CARE HOMES FOR OLDER PEOPLE
Green Gables 2 Woodside Road Low Moor Bradford BD12 OTX
Lead Inspector Sue Dunn Unannounced 11 April 2005 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 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 Gables Version 1.10 Page 3 SERVICE INFORMATION
Name of service Green Gables Address Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Green Gables, 2 Woodside Road, Low Moor, Bradford, West Yorkshire, BD12 OTX 01274 676231 01274 676231 R & N Partners Mr Ian Helstrrip Care Home 11 Category(ies) of Dementia (2), Old age, not falling within any registration, with number other category (10), Physical disability (1) of places Green Gables Version 1.10 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 18 October 2004 Brief Description of the Service: Green Gables is situated in the Low Moor area of Braford on a bus route into the city. The stone built detached house, which stands in a large garden with a small area for off road parking, is indistinguishable from other houses in the area. Sevaral local shops and a bookmakers are within walking distance of the home. All but one of the rooms is shared and none have en suite facilities. One of the shared rooms is on the ground floor, a stair lift provides access to the first floor rooms. Decorations and furniture give a homely feel and people are encouraged to bring some small personal posessions into the home.Two care staff are on duty at all times during the day with one waking and one sleeping person on at night. A cook is employed 7 days a week and tries to include residents choices into the weekly menu.At the time of the inspection all the residents were female. Green Gables Version 1.10 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 5.10 hours during which time care plans and records were examined. Residents, visitors, the manager and some staff were spoken with and daily routines were observed. The building was inspected briefly, two care files and a selection of other records were examined. What the service does well: What has improved since the last inspection?
There has been an improvement in the information gathered during pre admission assessments. Care plans were much clearer and the information staff recorded on a daily basis was more relevant to the care. The manager has purchased suitable door handles and locks for bedroom doors. These allow the doors to be locked from either side by each resident but opened easily in the event of an emergency giving people the right to privacy and security in their own rooms. The staff have had some training on understanding dementia and the benefit of this was seen in the way they were assisting and talking to a person who was showing signs of confusion. There has been an increased interest from staff in doing training. Three staff have almost completed the NVQ 2 award and were said to be keen to go on to do the level 3 award. Staff appeared relaxed and confident and in the absence of the manager were able to talk about how they met the care needs of each resident. The owner of the home is now providing an informative written report monthly about what he sees and discusses when he visits the home. Green Gables Version 1.10 Page 6 All relatives have been sent questionnaires inviting them to make comments and suggestions about the home. The results of these are to be examined at a meeting of all senior managers from the organisation who will agree a plan of action for any improvements in the way the home operates for the benefit of the residents. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Green Gables Version 1.10 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 Standards Statutory Requirements Identified During the Inspection Green Gables Version 1.10 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 standard(s) ,3,4,5 The quality of the pre admission information enables the home to confirm that a satisfactory level of care can be provided. Written information about the home’s facilities gives anyone considering moving into the home the opportunity to make an informed choice. EVIDENCE: The home has a large print brochure describing the facilities and services. This can be printed off for anyone who would like a copy. It would be helpful to have full information in the entrance area which residents and visitors can refer to at any time. One person said she chose the home because she had lived in the area and had been given written information about the home after asking a relative to visit on her behalf. Another person said she had visited and stayed for a meal before making a decision. Examples of assessments done by a social worker and by the manager of the home before a person was admitted gave enough information for the home to know what the care needs would be. However, this was not backed up by comments saying how the home would go about preparing to meet those needs.
Green Gables Version 1.10 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 standard(s) 7,8,9 There has been an improvement in the standard of recording in the care files and residents were satisfied with the way their care needs were being met. However, there is still some reliance on memory and word of mouth to pass on information, which should be recorded in the care plan. This raises concerns that some care needs may be overlooked. EVIDENCE: Two care files were examined, one for a person recently admitted to the home and one who had been in the home for a year. Plans of care appeared clear but tended to describe what people were unable to do rather than what they would need help with. One person was not sure if she had discussed her care preferences. A care worker said this had been done but it was not shown in the notes. Further conversations revealed that some routine health care information had not been written in the care plans. This treatment relied on word of mouth or memory. The family were not sure that particular care was given on a regular basis or that staff were aware of the purpose. The manager felt that as it was recorded on the medication sheets (kept in the medication trolley) this was sufficient.
