Inspection on 03/11/05 for Green Heys

This inspection was carried out on 3rd November 2005.

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 Heys 15/06/09

Green Heys 29/11/07

Green Heys 09/08/06

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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Green Heys Park Road Waterloo Liverpool Merseyside L22 3XG Lead Inspector Mrs Julie Garrity Unannounced Inspection 3rd November 2005 14:15 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 Heys DS0000017237.V263652.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 Heys DS0000017237.V263652.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION Name of service Green Heys Address Park Road Waterloo Liverpool Merseyside L22 3XG 0151 949 0828 0151 928 8967 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) 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.V263652.R01.S.doc Version 5.0 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. 10/05/05 Date of last inspection Brief Description of the Service: Green Heys is a Care Home with nursing care. In total the Home provides care for 47 service users over retirement age. There are 10 places available for resident’s aged 50 and above. The Home cares for individuals with mental health needs. The area close to Green Heys is residential, there is a local library within walking distance and a number of shops. The main shopping centres of Liverpool and Crosby are accessible by public transport. 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 catering for a variety of residents needs. The Home is purpose built on 1 level and all areas are accessible by residents. There are 34 single rooms, all with en-suite facilities, and 4 double rooms, all with en-suite facilities. There are gardens to the side and rear of the Home. There is 1 main dining room and 3 day rooms. Green Heys has a central enclosed courtyard accessible by the resident. Parking is available to the front and the side of the building and there are main travel routes that provide easy access to the area that the establishment is situated. Green Heys DS0000017237.V263652.R01.S.doc Version 5.0 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and started at 2.15pm on the 03/11/05 and continued from 9.00 am on the 04/11/05 the duration of the inspection was ten and half hours. Mrs Helen Cook represented Green Heys on the second day inspection. Due to the nature of dementia relevant conversation with residents is not always possible. For this inspection it was essential that the majority of information came from relatives, staff and the homes records. Although six residents were spoken with the conversations were brief. Four relatives, nine members of staff and the manager engaged in discussion. A variety of records in the Home were viewed and a tour of the Home was undertaken. What the service does well: What has improved since the last inspection? What they could do better: Staff rely heavily on their verbal communication and the perception that they understand the residents needs. This has lead to a paternalistic attitude in which many decisions are taken for residents based on insufficient information. Green Heys DS0000017237.V263652.R01.S.doc Version 5.0 Page 6 A number of records in the Home are not appropriately maintained and vital information needed to make sure that a quality service is delivered is missed. This has included explination of restraints for three residents and covert medication for three others. Whilst there are a number of areas of good practice in recording keeping this standard is not consistently maintained within all records 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 Heys DS0000017237.V263652.R01.S.doc Version 5.0 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.V263652.R01.S.doc Version 5.0 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): These standards were not fully reviewed at this inspection. EVIDENCE: Although not fully reviewed a copy of the Statement of Purpose and Service Users Guide is available in the Home, as yet a copy of these has not been forwarded to CSCI. Green Heys DS0000017237.V263652.R01.S.doc Version 5.0 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8 and 9. A number of areas of medication management have improved. However some areas of poor practice place residents at risk. Health Care provision is accessed as appropriate and fully recorded in resident’s records. A number of care plans were of a very good standard, however several care plans did not provide sufficient information for staff to be able to care for residents in an appropriate manner. EVIDENCE: In a number of cases care plans were thorough and contained good practice information such as residents likes and dislikes. However the good practice was not available in all plans. One care plan contained information that was not reflective of the resident’s needs and contained inaccurate information. Vital information needed to for staff to deliver appropriate care was missing from several care plans. Care plans are fully detailed for resident’s physical needs there is little exploration regarding the resident’s mental health and behaviour. Although records did contain clear consultation on a number of occasions with suitable heath care services. A number of areas noted in a CSCI pharmacy inspection had been addressed, however the staff were noted not to be following professional guidelines and the Homes policy. Medications were being given without following the proper Green Heys DS0000017237.V263652.R01.S.doc Version 5.0 Page 10 guidelines, medications leaving destroyed were not recorded and some medications were not being administrated in accordance with the GP’s prescription. A further pharmacy inspection has been arranged. Green Heys DS0000017237.V263652.