occupational therapists, physiotherapists and care staff at the home complete a further assessment during the first week of people’s stay at home. This gives the professionals a better idea of the support people will need to regain confidence and independence. Surveys from staff showed that 7 of the 14 responding were expected to care for people outside of their area of expertise, two told us this was usually due to urgent or unplanned admissions on Fridays. Staff told us that in these cases little information was passed to them about people’s needs. This could mean that some people will not be assured they needs can be met by the home. People admitted for rehabilitative care are well supported by skilled professionals, such as occupational therapist (OT), physiotherapist and rehabilitation nurse. Health and social care professionals involved with this service recognised the important role the home plays in helping people regain their skills and independence, and enabling people to return home where possible. Supported home visits are offered as appropriate before people leave the service and people are encouraged to take part in discharge planning arrangemnets. We spoke with several people who described the improvements to their confidence and ability since being admitted to the home. Comments included, “They are so encouraging, I would have given up without their help”, “I feel my stay has been very beneficial and I have improved in just two weeks”, and “The support from the OT and Physio has been very helpful”. Green Close DS0000039212.V344552.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 & 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People’s health needs are well met and staff respect their privacy and dignity. However a lack of detail in some care plans may lead to inconsistencies in care and a risk that some people may not receive all the care they need in their preferred way. Medication is generally well managed but some areas need attention to ensure safety is maintained. EVIDENCE: Surveys received from people who had used the service told us their needs had “always” or “usually” been met. One person felt their needs were “sometimes” met. On the whole the people we spoke to during our visit said staff met their needs well, particularly those who were more or less self caring. People requiring a little more help with things like personal care felt staff “usually” met their needs. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 14 Relatives contacted were generally happy with the service and support given, and told us that in their opinion needs were “usually” or “always” met. One relative told us that the home was particularly good at, “Motivating people who have lost confidence e.g. walking after a fractured leg”. Outside professionals told us people’s needs were “always” met and that the feedback from people who had used the service and their relatives had “always been positive”. People admitted for rehabilitation have good goals in place in respect of their recuperation. The OT and Physio work with individuals to agree a plan of action to aid their recovery. Attainable goals are set, and individual exercise programmes are implemented. People told us they were involved in planning this part of their care and that the care and support they expected was delivered. During the day we saw several people engaged in their exercise programme, getting assistance and encouragement from the therapists. People’s personal care, social needs and emotional and psychological care is less well planned. Currently the home uses ‘care plans’ completed by the referring professional rather than creating care plans with people following their admission. Although the care plans in place give a description of people’s physical needs they do not give detailed instructions to care staff about how to deliver care, including personal care, in a way that people prefer. Nor do they provide staff with details about people’s preferred routines, or social activities. One person told us they were hoping to be able to have a shower with the help of staff. We were told that this wish had not been discussed with staff and no detailed personal care needs were documented in the care plan for this person. This person was unsure how staff knew about their needs as no-one at the home had discussed their personal care with them since arriving. A person with a catheter told us that some staff were unsure of how to connect the night bag; this had resulted in an “uncomfortable” night and had caused some distress. On checking the care notes, no details were available to guide staff about how this person should be assisted with the catheter, just that a catheter was in place. One person was using oxygen when needed, this was mentioned in the care notes, but when it should be used and at what rate it was to be administered was not. Another care plan mentioned that the person had “some continence needs” but did not describe the needs or the action staff should take to support this person. 