Green Gables Version 1.10 Page 10 Any changes in behaviour or routines should be noted and action taken. One person was said to have improved, another had a significant weight increase. The first had not been recorded, and no action had been taken to investigate reasons for the second. Relatives confirmed that they accompany people on hospital and clinic appointments. A care worker was able to describe the way medication was managed and was able to explain the purpose of each medicine. She said staff are to have some refresher training in the near future. Green Gables Version 1.10 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 standard(s) 12,13,15 The home has a pleasant ‘domestic ‘atmosphere in which people lead a sedentary lifestyle. The range of recreational opportunities is limited and care plans do not give a lead to staff in how the day may be made more interesting and people given a feeling of self worth. Contact with families is good and their participation and involvement is encouraged as it provides a diversion for residents. The food is wholesome and meets the cultural expectations of the ladies. EVIDENCE: With one exception, the ladies living in the home rely on staff for assistance in all activities which involve moving about. Residents in the main lounge were either asleep or appeared withdrawn. There was nothing in the care plans to guide staff towards what each person’s particular interest might be or how to provide interesting and purposeful activities. Staff described the activities as, TV, video films, music CD’s and dominoes, which a couple of people liked. The cook said she had recently involved some people decorating buns. Staff confirmed that the manager is willing to provide funding to support any ideas they may have for activities. A number of people were asleep in their chairs during the morning. One person did not know what she would like to do, as she was physically unable to continue with past interests. One or two simple questions however revealed she liked cleaning brasses.
Green Gables Version 1.10 Page 12 Two visitors said they visit almost on a daily basis and one described how clinic visits are tied in with a meal out and a trip round the supermarket. The meals are nutritious, ‘homely’, and served in a pleasant dining room. A notice board with the menu of the day is kept up to date. All were satisfied with the food. Green Gables Version 1.10 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 standard(s) Staff deal with minor complaints as routine and do not make enough use of the complaints log to show how they listen to concerns and deal with them. This leaves them a risk of being seen not to take complaints seriously until they escalate. There are concerns that without training staff may overlook more subtle forms of abuse. It is encouraging to know that all staff will shortly receive training in this area. EVIDENCE: The home keeps a complaints record but this did not contain any entries. The proprietor recently dealt with a complaint with the assistance of a social worker but the content of the complaints and the outcome of the meeting to resolve them was not recorded. A visitor said generally staff try to sort out any problems that are brought to their attention. Residents talked about the forthcoming election which they have been watching on TV and confirmed that they have a postal vote. Staff, if asked, will assist people to complete their voting card. The manager said that two staff who are doing NVQ have been given the home’s booklet about Adult Protection. He is to give in house training on the subject in the near future. Green Gables Version 1.10 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 standard(s) 19,20,21,22,24,25,26 The building and facilities would not meet the standards if the home were to be registered today but their is a comfortable, homely atmosphere, which meets the expectations of the people who have made a choice to live there. The bathing and toilet facilities are not suitable for anyone with high physical care needs as the limited space in which to give assistance could place staff at risk and compromise the privacy of residents. The hours shown on the rota for providing care should not be used to carry out cleaning tasks which reduce the time care staff spend with residents. The present arrangements make this inevitable. EVIDENCE: The manager keeps written records of the routine safety checks to make sure the building is a safe place to live and work. Repairs and renewals are carried out as required. The manager had a sample of non-slip floor covering for replacing the flooring in bathrooms and toilets. Communal areas were well furnished and decorated but due to limited space, visitors have to use the dining area if they wish to have privacy during their visits