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, 14, 15 The Home provides a range of choices for residents both in the meals available and in the activities undertaken. There is a reliance on verbal discussions which will result in a compromise of residents choices if the verbal discussions breakdown. EVIDENCE: Staff on duty demonstrated genuine warmth in their dealings with individual residents and their relatives. It is the nature of dementia that communication with residents is not always easy in particular in determining their choices. There were good examples of opportunities taken to inform resident’s choices but this was not available consistently. Different activities are available and a number of residents join in these. One resident was enthusiastic about the painting activities and said that they “really enjoy painting”. The activities co-ordinators are keen to develop activities for residents. However there is no activities undertaken when the activity co–coordinators are not on duty. One resident spent the majority of their time in their room, this was happening as staff felt the resident was “noisy” and upset other residents. Little opportunity had been taken to explore the reasons for the individual’s agitation. Residents spoken with said the food was “good”, “tasty” enjoyable. Resident’s menus detailed a choice, in general the decision for many of residents as to Green Heys DS0000017237.V263652.R01.S.doc Version 5.0 Page 12 which food that they would like to eat that day was made by the staff. based on verbal information passed from one carer to another. For some residents the staff had recorded what residents liked to make sure that all staff were aware of the residents preferences. This was not available for all residents. Residents who needed “liquidized food” were given this in one bowl, which is unappetising and limits their choice. Green Heys DS0000017237.V263652.R01.S.doc Version 5.0 Page 13 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18 All staff have receive training in Protection of Vulnerable Adult. Recently the manager responded commendably to a concern raised. However the staffs desire to maintain the safety of residents has compromised their ability to appropriately protect the residents from abuse. EVIDENCE: As part of the induction training staff receive training in Protection of Vulnerable Adults. Staff were clear about what they consider was potential abuse and a recent incident was dealt with in a commendable manner by the staff and the manager. Whilst staff were aware of obvious potential abuse their understanding of Protection of Vulnerable Adults with regards to the inappropriate usage of lap straps on wheelchairs and medications given covertly is limited. Staff felt that this action was for the safety of the residents. Staff had not determined if the action they were taken was appropriate to the residents or if other actions more appropriate to the needs of the residents were available. Green Heys DS0000017237.V263652.R01.S.doc Version 5.0 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 The appearance of the Home has been extensively improved. CIC has invested considerable funds in upgrading the community areas of the Home. EVIDENCE: A number of areas have been redecorated and the Home is now much brighter and welcoming. One resident spoken with thought that the Home now looks “lovely” and is “a much nicer place to live”. Two relatives spoken with were “very pleased with the decoration, its so nice to come in and see it looking cheerful”. The redecoration has been managed by the staff with minimal disruption to the residents. Green Heys DS0000017237.V263652.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): 28, 29, 30 Staff are suitably checked prior to commencing employment. Training opportunities are available but need to be specific to the needs of the residents and the activities that staff undertake as part of their job role. EVIDENCE: Staff described a variety of training that is undertaken. Several staff have now completed their induction. Staff records show that all new staff have an induction that includes mandatory training and an orientation to the Home. Newly recruited staff have 2 references, Criminal Records Bureau check, full application and Protection of Vulnerable Adults check prior to commencing work. This is a considerably improved from previous inspections. Care staff are undertaking a number of activities for which they have not received training or guidance this includes the application of prescribed creams and the usage of food supplements. Although staff have received training in a number of areas there is poor practice in dealing with medications and their understanding of Protection of Vulnerable Adults. The Home is registered for dementia care and 10 places for residents with MH or Learning disabilities. However the majority of senior staff have no training or qualifications in dealing with residents with dementia, mental health issues or learning disabilities. Green Heys DS0000017237.V263652.