4 staff responding with surveys felt that care plans did not provide sufficient information for them to deliver care; at our visit two staff also told us that care Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 15 plans were “too vague”. Other staff felt they did have enough information and felt that the weekly multidisciplinary meeting was very useful for informing them of people’s needs. Staff said they were “usually” told of changes to people’s condition at hand over between each shift. During the inspection people indicated that the care provided could vary from one member of staff to another. This could be addressed by the provision of detailed care plans setting out clearly the care to be carried out by staff. The lack of person centred details in care plans was discussed with the manager, who said that a new approach was being developed to care planning by Devon County Council and this would be implemented soon. On the whole plans of care included risk assessments for most areas of care where there may be a risk. These include moving and handling assessments, risks of falls, slips and trips, and risks of choking. Actions are recorded to help reduce risks. People told us their medical needs were “always” or “usually” met. The home has a team of professionals providing care and support to people, including a nurse, OT and Physio. During our visit we saw therapists working one to one with people, providing support and encouragement with mobility and exercises. Many people praised the OT and Physio and described how their confidence and ability had improved with their support. An exercise class has been re-established and is organised and delivered by the Physio. During our visit eight people attended one of these sessions. Several people said how much they enjoyed and benefited from these sessions. One person told us they had “discovered the exercise class by chance” and would have liked to be informed so that they could join in. Many people at the home are encouraged to manage their medication. Secure storage is provided in people’s rooms to keep medicines safe. The rehabilitation nurse has set up new systems to ensure that medication is safely managed. She is responsible for checking medication into the home. She told us that staff had enough training and knowledge to manage medication at the home safely and that good systems were in place. Only senior staff, who have been trained, administer medicines. We found one unlabelled strip of tablets in the medicines trolley; staff could not identify whom they belonged to. This could be a risk. Staff agreed to remove these tablets from the trolley, and audit the medication to ensure that everyone had the medication they needed. Unwanted medicines are to be returned to the pharmacy as soon as possible. A large fridge in the administrator’s office is used to store medicines, which need refrigeration. This is secure as it has a key, but the key is left in the lock compromising safety. The temperature of the fridge is not monitored to ensure that it is within the temperature range specified by the medicine manufacturers. Insulin is kept in this fridge so it is important that temperatures are monitored. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 16 People we spoke with told us that most staff were respectful, and maintained their dignity and privacy. One person told us, “Staff are very pleasant and helpful”, another said, “Staff will do anything for you. Other comments included, “Care staff are fantastic” and “Staff treat you the way you like to be treated”. One person said that most staff were “wonderful” but that one staff member could be “short and rude”. We were told that the manager was aware of this and was dealing with it. People told us that they could express a preference with regards to the gender of staff providing care. During our visit we saw staff treating people with respect, addressing them appropriately. Staff were kind and helpful and the general interaction with people was positive. Green Close DS0000039212.V344552.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. 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 including a visit to this service. The routines at the home are flexible allowing people to exercise choice but people’s preferences and expectations with regards to social activity are not always met sufficiently. Visitors are welcome at the home and the food is generally enjoyed. EVIDENCE: People told us that the routines at the home were fairly flexible, comments included, “There are no strict rules”, “Our routine is flexible” and “There is no rush at all. I can get up when I want and go to bed when I want”. The rehabilitation service at the home provides intensive support each day to help people regain mobility. We saw some people were busy working with therapists. People’s interests and hobbies are not consistently recorded to ensure that appropriate social activities and stimulation are provided. Surveys received from people showed that the majority of people felt activities were available to participate in “sometimes” or “never”. Three people told us activities were appropriate “usually”. During our visit some people were occupied in their own Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 18 way, some were reading, others were watching TV. But one person told us they were “bored and lonely”, another person said, “I get really bored in the afternoon”. Another said that the lack of activities was “the only thing missing here”. There is no programme of activity at the home to stimulate people’s interests and meet their social needs. People told us they did see the hairdresser and one person said they enjoy the regular service at the home provided by the local church. Two relatives felt that activities could be improved, they wrote, “A few more activities in the afternoon would be an improvement” and another wrote, “Day trips would be good even if a small fee needs to be charged. This would avoid over dependence & depression”. Visitors are encouraged and can visit at anytime. One person told us, “Open visiting is useful and very nice relatives are offered a drink”. Relatives