Inspection on 15/06/09 for Green Heys

This inspection was carried out on 15th June 2009.

CQC has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CQC 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 Heys 29/11/07

Green Heys 09/08/06

Green Heys 03/11/05

Green Heys 10/05/05

Green Heys 09/09/04

Green Heys 19/05/04

Green Heys 07/03/04

Extracts from inspection reports are licensed from CQC, this page was updated on 16/02/2010.

Key inspection report CARE HOMES FOR OLDER PEOPLE Green Heys Park Road Waterloo Liverpool Merseyside L22 3XG Lead Inspector Jeanette Fielding Key Unannounced Inspection 15th June 2009 09:40 DS0000017237.V375911.R02.S.do c Version 5.2 Page 1 This report is a review of the quality of outcomes that people experience in this care home. We believe high quality care should: • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care homes for older people can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop. The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 2 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report Care Quality Commission General Public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Green Heys Address Park Road Waterloo Liverpool Merseyside L22 3XG 0151 9490828 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) www.c-i-c.co.uk. Community Integrated Care Mrs Helen Cook Care Home 47 Category(ies) of Dementia (10), Dementia - over 65 years of age registration, with number (47), Mental disorder, excluding learning of places disability or dementia (10) Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Service Users to include up to a maximum of 47 DE(E), of which up to a maximum 10 DE, and up to a maximum 10 MD. The service should employ a suitably qualified and experienced manager who is registered with the Commission for Social Care Inspection. Date of last inspection Brief Description of the Service: Green Heys is a purpose built Care Home, which provides nursing care to people who have dementia. The Home provides care for 47 service users over retirement age and care to ten people from the age of fifty upwards. Green Heys is situated close to Crosby village. There is a local library within walking distance and a number of shops. Public transport is approximately 5 minutes walk away. Green Heys is a privately owned establishment; the owners are a charitable organisation with a number of establishments in the North West. There are 34 single rooms, and 4 double rooms. All have en-suite facilities. There are gardens to the side and rear of the Home. There is 1 main dining room and 3-day rooms one of which is for residents who smoke. The home is built around a central courtyard, which is accessible to all. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 0 star. This means that people who use the service experience poor quality outcomes. This unannounced key inspection was undertaken over two days and a period of twelve and a half hours were spent in the home. As part of the inspection process, all areas of the home were viewed including many of the service users bedrooms. Assessments and care plans were inspected together with staff records and certification to ensure that health and safety legislation was complied with. Observation of the interaction between staff and people who live at the home provided further evidence of the actual care given. Four service users were case tracked to evaluate their care and obtain their views. Discussion took place with the assistant area manager, acting manager, staff, service users and visitors to the home. The acting manager completed an Annual Quality Assurance Assessment form prior to the inspection to give additional information regarding the home. An inspection of the medications was undertaken by a Pharmacist Inspector. What the service does well: The home provides accommodation in a purpose built, single storey building, which is provided with aids and adaptations to assist service users who have mobility difficulties. The home is decorated and furnished to a good standard and all areas of the home are clean and well maintained. A range of seating areas around the home are accessible to all service users. Detailed information is available regarding the facilities and services offered. A detailed assessment is undertaken on all prospective service users to ensure that the home can meet their identified needs. Meal are well cooked and attractively presented and special diets are carefully prepared. What has improved since the last inspection? What they could do better: Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 6 The care plans and risk assessments should be reviewed and updated to give staff full information about the care and support that each service user needs. These require reviewing and updating on a regular basis. The procedure to be followed in the event of accidents should be reviewed and the details given to all staff to ensure that service users are provided with the appropriate level of care whenever necessary. Care should be taken to ensure that handwritten entries on Medication Administration Record sheets are accurate and contain full information. The dignity of service users should be respected at all times by the staff team. On the appointment of an activities co-ordinator, a programme of meaningful activities should be prepared to provide service users with stimulation and entertainment. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line – 0870 240 7535. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 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 Heys DS0000017237.V375911.R02.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 1 and 3. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Sufficient information is provided by the home to enable prospective service users and their families to make an informed decision regarding their care provider. EVIDENCE: The home provides prospective service users, and their relatives, with a brochure and a handbook which provide full information about the services and facilities that the home can offer. Copies of these are displayed in the foyer of the home and additional copies can be provided by the home on request. A full assessment is undertaken on all prospective service users prior to their admission by one of the qualified nurses. A dedicated form is used to record Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 9 the service users nursing, care and social needs. The assessments of the most recently admitted service users were inspected and were found to be detailed and informative. Information is gathered from the service user, their relatives and any other person involved in their care. Sufficient information was recorded to enable the initial plan of care to be prepared. The home does not offer intermediate care. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care planning is not sufficiently clear to adequately provide staff with the information they need to satisfactorily meet service user’s needs. EVIDENCE: Individual care files are prepared for all service users. Care plans are prepared for a range of care needs. Some files were noted to lack the necessary information to inform staff of the specific level of care and support that is to be given. Some care plans are detailed but there is a lack of evidence that the staff are following the plans. The care need of one service user is mis-spelled in relation to their blood pressure and indicates that the service user suffers high blood pressure when the problem relates to low blood pressure which may impact on the care given. No instructions for staff are recorded in relation to Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 11 checking the service user’s blood pressure in a specific way and the staff have failed to check the blood pressure at the frequency detailed in the plan. The plan in relation to the service users nutrition requires that the staff weigh the service user each week, but have only weighed the service user four times in the last six months. This was noted in relation to three other service users and may place the service users at risk. Two service users are recorded as having lost an excess amount of weight over a short period but the records do not identify any remedial action to rectify this or to contact the doctor or dietician for advice. The weighing of service users was discussed with the two nurses on duty. Both confirmed that they had left instructions for the staff to weigh the service users over the weekend prior to the inspection but only a few service users had been weighed. This indicates that staff are failing to follow instructions given to them. Arrangements were made for the weights to be checked on the days of the inspection. The manager must ensure that staff follow the instructions given in the care plans to ensure that the service users are checked at required intervals and that appropriate action is to be taken to ensure that those needs are met. The care file for one service user identifies that a wound requires regular treatment from the staff but no details are recorded of the actual care required. No photograph of the wound is on the file and no records were found of when the treatment was given or of the progress of healing. The information provided by the Speech and Language Therapist, for one service user, states that they should be given a soft moist diet and slightly thickened fluids via a spouted cup. The care plan prepared by the staff states that the service user takes a normal diet. One service user is reported as having had a fall, four days prior to the inspection. The home had not taken appropriate action in relation to the provision of medical advice until the day of the inspection. On the second day of the inspection, it was established that the service user had still not been given the appropriate care and the manager of the home was strongly advised to address this matter as a priority. The daily records for one service user contained an entry by the night staff to inform other staff that the service user had a blister which required monitoring. No evidence of this monitoring is recorded and would indicate that the staff are failing to meet the needs of the service user. The care files include a social assessment. The assessment for one service user identifies that they enjoy one to one company, but there is no evidence to suggest that this has been provided. Staff spoken to said that they did not have time to provide activities or social stimulation for the service users and were waiting for the new activities co-ordinator to commence work at the home. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 12 As part of the inspection a pharmacist inspector visited on 6th July 2009 to check how medicines were being handled because we had found serious shortfalls on our last visit that meant medicines were not always being handled safely. We found medicines stock and records to be well organised and securely stored. Our checks of the records and current stock showed that medicines were usually being given to people properly and accurate records were being made. A clear system of stock control was in place that helped make sure medicines did not run out of stock and made sure they could be fully accounted for. We saw good improvements about the way creams were given and recorded and we gave some further advice about how to improve their storage. We found occasional mistakes notably with handwritten records and when medicines had run out of stock but good improvements in the checking of medicines had been made. New daily checks of the medicines records and stocks were finding most problems and action was being taken to help prevent them happening again. The manager told us that all staff who handle medicines had carried out further training and some formal checks of their competence when handling medicines had been made. We saw some evidence of this and also saw that when staff persistently failed to follow the correct procedures then immediate action was taken against them. We checked how controlled drugs (medicines that can be misused) were handled. The cupboard used for storage was secure and a special register was used for record keeping. Stock levels were correct and all entries were properly witnessed. Secure storage and witnessed records help make sure controlled drugs are not mishandled or misused. We looked at a sample of care plans and records to check if medicines were properly reflected in them. We found some good information about how medicines should be safely used and we saw up to date directions about how to use specific medicines either in peoples care plans or kept with the medicines records. People that were taking when required medicines for anxiety had good care plans in place and we saw some good care plans for people that were taking painkillers. However, one persons care plan who was occasionally refusing their medicines was not up to date because a formal assessment of their mental capacity had not been carried out. Another person who had raised blood pressure was not being checked weekly as their care plan instructed and had not been checked for the last six weeks. This persons GP had not been contacted so there was a risk that they might not receive the right treatment. Having clear written care plans helps make sure peoples health is protected and helps make sure their medicines are handled safely. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 13 There is little evidence that the service user’s dignity is respected. One care assistant was observed to place a clothes protector on a service user without any interaction. The carer did not explain what she was doing or advise the service user that the meal would be served very soon. The carer then left this service user and went across the lounge to another service user who was in a Kirton chair. She approached this service user from behind and wheeled the chair across the room. At no time did she speak to the service user, explain that she was going to move them or give information as to where they were being taken. One carer was heard to call across the dining room to another carer. She said ‘Don’t give ‘service user’ more tea, he pours it on his plate’. The second carer gave the service user another cup of tea which he drank without any problems. One male carer, employed from an agency to provide one to one care for a service user, did not spend time with the service user in the dining room. He walked up and down the room but did not speak to any of the other service users. Another male carer was providing one to one care for another male service user and was clearly supportive and caring in his interactions. This was discussed with the manager who said that she would address this. Relatives spoken to at the time of the visit said that the staff worked hard to provide care. Two relatives contacted CQC to express their concerns about the care and these are currently being investigated by Sefton Social Services Safeguarding Team. It is essential that all care plans and risk assessments are reviewed to ensure that they are accurate and that detailed instructions given to staff to ensure that service users’ individual needs are being met. The manager must ensure that staff are appropriately supervised in all aspects of care provision and appropriate action/training implemented where necessary to ensure that service users receive the level of care appropriate to their needs. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 14 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14 and 15. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a lack of social activities which denies service users the opportunity to participate in stimulating or entertaining activities of their choice. EVIDENCE: At the time of the visit to the home, no activities co-ordinator was in post. The acting manager explained that the vacancy for the position had been filled but the identified person had not yet commenced work. The co-ordinator is due to start work at the home within the next few weeks. Service user’s social preferences are identified in their care plans but there is no evidence that activities, or social stimulations, are currently being provided. The care plan in relation to socialisation for one service user states that they ‘enjoy one to one company’. There is no evidence that one to one stimulation has been provided. Staff spoken to during the inspection said that they did not have time to provide activities. The televisions were switched on in lounges throughout the home and in some of the bedrooms. Few service users were Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 15 watching the televisions and most were observed to sleep in the armchairs. The acting manager said that plans are in place to improve the range and number of activities provided when the activities co-ordinator is in post. Clergy are invited to the home and can provide services on request. Visitors are welcome at the home at any time and some relatives have chosen to assist with the care of their relatives, particularly at mealtimes to assist with feeding. One relative said that the meals provided were of excellent quality and well presented. There is little evidence that choices are offered in respect of day to day living, although there is evidence that choices are offered in respect of meals. Service users can take their meal in the dining room, one of the lounges or in their bedroom as appropriate. The meals are prepared in the main kitchen and fresh produce is used as much as possible. A good supply of tinned and frozen foods are available to enable a greater range of meals to be provided. The kitchen is clean and organised and the chef is clearly aware of the needs of the service users. Special diets are prepared where necessary and the chef takes pride in the presentation of meals. Soft and liquidised meals are prepared in moulds to give the shape of the specific food being served. The chef explained that any request for specific food can usually be met and that purchases for these can be made at nearby shops. The service users are offered a choice of meal on the day previous, although staff said that the service users had often forgotten what they had ordered and requested that they have the same meal as someone else on the day. The chef said that this was not a problem and that additional food of each choice was prepared to enable the preferences of the service users to be met. Staff assist service users to take their meals and were observed to do so with dignity and care. Meals served on the days of the visits were noted to be attractively served and smelled appetising. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 16 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18. People using the service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Practices and record keeping within the home do not ensure that service users are adequately protected. EVIDENCE: The home has a complaints procedure which is displayed in the foyer and is also detailed in the brochure and service user guide. The records held in the home show that five complaints have been received by the home in the last twelve months and that all have been dealt with appropriately. Safeguarding issues have been referred to Sefton Social Services, by both the home and by relatives of service users. These are investigated and addressed by both the home and Social Services where appropriate. The referrals identify shortfalls in care practice by the staff at the home and the failure of staff to address medications safely. Staff training and assessment of staff competencies are being addressed by the management of the home. The record keeping and management of medications do not ensure that all service users are adequately protected. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 17 All staff have been given training in the protection of vulnerable adults and evidence of this was seen on the staff files inspected. A member of staff was observed to be supervising service users in the smoking lounge. It was established that this member of staff did not smoke and did not like the atmosphere in this room. A risk assessment should be undertaken on staff who supervise service users in this room and their agreement to do so should be obtained. The home has a responsibility for ensuring that staff are not placed at risk whilst supervising service users in smoky environments. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 18 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 19, 20, 22, 24 and 26. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Service users are provided with a bright, homely and well maintained home which provides a pleasant environment in which to live. EVIDENCE: Green Heys is a purpose built care home which provides all services and facilities on one level. This provides service users and visitors with full access to all areas of the home. A selection of lounges and dining areas are provided and service users are free to choose where they spend their day. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 19 The home provides a selection of disability equipment including specialised seating, assisted baths, raised toilets and hoists to assist those who are frail or who have mobility difficulties. All bedrooms and en-suite facilities have been personalised by staff and relatives to reflect the lifestyles of the individual service users. Service users and relatives are encouraged to provide photographs and items of memorabilia to personalise the rooms and to aid reminiscence. The décor and furnishings in all bedrooms inspected was domestic style and in good condition. Since the last inspection, the programme of redecoration and refurbishment of the home continues and all areas were bright and clean with the exception of the corridor carpets. Housekeeping staff said that they clean the corridor carpets regularly but they become stained and dirty very quickly. Two bedrooms have been fitted with new flooring. The furniture and carpet in the smoking lounge are worn and stained and consideration should be given to replacing these. Bathroom number 4 was found to contain razors, hairbrushes and a bag containing personal items. The bag and hairbrushes should be returned to their owners and the razors disposed of. Razors must not be stored in communal areas as this places service users at risk. The home employs a maintenance person who attends to repairs and a record of all work undertaken is held. The home provides a central courtyard which service users can safely access. Tubs with flowers brighten the courtyard and seating is provided. The area has been fitted with a soft ground surface to avoid injury to people in case of trips or falls. The home is surrounded by lawns but these areas are not secure and cannot therefore be used by service users. All linens and service user’s personal laundry is attended to by designated laundry staff. It was noted that the laundry is not provided with a wash basin where staff can wash their hands or attend to items of clothing which require to be hand washed. The laundry provides two washing machines and two dryers, although one of the dryers was out of order at the time of the visits. Observation of service users clothing provided evidence that care was taken with the laundering of personal items. Discussion with the laundry staff confirmed that infection control procedures were followed. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 20 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The procedures for the recruitment of staff need to be more robust to ensure suitable staff are employed to safeguard the service users. EVIDENCE: Since the last inspection, there has been a high turnover of staff, although many of the current staff have been employed at the home for a number of years. The home employs qualified nurses, both general and mental health, together with care staff to provide for the service users. The staff structure is clear and each member of staff is provided with full details regarding their role, responsibilities and tasks for the time that they are on duty. The home also employs housekeeping, laundry, catering, administration and maintenance staff. The staff rota shows that sufficient staff are on duty to provide care and support for the service users with additional staff to provide one to one care were necessary. