Inspection on 13/01/06 for Green Gables

This inspection was carried out on 13th 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 Gables 14/11/06

Green Gables 06/07/05

Green Gables 10/03/05

Green Gables 14/09/04

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

CARE HOMES FOR OLDER PEOPLE Green Gables Green Gables 6 Northdown Avenue Cliftonville Margate Kent CT9 2NL Lead Inspector Christine Grafton Unannounced Inspection 10:35 12 January 2006 th X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 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 Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Green Gables Address Green Gables 6 Northdown Avenue Cliftonville Margate Kent CT9 2NL 01843 227770 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) Miss Annette Smith Carol Lewis Care Home 18 Category(ies) of Old age, not falling within any other category registration, with number (18) of places Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: 1. The Home may, from time to time, admit persons between the ages of 60 and 65 years of age. 6th July 2005 Date of last inspection Brief Description of the Service: Green Gables is a detached three-storey property, providing 14 single bedrooms and 2 doubles. Five of the single bedrooms have ensuite facilities. There are stair lifts to the first and second floors. All bedrooms have a call bell point and television point. There are three lounge areas and a dining area, all of which are interlinked, plus a conservatory, where smoking is allowed. Green Gables is situated in a residential part of Cliftonville, close to shops and other local amenities. There is unrestricted parking on street, with one off-street parking place. There is a well laid out back garden accessible to residents. The registered providers, Annette Smith and Carol Lewis, have run the home since August 2003. Both work full time and they are assisted by a team of carers who cover care, domestic and cooking duties, including two senior carers who cover when the registered providers are off duty. The staff team work a rota that includes one carer on waking duty at night and one carer sleeping in. According to its statement of purpose, Green Gables aims to provide a home from home environment to meet the needs of elderly service users within its care. Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place on Friday 13th January 2006 between 10.35 hours and 14.45 hours. The inspection consisted of speaking with one of the registered providers, 7 residents, 2 visiting relatives and 1 staff member, plus checking some records, looking round communal areas and visiting one resident’s bedroom. At the time of this inspection there were 18 residents. The care of 4 residents was case tracked. As the majority of the national minimum standards were assessed at the last announced inspection of 6th and 7th July 2005, this inspection mainly focussed on checking the 7 requirements and 2 recommendations made at that visit and following up on some of the key standards. This report confirms that 6 of the requirements and the 2 recommendations have been met. As the report does not cover all the standards, the reader may wish to refer to the last inspection report, for a fuller overview of the home. What the service does well: The home has a thorough admission process that makes sure that the care needs of people can be met at the time of their admission. This involves the registered providers visiting prospective residents prior to admission, to meet them, assess their needs, give them information about Green Gables and let them know what to expect upon moving in. New residents can therefore be assured that the home is right for them at the start of their stay. Three new residents, who have been admitted since the last inspection, all said how pleased there were to have moved into this home. There is an enthusiastic workforce that is well motivated and works positively with residents to ensure that all their health and welfare needs are met. Staff spend time with residents, talking to them and offering discreet assistance that respects dignity. Residents benefit from a range of activities organised by an activities co-ordinator, who spends two hours a day at the home during the week. Green Gables provides a homely environment for residents and has a warm and friendly atmosphere. Commendable standards were again apparent with regard to standard 19 relating to the maintenance, décor, furnishings and fabric of the environment. The home is comfortably furnished and pleasantly decorated. Two visiting relatives both said how homely Green Gables is, how friendly the staff are and that their respective parent is being well looked after. A staff member said, “this is one of the best homes I’ve worked in, there is no smell of urine. It is nice and clean here.” Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 6 What has improved since the last inspection? What they could do better: It was pleasing to see all the things that have improved since the last inspection. However, it was disappointing that staff recruitment practices have still not improved sufficiently to ensure that all the necessary checks have been completed before new staff start working with residents. Without these being properly completed there is a risk that residents could be cared for by unsuitable people. The registered provider apologised for the oversight and made a commitment to fully complete things in future before employing new staff. There is proper induction training that includes new staff working with an experienced, competent senior carer initially until it is deemed alright for them to work alone. The registered providers also need to make sure that the risk assessment for a resident is sufficiently detailed to show staff what they need to do to manage behaviour to prevent people from being harmed. Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 7 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 Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 8 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 Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 9 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): 3&4 The assessment process is very thorough and makes sure that the person’s needs can be met at the home. The management can demonstrate through the home’s records, practices and staff competency that it can meet residents’ needs. It is not the general policy of the home to admit people for intermediate care, so standard 6 was judged as not applicable. EVIDENCE: There have been three new residents admitted since the last inspection and their care was case tracked. There was much evidence to show that the registered providers had ensured that comprehensive needs assessments had been completed for each of the them. The pre-admission process consisted of obtaining copies of the care management assessments plus the home’s own written assessments carried out prior to admission. This documentation provides a full picture of each resident’s needs, covering all the components specified in standard 3. The three new residents were spoken to individually and they each said they were pleased that they had decided to move into Green Gables. From speaking with the residents, it was clear that the information in the records matched their actual needs. Since the last inspection, the resident with signs of dementia has left the home. Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7&8 The care planning system is clear and consistent, providing staff with the information they need to meet residents’ needs. Residents’ health care needs are well met. EVIDENCE: Since the last inspection, action has been taken to provide more detail in the care plans and to carry out and record monthly reviews. The registered providers have listened to previous suggestions made and have given responsibility to a designated senior carer to carry out and record monthly reviews, updating the care plans where necessary. Care plans have been developed and include dependency assessments, skin integrity assessments, nutritional assessments and appropriate risk assessments. Very detailed monthly review reports are recorded. All the information contained in the care plans indicates that residents’ health care needs are closely monitored and action is taken to access health care services when necessary. From the case tracking, which involved talking to three residents, a relative and staff member, as well as reading the daily records and care plans, it was possible to fully audit the care provided and to see that the outcomes for those residents confirmed that their needs were being fully met at this home. Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 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 & 13 Residents are happy with the lifestyle they have, living at this home. Contacts with families and friends are positively encouraged. EVIDENCE: Seven residents were spoken to during this inspection and each had positive things to say about the home, for example, two residents spoke of enjoying their glass of sherry before lunch, another resident said what a lovely Christmas they all had, commenting on how the registered providers and staff had made such an effort to make sure it had been an enjoyable time for everyone. Residents call the registered providers and staff by their first names and said that this is a very friendly place. Two visiting relatives reiterated this, one said, “this is the best home out of 5 I took mum to visit, it is so homely, the staff are friendly, caring and look after mum well.” The other relative said she is very happy with her mother’s care. An activities co-ordinator is employed to spend two hours a day at the home on weekdays. The registered provider said that residents are asked each day what they would like to do and activities are tailored to suit their mood at the time. A record is kept of the activities and who participates. Entries were also seen in residents’ daily records. Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 12 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): 18 Policies and procedures are in place to safeguard residents from abuse. Strategies for the management of behaviour (in one particular case) need to be formalised to fully protect the resident, staff and other residents in the home. EVIDENCE: The policies and procedures file contains detailed guidance on abuse and what to do if abuse is suspected. The abuse policy is regularly discussed with staff in their supervision meetings, and the procedures are covered in the staff induction programme. Staff have told the inspector at a previous inspection, that their NVQ training had also covered this. The provider confirmed that staff know to contact care management and the commission if abuse is suspected. The registered providers are contactable when off duty and an incident report was seen confirming this. The ‘whistle blowing’ policy has been seen at a previous inspection and there is also a policy on restraint and a management of aggression document. An incident had recently occurred that had been reported to the commission as a notifiable event under regulation 37. From the discussion with the registered provider, reading the records and meeting the resident, it was apparent that the incident had been appropriately managed and followed up. The incident had involved physical and verbal aggression. It was clear that staff had the necessary skills to defuse the situation and the resident’s behaviour had changed as a result of consultation with a doctor and a change of medication. However, the risk management strategy was not sufficiently detailed. The registered provider said this would be expanded. Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20 & 26 The routine maintenance, decoration, and renewal of the fabric of the premises is exemplary. The addition of the new conservatory has enhanced the homeliness and comfort of the communal facilities provided for residents, offering extra choice. EVIDENCE: The registered providers have continued with their programme of improvements to the home. Since the last inspection, a new conservatory has been built, adjoining the main lounge. This has been decorated and furnished to a high standard with a sunscreen roof, vertical blinds, two fans, comfortable seating and a coal effect convector heater. It provides a separate room where residents may smoke if they wish, without it affecting the other interlinked lounge and dining areas, which are all now designated as non-smoking areas. This has been added following recommendations made at previous inspections. Other improvements include: the installation of a new boiler to replace the home’s second boiler. The registered provider stated that plans are in hand to re-carpet the dining room and small lounge in the near future and they are considering having a new call bell system when finances permit. Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 14 Since the last inspection, a paper towel dispenser and liquid soap dispenser have been fitted in the toilet adjacent to the dining room and there is a separate bin for used paper towels, in addition to the foot operated clinical waste bin. A staff member said, “this is one of the best homes I’ve worked in, there is no smell of urine. It is nice and clean here.” Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 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 Recruitment procedures still need to be tightened to ensure that residents are fully protected. EVIDENCE: Two staff files were checked and it was seen that a new member of staff had commenced work without full employment checks having been completed. The files contained application forms, identity checks and reference requests, but one file only contained one reference and a criminal records bureau (CRB) disclosure from a previous employment. The second file did have two references, but the protection of vulnerable adults register (POVA) and CRB checks had not been obtained until three and six months later respectively. There were no interview records and there was no evidence to show whether gaps in employment had been checked out. Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 16 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): 38 The health and safety of residents, staff and visitors to this home is promoted. EVIDENCE: At the last inspection, there were a number of bedroom fire doors wedged open. Only the ground floor bedroom corridor was visited on this occasion, but all the doors were safely shut and some corridor fire doors have automatic closures fitted. The registered provider said that they have looked into the feasibility of having automatic closures fitted and they are also looking into other options, such as sound activated door closures. No decision has been made yet, but in the meantime, it was stated that the staff have been reminded to be more vigilant in making sure that fire doors are kept shut. No other safety hazards were observed on this occasion. Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 x x 3 3 x N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 x 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 x 15 x COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 4 3 x x x x X 3 STAFFING Standard No Score 27 x 28 x 29 2 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score x x X x x x x 3 Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 18 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 OP18 Regulation 13 Requirement Timescale for action 31/01/06 2 OP29 19 There must be a written strategy in place for staff to follow re: the management of a resident’s behaviour, to address the risk of harm. New staff must not be employed 31/01/06 unless they are fit to work at the care home and information is obtained as specified in Schedule 2. Recruitment procedures must ensure that gaps in employment are checked out, appropriate references obtained and CRB/POVA checks are carried out for all employees prior to their start date. Where an employee starts work after a POVA first check, before return of the CRB, they must be properly supervised as specified in the Miscellaneous Amendments Regulations 2004 and records kept. (Previous requirement 07/07/05 not met) Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 19 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Green Gables DS0000047327.V251944.R01.S.doc Version 5.0 Page 20 Commission for Social Care Inspection Kent and Medway Area Office 11th Floor International House Dover Place Ashford Kent TN23 1HU National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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