told us they were “always” kept up to date with events affecting their relative at the home and the that the home keeps in touch with them. One wrote, “Good friendly approach both to mother and myself”. Surveys received by CSCI showed that staff listen and act on what people say. During our visit there were several occasions where staff offered people choices in a meaningful way. Staff responded to people’s requests in a polite way, saying things like “of course” and “that’s no problem”. One professional told us, “Staff are always willing to listen and respond to individual needs”. On the whole people said they usually enjoyed the meals provided. Surveys showed that people “usually” enjoyed the food, comments made included, “A lot of heavy puds and cakes – not enough fruit/yogurt”, “Soup would be nice”, “Quality of food is very good”, “It would be nice to have alternatives other than salad or sandwiches” and “Lunch very good, supper doubtful”. People we met during our visit echoed some of these comments but most did say that the quality of the food was good. People said, “Food is pretty good, plenty of it”, “Food is very good but can be repetitive”, “The only alternative is salad or sandwiches, some thing else would be nice” and “The food is very good”. Some people were not aware that alternatives were available to them. Menus were not freely available to inform people of choices but the main meal was advertised in the dining room. The chef and the manager have just completed a review of the menus and are hoping to implement new ideas once they have been approved. The chef has a copy of people’s dietary needs and is also aware of some likes and dislikes. He is keen to improve the variety of food available to people. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 & 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a satisfactory complaints process and people are protected from abuse and harm by well informed staff. EVIDENCE: The home’s complaints procedure is displayed in the entrance hallway and a copy has is also included in the Statement of Purpose that is supplied in each bedroom. No formal complaints have been received by the commission about this service. Surveys showed that people knew whom to speak if they had a concern or a complaint and most, seven of the nine responding, said they were aware of how to make a complaint. During our visit people said they would have no hesitation in talking to the manager or senior staff about any concerns. One person told us they had raised a concern about the attitude of one staff member. There was no record of this concern but the manager told us this was being dealt with. The manager also told us that no “formal complaints” had been received since the last inspection. Three relatives told us they knew how to raise any complaints, one wrote, “Not been in this situation”. Three relatives said they did not know who to make a complaint and one told us, “Written info a little scant”. Outside professionals said any concerns were responded to appropriately, one wrote, “Staff are always willing to listen and respond to individual needs”. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 20 All staff responding with surveys said they were aware of the adult protect procedures, which helps to protect people. Staff spoken with showed a good understanding of issues and they would report any concerns to the manager or senior staff. Staff were also aware of the agency to contact outside of the home should they have any unresolved concerns. The manager has organised for the adult protection officer working within Devon County Council to attend the next staff meeting for informal discussion about adult protection issues and to explain their role and responsibilities. People at the home told us staff were “kind, respectful, thoughtful and accommodating”. During the inspection staff approach was friendly and professional. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 21, 22, 25 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is safe, generally clean and well equipped to meet people’s needs. The décor is beginning to look tired and worn and does not always present a homely appearance. EVIDENCE: The home is purpose built and accessible throughout. It is arranged over three floors, with a passenger lift between each floor. On each floor there is a lounge and dining room, toilets and bathrooms. It is located in a residential area, close to shops and bus services. There is a courtyard entrance, and many people were sitting outside in enjoying the warm weather. Although there are some good facilities at the home, the décor of the home is in need of attention. One person wrote, “Impression facility is being run down in terms of décor”, another person wrote, “Reception area could be more welcoming. More pleasant outside area could be provided”. During a tour of Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 22 the building several areas of improvement were identified. The walls in the dining room on the first floor had chipped paper and woodwork and the carpet was heavily stained in places. The cloakroom on the first floor had peeling paint, which looked unattractive and dirty. Staff spoken with felt that parts of the home needed “up-dating” and redecorating. Comments in staff surveys included, “No money spent on up keep, home always looks shabby”. Two professionals felt that the home was looking “shabby” and could do with redecorating. One said they thought the last time it was decorated was seven years ago. There are sufficient and suitable bathing and toilet facilities