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 21 Staff interactions were observed throughout the visit and concerns were noted as previously detailed in this report. This information was reported to the acting manger who stated that she would address this matter. The home has a detailed recruitment procedure but two staff files identified gaps in employment history which had not been explored. One staff file contained undated testimonials and not personal references. The new manager stated that she is aware that only references are required and will ensure that these are obtained for all staff in the future. All staff are required to be checked through the criminal record and protection of vulnerable adults bureaux to ensure that service users are protected. New staff are required to undertake induction training provided by the company training department and through e-learning. The e-learning computer is located in the manager’s office and so access to this can be difficult when meetings are taking place in the office. Training continues to be offered to staff, particularly in relation to dementia care. At present 50 of the care staff hold NVQ qualifications and additional staff are working towards this. Only six of the care staff hold food hygiene certificates. It is advised that all staff who are involved with serving meals or assisting service users to take meals undertake this training. The manager is new to the service and is working hard to identify training undertaken by staff and training needs. This could be rectified by the use of a training matrix. Staff who deal with medications have recently undertaken training and their competencies assessed. Evidence of this is held on their individual files. Discussion was held with the qualified nurses on duty. They said that they were kept busy all day with the medications and the reports. One said that there was not enough time to review care files to the standard they would like as there were no supernumerary hours available to do this. There are two qualified nurses on duty at all times, together with a manager and/or deputy manager each day. Supervision is given to all staff on a regular basis and evidence of this is held on the staff’s individual files. Regular staff meetings are held to enable topics to be discussed in an open forum and for the manager to disseminate information. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 22 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 37 and 38. People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The manager has a good understanding of the area in which the home needs to improve to provide service users with a good level of care. EVIDENCE: The home employs an acting manager, who is new to the service, and a temporary deputy manager, who is also new to the service, to take responsibility for the day to day running of the home. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 23 The acting manager is a qualified nurse and an experienced manager who is well supported by senior managers within the company to address shortfalls in service provision. The acting manager has identified areas within the home which she is in the process of changing to ensure that the home is run in the best interest of the service users. This will be through staff training, supervision and regular audits of all aspects of care. Service users money is held in a designated bank account which provides service users with interest as appropriate. Robust procedures are in place to manage the money and to protect the service user’s best interest. Health and safety issues are addressed as soon as they are identified to ensure that staff and service users are protected. Regular checks are made on fire detection equipment and regular fire drills are held. Safety checks on the premises and on equipment are undertaken and certification of this is held in the home. All certificates inspected were up to date. Improvements are needed to some of the record keeping within the home, particularly in relation to the care required by and afforded to service users. Policies and procedures are in place and are accessible to all staff at all times. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 24 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 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 2 10 1 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 1 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 1 3 3 X 3 X 3 X 3 STAFFING Standard No Score 27 2 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 3 X 3 X 2 3 Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 25 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 15(2) Requirement All care plans and risk assessments must be reviewed and updated to ensure that full and accurate information regarding the care required is recorded. Arrangements must be made for service users to receive treatment and care from healthcare professionals particularly following accidents and when dietary needs are identified. The registered person must make proper provision for the care, and where appropriate, treatment of service users which includes taking of blood pressure and weighing people. The registered person must ensure that staff respect the dignity of all service users in their interactions with them. The registered person must consult service users about their social interests and make arrangements to enable them to engage in social activities. The registered person must DS0000017237.V375911.R02.S.doc Timescale for action 30/09/09 2 OP8 13 30/09/09 3 OP8 12(1) 30/09/09 4 OP10 12(4) 30/09/09 5 OP12 16(m) 30/09/09 6 OP27 18 30/09/09 Page 26 Green Heys Version 5.2 7 OP29 19 8 OP30 18 9 OP31 8 10 OP37 17 ensure that all staff are sufficiently competent to undertake the tasks that they are to perform. The home’s policy and procedure for the recruitment of staff must be followed to ensure that two relevant references are obtained prior to them commencing work at the home. Appropriate training must be given to staff to ensure that they have the necessary skills to protect service users dignity. An application to register a manager of the home to be responsible for the day to day running of the home is to be submitted to CQC. Records required by regulation for the protection of service users and for the effective and efficient running of the business are maintained, up to date and accurate. 30/09/09 30/09/09 30/09/09 30/09/09 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 OP14 Good Practice Recommendations Service users should be offered choices in all aspects of daily living including the participation in activities. Green Heys DS0000017237.V375911.R02.S.doc Version 5.2 Page 27 Care Quality Commission North West Region Citygate Gallowgate Newcastle upon Tyne NE1 4PA National Enquiry Line: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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