Inspection on 16/02/06 for Green Gables

This inspection was carried out on 16th February 2006.

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

The inspector found no outstanding requirements from the previous inspection report, but made 3 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Green Gables 01/12/08

Green Gables 07/12/06

Green Gables 22/06/05

Green Gables 02/03/05

Green Gables 01/06/04

Green Gables 27/01/04

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

CARE HOME ADULTS 18-65 Green Gables Wingfield Road Alfreton Derbyshire DE55 7AN Lead Inspector Gail Meads Unannounced Inspection 16th February 2006 10:00 Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 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 DS0000019997.V285983.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 Adults 18-65. 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 DS0000019997.V285983.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Green Gables Address Wingfield Road Alfreton Derbyshire DE55 7AN (01773) 832422 (01773) 522502 linda.barker@lc-uk.org www.leonard-cheshire.org.uk Leonard Cheshire 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) Linda Barker Care Home 28 Category(ies) of Physical disability (28) registration, with number of places Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: 1. Plus Two (2) Day Care Places Date of last inspection 22nd June 2005 Brief Description of the Service: Green Gables is purpose built and suitably adapted and equipped and provides personal care and support for up to 28 service users with severe physical disabilities who are wheelchair users. It is located on the boundary of the village of Oakerthorpe within fairly short vehicular access to Alfreton town centre. Accommodation comprises of three units all named by service users who live there - Treetops and Fairways are single storey level access accommodation and The Snug, being the original building, is split level and provides both passenger lift and wheelchair access. Each unit has its own dedicated facilities, although there is also a central kitchen/catering facility. All service users are provided with single room accommodation with accessible en suites. The homes stated aims include that of enabling service users to take an active part in the management of the home and promoting their independence and right of choice. Services are designed to meet the physical, social and emotional needs of service users. The Registered Manager is supported by a team of care services staff and also via external management arrangements. Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit that took place at the home over a five hour period. Additional time was spent in preparation for the visit, looking at previous reports and other documents. During the inspection process a number of documents were examined, including staffing rotas, health and safety records, staff files and recruitment documents time was spent speaking to a number of residents, staff, and the manager. The inspector spent a specific amount of the inspection concentrating on the Standards, which were not assessed during the last inspection dated 22/06/05 and any areas of concern. What the service does well: What has improved since the last inspection? What they could do better: The staffing levels provided must be reviewed and set against the assessed needs of residents; this must include the residents right to be offered a Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 6 programme of leisure and social activities which must be negotiated with residents and implemented. Safe moving and handling practices must be adhered to at all times. 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 DS0000019997.V285983.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These Standards were not assessed during this inspection as they were inspected 22/06/05 and found to meet the requirements. EVIDENCE: Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 9 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These Standards were not assessed during this inspection as they were inspected 22/06/05 and found to meet the requirements. EVIDENCE: Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 14. Residents do not appear to be having the opportunity to access leisure activities and social events. EVIDENCE: Both staff and residents spoken to were concerned about the lack of provision for residents to enjoy appropriate leisure activities. Staff spoken to stated that due to low staffing levels they were unable to provide the leisure activities and social events that residents needed. One member of staff said “activities are the first thing to go when we are short of staff” Another member of staff said “it would be nice to take residents to the park but we don’t have time” the member of staff added “because they do not get the activities some residents have put weight on and then staff don’t feel able to push residents in their wheelchairs so they are not motivated to motivate residents even if they had time”. One resident said “ we don’t go to evening activities because if it finished late it could be one o’clock in the morning before some of us are put to bed because there are not enough staff to help us” . Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 11 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 21. Care for residents who are dying would be provided in an appropriate and sensitive manner. EVIDENCE: The home has a policy for the care of residents when dying residents would be offered the identified care, the general practitioners advice and support would be sought and relatives/significant others would be informed. Relatives and friends could visit at any time and staff would not leave the resident alone. The identified spiritual needs of the resident would be requested and respected. Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 12 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These Standards were not assessed during this inspection as they were inspected 22/06/05 and found to meet the requirements. EVIDENCE: Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 13 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These Standards were not assessed during this inspection as they were inspected 22/06/05 and found to meet the requirements. EVIDENCE: Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 14 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31.32.33.34.35.36. Staff have good training opportunities and work together as a team. The homes recruitment policy and procedures are adhered to through the recruitment process. Resident’s needs at the time of the inspection were not being fully met. EVIDENCE: Staff spoken to confirmed that they had good training opportunities provided within the care workers 47 have now achieved National Vocational Qualifications (NVQ) level 2 and above. One member of staff spoke of not receiving supervision as often as it should be although the member of staff did say that supervision was given quite frequently. The homes recruitment policy and job descriptions were examined during the inspection and were found to be satisfactory. As previously mentioned in this report Standard 14 residents did not feel their assessed needs were being met due to what they describe as staff shortages. Staff members spoken to felt that the staff group did function well as a team and would pull together when needed to provide a good service to residents. Staff meetings are held on a regular basis as and when needed and there is a staff association group in place this is a time for staff to discuss staffing issues with their colleagues. Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 15 The manager herself has carried out a comprehensive analysis of the residents needs and staffing levels provided her findings were that all three of the homes units had a considerable staffing deficiency. The staffing rotas were examined and on the day of the inspection staffing levels were two down. Over the four weeks rota examined there had been frequent shifts where there were two members of staff on a unit when there should be three. Staff spoken to confirmed that there had been numerous occasions when staffing levels on each of the three units had been running at two and not three. The manager stated that no agency staff had been employed nor were they likely to provide agency staff in the future. Residents spoken to on the day of the inspection stated that they thought the staff were very good and worked hard. Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 16 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37.38.40.41.42.43. The manager has been in the post for a year now and during this time she has clearly grasped the issues and familiarised herself fully with the systems and structures within the home. The manager appeared competent and confident during the inspection. The health and safety records need to be better organised for easy access to information. Record keeping within the home is generally well maintained. EVIDENCE: The manager is a registered nurse and is very experienced within the caring field of work she is in the final module of her National Vocational Qualification (NVQ) level 4 and Registered Managers Award (RMA). Staff spoken to on the day of the inspection stated that they had a good relationship with the manager and found her to be supportive. Staff were equally confident that if they had any concerns they could approach the manager and the appropriate action would be taken. Residents meetings are held as and when there are issues to discuss and residents do have a say in matters concerning the home. Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 17 The home has a robust recruitment policy and procedure, which is clearly adhered to. The homes policy and procedures manual is very comprehensive and detailed it was examined and found to contain the policies identified in Appendix 3. One resident spoke of not feeling safe when only one member of staff assisted him with the hoist. A member of staff also sighted this practice as “quite common but very unsafe” but added “it is the only way we can get residents up or into bed at night at a reasonable hour”. The service records for gas; hoists, wheelchairs and electrics were examined and found to up to date. The Environmental Health inspection had taken place there were no recommendation made. Water tests had been carried out for the prevention of Legionella as required. Health and safety posters were displayed throughout the home and protective clothing was provided for staff. The home has a comprehensive containment of substances hazardous to health (COSHH) manual available to staff. There are weekly fire alarm test, which are recorded as required. Mixer valves are fitted to all water outlets to residents and these had been serviced 16/02/06. The home has a current liability insurance certificate displayed in the front entrance alongside the homes certificate of registration. Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 18 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 x 2 x 3 x 4 x 5 x INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 x 23 x ENVIRONMENT Standard No Score 24 x 25 x 26 x 27 x 28 x 29 x 30 x STAFFING Standard No Score 31 3 32 3 33 2 34 3 35 3 36 2 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score x x x x x LIFESTYLES Standard No Score 11 x 12 x 13 x 14 2 15 x 16 x 17 x PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score x x x 3 3 3 x 3 3 2 3 Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 19 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 YA42 Regulation 13(5) Requirement The registered person must ensure that staff are able to provide safe moving and handling practices at all times. Staff must not move residents alone, as this is not safe practice. The registered person must ensure that the staffing levels provided are adequate to enable residents to participate in their chosen leisure activities and social events on a regular basis. The registered person must employ staff in sufficient numbers to meet the identified needs of the residents. Timescale for action 01/04/06 2 YA14 16(2)(m) and(n) 01/05/06 3 YA33 18(1)(a) 01/05/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard YA42 Good Practice Recommendations The service records would benefit from being organised in such a way as to enable easy access to the information DS0000019997.V285983.R01.S.doc Version 5.1 Page 20 Green Gables 2 YA36 when needed. Staff should receive formal supervision at least 6 times per year this should be recorded and copies given to the staff member. Green Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Derbyshire Area Office Cardinal Square Nottingham Road Derby DE1 3QT 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 Gables DS0000019997.V285983.R01.S.doc Version 5.1 Page 22 - 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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