in the home but one bathroom on the first floor did not have a lock. Staff said the lock had been removed following someone being locked in the bathroom. This has left a hole in the door, which does not promote people’s privacy. The home does have the services of a ‘handy man’ and this should be address as soon as possible. The shower on the middle floor has been re-plastered and redecorated since the last inspection and provides a pleasant facility for people to use. The home has ample specialist equipment to help maximise people’s independence. Corridors have handrails to help people walk; there are a number of hoists and standaids, and various walking aids to assist people. Many people told us about the “useful” equipment they had been given by the OT and Physio to aid their mobility. There is a separate treatment room, where therapists can work one to one with people, and a small kitchen where people can practice their skills. One person said she had enjoyed making cups of tea and had also made biscuits recently, developing her skills and confidence. The home is generally safe for people; radiators are low surface heat to reduce the risk of burning to people. Windows on the upper floors are restricted to prevent accidents from falls, and water temperatures are regulated to prevent harm from scalding. Surveys from people using the service told us that the home was “always” clean and fresh. One person wrote, “High standards of cleanliness”, although another said, “Noticed deterioration in cleaning standards”. During our visit the home was clean and free from offensive odours. The manager has improved infection control measures at the home by installing alcohol gel dispensers, and was trying to ensure that all rooms were fitted with soap dispensers and paper towels. The home has good practice guidance and the manager said that most staff had received infection control training. Two long serving staff confirmed this and a newly appointed staff member said she was due to attend training. All showed a good understanding of basic infection control practice. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 23 The laundry was well equipped and well organised. The person working in the laundry told us she had the training and equipment to do her job well. Good infection control is maintained by the systems in place, including the use of protective clothing such as gloves and aprons. The laundry person said she is aware of any communicable infections and a special process is in place for dealing with any infected laundry. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 24 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. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 & 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The number of staff on duty meets people’s personal and health needs, and people benefit from staff who are qualified and competent. Robust staff recruitment means that people are protected from unsuitable workers. EVIDENCE: We received 14 surveys from staff and 10 of them commented on the poor staffing levels at the home at times. Comments included, “Not enough staff”, “Low staffing an issue”, “Care staff under great pressure at the moment” “Due to staff shortages, particularly at weekends only basic care needs met, not receiving proper rehab”, “Over stretched staff not being able to answer call bells in a reasonable time”, “Staff cut back to minimum” and “People have to wait”. Surveys received in August from people using the service and their relatives also raised concerns about staffing levels at times, they told us, “Not enough staff at times. Call bell not answered for a while in the day. Excellent at night”, “Short of staff, not always available when needed”, “Sometimes it would be helpful if there were more staff available. They seem to be very busy a lot of the time”, “Due to staff shortages daily exercises are cancelled”, “Lack of staff main criticism for help when needed”. Relatives told us, “Shortage of staff results in delays in answering calls when help is needed”, “More staff required” Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 25 and “A very pleasant home with caring but over-worked staff unable to give adequate attention”. Overall staffing levels have improved in the past few weeks and the number of people using the service has reduce, meaning that staff have the time to assist people in a timely way. All the people we spoke with during our visit told us that staff were available when needed, they all said that staff respond swiftly when they ring for assistance. Comments included, “They come very quickly when I need them”, “They are lovely staff, never a long face”, “There is very little delay when I ring for assistance” and “I am never left in distress, they come quite quickly”. During our visit care was delivered in an unhurried way and staff appeared to have time to spend with people assisting them as needed. We spoke with several staff who said the situation had improved more recently. New staff have been recruited and we were told that the team worked well together and morale was good. Therapists working in the home felt that staffing levels had improved and that on the whole staff had enough time to deliver the care needed. The use of agency staff has decreased, which means people receive better continuity of care. The manager said he was monitoring staffing and dependency levels to ensure that people got the support and care they needed. We looked at three staff files for people recruited recently. All contained the necessary checks to ensure that people using the service were safe. The manager has robust systems in place to ensure that agency staff used at the home have had the necessary checks and training, this helps to protect people. Information received from the home shows that 25 of the 28 permanent staff have obtained a nationally recognised qualification in care (NVQ 2). This is to be commended and will ensure that people are cared for by competent staff. 