Inspection on 30/01/06 for Green Close

This inspection was carried out on 30th January 2006.

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 19/10/07

Green Close 20/11/06

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 Vivien Stephens Announced Inspection 30th January 2006 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.V279556.R01.S.doc Version 5.1 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.V279556.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Green Close Address Drakes Avenue Sidford Sidmouth Devon EX10 9JU 01395 515050 01395 512815 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) Devon County Council Mrs Frances Ella Lee 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.V279556.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Service users in the category PD Physical Disability must be over the age of 50 years 9th August 2005 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. There is currently only one long stay service user and the home does not intend admitting any further persons on a long stay basis. The home has three short stay beds, 3 recuperative care beds, and sixteen rehabilitation beds. 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 service users a stay of up to eight weeks, during which intensive therapy is provided by health and social care professionals. The service user is 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. 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. Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection started at approximately 9am and finished at 1.45pm. During the inspection conversations were held with 10 service users, 3 staff and two visitors. The communal areas were seen plus two bedrooms. Tina Schofield, deputy manager was on duty at the time of this inspection. The inspection focussed on those standards not covered during the last inspection – choice, staff recruitment and training, quality assurance and protection of service users financial interests. What the service does well: What has improved since the last inspection? What they could do better: Service users receive good information about the home on admission. This could be further improved by the inclusion of the home’s complaints procedure and information about planned activities. The level of communication and joint working between the rehabilitation team and the care team should be improved. Care plans should contain detailed Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 6 instructions on how the care staff will assist the service user. These should be drawn up with the service user, and either a signature to show that they are in agreement with the content or a record of the discussion with them. Recruitment procedures are satisfactory, but could be further improved by ensuring that a reference is obtained from the current or most recent employer. At the last inspection requirements were made for all staff to receive training on the protection of vulnerable adults, and in the prevention of fire. Evidence provided for this inspection showed that only three staff have received training on the protection of vulnerable adults – this is unsatisfactory and must be addressed as a priority. Evidence of fire training was not available at the time of this inspection – this must be forwarded to the Commission as a matter of priority. 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. Green Close DS0000039212.V279556.R01.S.doc Version 5.1 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 Green Close DS0000039212.V279556.R01.S.doc Version 5.1 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 Service users receive good information about the home on admission, although would be further improved by a few additions. EVIDENCE: All service users are admitted on a short-term basis for either rehabilitation or respite care. A care manager carries out an assessment prior to admission, and this information is passed to the home to ensure they are aware of the service users’ needs. The home has a welcome folder that is given to all new service users. This contains a range of useful and easy to read information about the home. The folder was in the process of being updated at the time of this inspection – it is recommended that the home’s complaints procedure is included in the folder, and also details of the regular activities provided in the home. Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 Each service user has an excellent goal plan in place. However, the lack of detailed care plans is unsatisfactory. EVIDENCE: Care plan files were sampled during the inspection. These contained goal plans that have been drawn up by the rehabilitation team and provide a clear focus for the expected outcome of the service users’ stay at Green Close. The care staff use the goal plans as indications of how the care needs are to be met. However, the plans do not contain specific detail about the individual tasks that staff will be expected to carry out on a daily basis. As example of this was whether staff should help a service user to brush their hair – some staff were uncertain whether they should carry out this task as the goal they were working towards was for the service user to become independent. In this case a clear agreement on admission about which tasks the service user wants help with and how they should be carried out would ensure all staff are working in a consistent manner. At present decisions about whether to provide assistance or not with certain tasks is left to the individual discretion of the care staff to determine, and at times this can cause dissatisfaction and uncertainty. Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 10 Overall there was a high level of satisfaction in the standards of care provided. However, comments by service users during the inspection 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 tasks to be carried out by staff. The care plans must be agreed with the service user and the service user should hold a copy. The plans must be regularly updated, as care needs change. The level of communication and care planning between the rehabilitation team and the care home staff should be improved in order that both teams are in full agreement about both the goal plans and the care plans and how these are to be carried out. Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 14 The home provides a suitable range of activities and exercises in line with the aims of the service. Service users rights to make choices over all aspects of their daily lives are upheld. EVIDENCE: The rehabilitation service provides intensive support each day to help service users regain mobility. This includes physiotherapy and exercise sessions. The home does not provide outings. On the day of this inspection a specialist service providing visiting dogs (often referred to as Pets as Therapy scheme) were in one of the lounges. Those service users who were animal lovers were clearly pleased to see the dogs, and also appreciated the company and conversation from the dogs’ owner and handler. The home also has a range of books and board games. Service users talked about the ways in which they can exercise choice in their daily lives. They talked about getting up/going to bed, choice of where they sit during the day, and choice of food. Those receiving rehabilitation services Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 12 have a fairly structured day and said that, other than when they are taking part in the planned activities, they are free to choose what they want to do. Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 13 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 complaints procedure is clear and robust. Service users are fully protected from abuse. EVIDENCE: The home’s complaints procedure is displayed in the entrance hallway. In discussion with the Assistant manager it was agreed that residents might miss the notice and that a copy could also be included in the welcome folder that is supplied in each bedroom. At the last inspection a requirement was made for all staff to receive training on the protection of vulnerable adults by 9th November 2005. Information provided for this inspection shows that only 3 staff have received this training. The home must produce evidence to show that training will be provided in the very near future – if this is not received further action will be taken by the Commission to ensure compliance. Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 14 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): EVIDENCE: These standards were not covered during this inspection. Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 15 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): 29, 30 Recruitment procedures ensure that service users are safe hands. These could be further improved by ensuring that a reference is obtained from the current or most recent employer. Staff training is given a high priority. The level of NVQ training is excellent. EVIDENCE: Staff rotas provided at the time of this inspection show that there are usually 6 care staff on duty in the mornings, and 5 care staff on duty during the afternoons and evenings. The evening staff finish work at either 9pm, 9.30pm or 10pm. At night there are 2 care staff on duty from 9.30pm to 7.30am. In addition the home employs 2 cooks, five kitchen assistants, a domestic, a handyman and an administration assistant. There is a manager and assistant managers. The home employs contract cleaners. The rehabilitation team based at the home are not directly employed by Devon Social Services and therefore they are not included on the staff rota and their recruitment files were not inspected. Files were checked of those staff recruited since the last inspection. Two references, CRB and POVA checks have been carried out before new staff have been appointed. In some cases the home has not taken up references from the current or most recent employer. It is recommended that wherever possible references are taken up from the current or most recent employer in order to ensure complete protection for service users. Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 16 Staff training records have been maintained. These were seen during the inspection. New staff undertake a 2 day induction course and also ‘shadow’ an experienced member of staff for approximately 2 weeks. All staff either hold or are currently undertaking an NVQ. Records also showed that staff have undertaken all required mandatory training. Future training planned for 2006 includes – Stroke awareness, Parkinson’s disease, diabetes, tissue damage – wound care, Continence, hearing, moving and handling, infection control, attitude, hip precautions, dementia, equipment, falls. This range of training will ensure that staff have a wide range of knowledge relevant to their work. Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 17 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): 33, 35, 38 Service users are consulted to ensure good standards of care and facilities are maintained. Good systems are in place to ensure service users’ finances are safeguarded. Equipment, including fire protection equipment, has been well maintained and is safe and in good working order. The home was unable to provide evidence to show that staff have adequate knowledge or understanding of fire prevention. EVIDENCE: Service users are invited to complete a questionnaire on the quality of the service they have received before they leave the home. These are a useful source of information to help the home review the quality of care and facilities provided. Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 18 Most service users 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. Records provided for the inspection show that all equipment in the home has been regularly maintained and serviced and is therefore safe and in good working order. 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. Evidence to show that this requirement has been met was not available at the time of this inspection. The home is therefore unable to prove that staff have adequate understanding of the action necessary to prevent or deal with fire. The home must provide evidence of fire training – failure to meet this requirement will result in further action being taken by the Commission. Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 19 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 X X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 X 9 X 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 X 14 3 15 x COMPLAINTS AND PROTECTION Standard No Score 16 2 17 x 18 1 X X X X X X X X STAFFING Standard No Score 27 x 28 x 29 2 30 4 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x 3 x 3 x x 1 Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 20 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 OP38 Regulation 23(4)(d) Timescale for action The registered person shall make 09/11/05 arrangements for persons working at the care home to receive suitable training in fire prevention. The Registered person shall 09/11/05 make arrangements by training staff to prevent service users being harmed or suffering abuse or being placed at risk of harm or abuse. Requirement 2. OP18 13(6) 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 3 Refer to Standard OP7 OP16 OP29 Good Practice Recommendations Care plans should be expanded to include detail as to how specific medical conditions should be managed (ie. diabetes, epilepsy). The complaints procedure should be included in the Welcome Pack. The home should obtain a reference from the current or DS0000039212.V279556.R01.S.doc Version 5.1 Page 21 Green Close most recent employer before new staff are confirmed in post. Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 22 Commission for Social Care Inspection Exeter Suites 1 & 7 Renslade House Bonhay Road Exeter EX4 3AY 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. Extracts may not be used or reproduced without the express permission of CSCI Green Close DS0000039212.V279556.R01.S.doc Version 5.1 Page 23 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!