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): 31, 32, 35, 36 and 38 Residents are supported to access their personal funds as and when they would wish to do so. The lack of supervision for some of the staff and appropriate auditing of the Home has lead to lack of consistency in approach. This has resulted in some weak practices going unreported to the manager and unaddressed by the staff. EVIDENCE: The manager is registered with CSCI, she has management experience and is undertaking to further enhance her skills. Residents, relatives and staff were complimentary about the manager, comments include “easy to approach”, “happy to talk”, and “very proactive” and “ready to make the changes that the Home needs to improve things”. The Home has an assistant manager and a lead nurse who are responsible in ensuring that the day-to-day quality of care is maintained. It is anticipated that these staff provide the daily leadership to the nursing team and care assistants and to audit regularly the care provided. Green Heys DS0000017237.V263652.R01.S.doc Version 5.0 Page 17 Both of these staff, the nursing team and the care team were aware that the Home was administrating medicines covertly to three residents and that two residents were confined to wheelchairs with a lap strap in usage. Two staff reported that they had not questioned this practice as it was in place to “keep the residents safe”. Additionally staff had not reviewed the Homes policy and procedures or referred to best practice guidance readily available in the Home. The Home had not maintained formal supervision up to date for all the staff in order to highlight good and poor practice and develop staffing skills. The administrator is responsible for maintaining the records of residents personal allowances this were kept up to date and detailed residents spending. The manager makes sure that residents are able to access their personal allowances with minutes for small amounts and days for larger amounts. All relatives are informed that large amounts of funds need to be requested in advance. Fire records demonstrated that alarm tests and drills were up to date. Two bedroom doors were inappropriately propped open. These present a serious risk in preventing the spread of fire should it occur. Risk assessment were confusing and in some instances were not available. Accidents in the home have been monitored and have assisted in identifying those residents most at risk. Green Heys DS0000017237.V263652.R01.S.doc Version 5.0 Page 18 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 X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 1 10 X 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 x 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 x 17 x 18 2 3 X X X X X X X STAFFING Standard No Score 27 X 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 2 X X 3 2 X 2 Green Heys DS0000017237.V263652.R01.S.doc Version 5.0 Page 19 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. 2. Standard OP7 OP9 Regulation 15 (2) (a) (b) 12(3) Requirement Residents care plans must be kept under review and updated, as the residents needs change. The manager must ensure unwanted medicines are stored and disposed of safely and accurate records are made. (Outstanding from previous report). The manager must ensure an accurate record of all administered medicines is made. (Outstanding from previous report). The manager must ensure all medicines are administered accurately and in accordance with the prescription. (Outstanding from previous report) The usage of covert medications for three residents and restraint of two residents must be risk assessed and a plan as to how the home is to manage the safety concerns of the residents. This is subject to the outcome of an investigation from Social Services. DS0000017237.V263652.R01.S.doc Timescale for action 03/01/06 24/11/05 3. OP9 12 (3) 24/11/05 4. OP9 12 (3) 24/11/05 5. OP18 12 (3) (7) (8) 07/11/05 Green Heys Version 5.0 Page 20 6. 7. OP30 OP36 18 (1) (a) 18 (2) 8. OP38 23 (4) (a) 9. OP38 23 (4) (a) All staff must receive the training that they need in order to fulfil their job role. All care staff must have formal supervision 6 times a year. (Outstanding from previous report) Put in place the fire door magnetic closures as required from the Fire Authority. (Outstanding from previous report) The practice of wedging open fire doors must cease. (Outstanding from previous report) 03/01/06 03/12/05 03/12/05 03/11/05 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 OP7 Good Practice Recommendations Information within the Home should be written in formats accessible to the residents. Care plans should be simplified in order to ensure that they are accessible by service users and meaningful to the staff. Care plans should be individual and reflect the changing needs of care in all areas. The Manager should provide an index system for care plans, to aid ease of reference. All patient information leaflets for medications should be obtained and presented to staff for training and information. A local procedure should be written describing all medication handling procedures within the home. Non-prescribed medication should be recorded on the MAR and marked appropriately. Review the arrangements for determining service users less able to convey their choices and likes and dislikes to fully develop a completed social assessment. Liquidised food should not be presented to residents combined in a single bowl. The manager should make sure that liquidised food is presented to the residents in an DS0000017237.V263652.R01.S.doc Version 5.0 Page 21 3. 4. 5. 6. 7. OP9 OP9 OP9 OP14 OP15 Green Heys 8. OP38 appetising manner. Risk assessments for falls/injuries and the usage of fire equipment should be regular reviewed. More frequently for those identified as being at greater risk and following an accident to determine if the actions and equipment in place remains suitable to the needs of the service user. Green Heys DS0000017237.V263652.R01.S.doc Version 5.0 Page 22 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 Heys DS0000017237.V263652.R01.S.doc Version 5.0 Page 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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