12 of the 14 staff responding with surveys told us they received funding and time for relevant training to help them do their job well. The training records at the home were not up to date and care staff keep their individual training folder, so these could not be inspected. The manager explained that he is currently developing a training matrix to ensure that all staff training needs were identified and met. New staff receive a structured induction, most staff (10 of 14) returning surveys said they had enough support and training when they first started work to help them understand how to work safely and respectfully with people. The majority of relatives returning surveys to us said that staff “always” have the skills and experience to deliver the care needed. Two outside professionals also felt that staff had the necessary skills to support people. Therapists Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 26 working at the home also felt that care staff had the skills and experience to support and care for people at the home. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 27 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 & 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. People benefit from the manager’s approach, which is open and friendly. On the whole, people can be confident that their views will be sought and acted on. Arrangements are place to safeguard people’s finances. Health and safety of the building is generally satisfactory, but without adequate staff training and other arrangements, people could be placed at risk. EVIDENCE: Since the last inspection the registered manager has retired and a new manager has been appointed. The new manager has experience and qualifications in health and social care. He is in the process of completing a application to be registered with the Commission, although a completed application has not been received. He plans to start the Registered Manager’s Award as soon as possible. People using the service and staff described the Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 28 manager’s approach as inclusive and accessible. People using the service knew who the manager was and felt that they could speak with him about any issues; staff also indicated that he had “an open door” style and they felt well supported. Some surveys showed that staff felt that communication could be better between the team and four did not feel they received the support they needed. People’s views are sought about the quality of the service provided. People leaving the service are invited to complete questionnaires about the care they received during their stay. We looked at some questionnaires returned in October. Most were very positive, some describing staff attitude and rehabilitation as “excellent”. The manager is to collate the responses and ensure that results are made available for interested parties, such as future users, commissioners of the service and CSCI. Most people retain responsibility for their own cash and valuables during their stay at Green Close. However, in a few cases the home has agreed to hold small amounts of cash on their behalf. Records were seen of cash held by the home – these were found to be satisfactory, with good practice in place to ensure accuracy and accountability. The majority of staff responding with surveys (10 of 14) said they were not receiving formal supervision, which provides an opportunity for staff to discuss aspects of practice and training and development needs. The manager is providing regular supervision for the assistant managers at the home. Assistant managers have received training to ensure that they can deliver staff supervision, supervision is offered to staff but as yet regular sessions have not been carried out. Staff meeting are beginning to happen more frequently and this should help to improve communication between the team. Minutes of the meetings are available to inform staff of the outcome of meetings. At the last inspection a requirement was made for all staff to receive fire prevention training at intervals recommended by Devon Fire and Rescue Service. Three staff spoken with said they had received recent fire training but a fourth told us they had not been able to attend and needed up-dating training. Records to show that this previous requirement has been met were not available at the time of this inspection. The manager said he would forward accurate records to the Commission but at this time no records have been received to verify that all staff had received the necessary training. Therefore the requirement remains. Fire equipment had been regularly serviced to maintain safety and records showed that 9 staff had been involved in a fire drill back in April, to ensure they knew the procedure in the event of a fire. The home’s fire risk assessment had not been fully completed with actions to be implemented, which may reduce fire safety and staff awareness of what is expected of them in the event of a fire. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 29 New staff had received manual handling training but records showed that other staff had not had the necessary up-dates to ensure their practice remains safe. Information received from the home about staff training shows that all catering and care staff have undertaken food hygiene training to ensure that standards in this area remain high. The home did not have copies of the landlord’s Gas safety certificate or the periodic electrical certificate showing that these systems are safe. The manager said this information would be sent to CSCI following the inspection. We contacted the manager following the inspection to request the certificates. We were told that the estates department at Devon County Council had a copy of the electrical certificate but that a gas certificate could not be found. The manager was arranging for a local contractor to visit the home to ensure gas systems were safe. Copies of the relevant certificates were to be sent to CSCI but to date we have only received the periodic electrical certificate to confirm systems are safe. The portable appliance testing (PAT) was out of date and should have been re-checked in March 2007. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 30 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 2 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 2 3 X X 3 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 3 2 X 1 Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 31 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. 1. Standard OP7 Regulation 15 (1) Requirement In order to deliver care to people in a way they prefer and need, you must ensure that plans of care contain sufficient information about individual’s needs and how these needs are to be met. Where possible, you must consult with people or their representatives when planning and delivering care. Timescale for action 14/12/07 2. OP33 24 (2) 3. OP38 234d 31/12/07 The registered person shall supply to the Commission a report in respect of any review conducted by him for the purpose of reviewing and improving the quality of care provided at the home and make a copy available to people using the service. Previous timescale of 20/05/07 The registered person shall after 30/11/07 consultation with the fire authority make arrangements for persons working at the care home to receive suitable training in fire prevention. Previous timescale of 21/12/06 & 09/11/05 not DS0000039212.V344552.R01.S.doc Version 5.2 Page 32 Green Close 4. OP38 13 (4) (c) 5. OP38 13 (5) met. You must ensure that unnecessary risks to the health and safety of people at the home are identified and eliminated as far as possible. You must have an up-dated Gas safety certificate. PAT must be carried out to ensure that people are safe. You must ensure that suitable arrangements are in place for a safe system for moving and handling people. This includes staff training. 14/12/07 31/12/07 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. 2. Refer to Standard OP2 OP3 Good Practice Recommendations It is recommended that people receive a copy of the terms and conditions of their stay at the home in order to ensure they are aware of their rights and responsibilities. People should only be admitted to the home on the basis of a full assessment being undertaken on which the home can assess whether they are able to fully meet their individual needs. In order to maintain the safe management of medicines at the home, you should ensure that any unused or unwanted medicines are returned to pharmacy. In order to store medicines correctly, you should ensure that the fridge temperature is monitored and accurately recorded, to include maximum and minimum temperatures. You should also ensure that medication stored in the fridge is secure to reduce any risk to people at the home. You should ensure that people’s interests and hobbies are explored and recorded on admission to the home and that suitable activities are provided which meet people’s preferences and expectations during their stay. It is recommended that all concerns or complaints be recorded to ensure that accurate records are kept and that DS0000039212.V344552.R01.S.doc Version 5.2 Page 33 3. OP9 4. OP12 5. OP16 Green Close 6. OP19 7. 8. OP21 OP30 9. OP31 10. 11. OP36 OP38 evidence is available to show that people’s concerns have been acted on and responded to appropriately. To ensure the home is maintained to a satisfactory standard for people living there, you should have a programme of maintenance and renewal. Areas of the home should be redecorated and some carpets should be replaced. In order to maintain people’s privacy, dignity and safety a suitable lock should be fitted to the bathroom on the first floor. Accurate records of staff training should be kept to ensure that the manager can assess staff training needs and provide staff with the necessary training to do their job well. In order to ensure the long term management of the home, the manager should complete and submit an application to CSCI to be the registered manager for the service. In order to ensure that staff have the necessary support to do their job well, and that their performance is monitored, they should receive regular supervision. All staff should be aware of the procedures outlined in the home’s fire risk assessment in order to keep people safe and ensure that appropriate action is taken in the event of a fire. Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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. Extracts may not be used or reproduced without the express permission of CSCI Green Close DS0000039212.V344552.R01.S.doc Version 5.2 Page 35 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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