Green Gables Version 1.10 Page 15 There are no en suite facilities in the home, only one communal bathroom, which has a bath and shower cubicle. Communal lavatories are very small for any resident needing more than the minimum of assistance. All fall below the standard required if the home were to be registered to today’s standards. A stair lift is used for residents to get to the first floor bedrooms. This means most people have to rely on the assistance of staff if they wish to use their rooms during the day. Special mattresses to reduce the risk of pressure sores were on the beds in some of the rooms. Locks have now been purchased for bedroom doors and the first of these has been fitted to the door of a ground floor bedroom. Some rooms have interlinking fire doors compromising the privacy of the bedrooms. The manager, in cooperation with the fire safety officer, is seeking a solution to this problem. The home does not have a cleaner therefore some of the care staff time is spent away from residents whilst they are doing the cleaning. Green Gables Version 1.10 Page 16 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,28,30 Staff appear to have benefited from training, with increased knowledge and confidence in the way they were caring for residents and the information they were recording. NVQ training is well under way and the target number of staff with the NVQ award should soon be met. EVIDENCE: The home has a total of 10 care staff. Three have the NVQ award and three more have almost completed it. The manager said that staff are showing more interest in doing training. Two staff said they had been given a talk on dementia by someone from the Alzheimer’s Society. The way they were seen to work with one of the residents showed they had a better understanding of how to assist someone who was confused. The two staff who were working said they had completed First Aid and Manual Handling training and one person said the National Minimum Standards book was available in the home for staff to read. Green Gables Version 1.10 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 31,32,38 The manager has acted on the requirements and recommendations made at previous inspections. This has sometimes been slow due to his efforts to ‘get things right’ but there had been a noticeable moving forward seen on this inspection. Residents are to have the option of being able to lock their bedroom doors. Staff appear to be benefiting from closer leadership and staff training has improved the way staff were seen to care for people in the home. EVIDENCE: The manager has the NVQ manager’s award and is introducing more in house meetings and training for staff. A record is kept of the topics discussed at meetings. The manager has trained to become the Manual Handling trainer for all staff in the home. Visitors said that it is reassuring to see the manager around the home more often when they visit. The proprietor’s monthly reports on the conduct of the home gave a good picture of what he monitors when he visits the home.
Green Gables Version 1.10 Page 18 The home is carrying out a survey of relatives views of the service. A meeting has been arranged with managers to look at any changes which may need to take place as a result of the comments and suggestions received. Routine safety checks are recorded. Green Gables Version 1.10 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 x 15 3
COMPLAINTS AND PROTECTION 3 x 2 x x 2 3 2 STAFFING Standard No Score 27 3 28 3 29 x 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 3 2 3 3 x x x x x 3 Green Gables Version 1.10 Page 20 Yes Are there any outstanding requirements from the last inspection? 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 OP8 Regulation 13,15 Requirement There must be a plan of care for each person which clearly shows how their health care needs are to be met The home must show evidence that a range of social and recreational activities are made available based on each persons interests and abilities All concerns brought to the attention of staff must be recorded in the complaints log All staff must have training on the protection of vulnerable adults The manager must ensure care hours are not being used during the day for cleaning Fire exit doors between bedrooms must be fitted with privacy locks that can allow ease of exit in the event of an emergency 50 of care staff are required to have NVQ The number of bathing facilities and the small size of the w/cs fall short of the standard for a care home for older people. This must be taken into consideration when assessing if the home can
Version 1.10 Timescale for action 31 May 2005 30 June 2005 2. OP12 12,16 3. 4. 5. 6. OP16 OP18 OP26 OP24 OP10 22 18 18 23 31 May 2005 30 June 2005 30.June 2005 31.Decemb er 2005 7. 8. OP28 OP21 18 23 31March 2005 31 May 2005 Green Gables Page 21 meet future care needs 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 OP1 OP4 Good Practice Recommendations It is recommended that the manager provides a full information pack to be made available in the entrance hall for all visitors to the home The comments section of the homes pre admission assessment should be detailed enough to form the basis of an initial care plan Green Gables Version 1.10 Page 22 Commission for Social Care Inspection Aire House Town Street Rodley Leeds, LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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