CARE HOMES FOR OLDER PEOPLE
Green Heys Park Road Waterloo Liverpool Merseyside L22 3XG Lead Inspector
Mrs Joanne Revie Unannounced Inspection 9th August 2006 10:00 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.V302301.R01.S.doc Version 5.2 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.V302301.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION
Name of service Green Heys Address Park Road Waterloo Liverpool Merseyside L22 3XG 0151 949 0828 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.V302301.R01.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. 03/11/05 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.V302301.R01.S.doc Version 5.2 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspection took place over two days and lasted approximately ten hours. Discussions were held with the manager and other key staff. Discussions were also held with three relatives. Some brief discussions were held with residents but these were not in-depth due to the resident’s individual needs. A telephone discussion took place with one person whose relative had recently moved into the service. Comments from all the above groups are included within the summary section of the report During the visit a variety of records were viewed and read. These are referred to in the evidence section of the report. Four residents were “case tracked”. This means that the visit concentrated on these peoples experience of living in the service.Rather than viewing everyone’s records briefly, their records were reviewed in depth. This helps to give an understanding of what it must be like to live at the service. On the day of this visit the service was providing care for 43 residents. Fees range from £ 483.00 per week to £580.00 per week. What the service does well:
The service makes sure that it acquires as much information as possible about a residents needs and preferences before admission takes place. This means that staff can plan and prepare to meet the resident’s needs and the risk of the resident living somewhere, which cannot provide suitable care, is greatly reduced. A relative commented that “ it was nice to meet a friendly face” and that the service had provided clear literature about the service before admission took place. Each resident has a care plan which has been developed with input from relatives, residents and representatives. These plans are written in the first person, which gives the reader an insight into the resident’s personality, needs, and preferences. This means that in situations where residents are unable to voice their needs clearly, staff have clear written instructions to refer to so that they are able to deliver care how the resident would like it. Staff understand the importance of offering choice to the residents in all aspects of their life. This empowers the residents to have some control over their lives.
Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 6 One relative was particularly impressed with the level of flexibility within the service. This was especially important to his relative who quickly becomes agitated if pressured to cooperate with staff. This resident had recently moved into the service and the relative commented that “ staff are very good”, “ we are very happy” and “ its much better than the care she received before” Family members are encouraged to be part of the service by helping and by joining in activities and taking part in trips out. One relative dines at the service on a daily basis and was impressed with the support offered by the service not just for the resident but also for himself. Plans had been made for staff to support them both on a short holiday. This relative believed that he was involved in all aspects of the residents care and that staff always informed him if there were any changes in the resident’s needs or health. He commented very positively about the staff by saying that “ the girls are very good” and “ she wants for nothing”. This relative also commented that the manager is very good, very approachable and she gets things done quickly”. The service understands how to deliver care, which promotes diversity and equality. Residents are called by names of their choice, which are sometimes different to their christened names and are supported to maintain their religious beliefs. Both relatives confirmed that staff are always welcoming and that they are free to visit when they choose. When asked if they knew how to complain one relative responded by saying,” don’t need to, If I want something doing, I ask and its done- no problems here” Care plans contain instructions regarding the residents individual health needs. Residents are encouraged to remain healthy by ensuring age appropriate health checks are carried out.e.g breast screening etc. Residents are encouraged to have hearing, sight and dental checks according to their wishes. Sometimes people who have mental health needs, at times, can display behaviour, which can be challenging to staff and other residents. Staff were observed to deal with this type of behaviour in the correct manner, which quickly diffused the situation. This shows that staff are aware and have an understanding of how to deal with aggression whilst respecting the residents rights and choices. The service offers a good provision of activities, which can sometimes be difficult to sustain for this client group. Previous hobbies and interests are considered however activity staff are very aware of changing prefences due to deterioration in mental health needs and therefore will offer a variety of activities to all. Staff monitor residents participation and progress with activities so that if residents are unable to express their wishes staff become familiar with what they like to do and how they like to spend their time. This
Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 7 reflects good practise and means that the residents are supported to take part in fulfilling activities. The service has access to a minibus and weekly trips within the local community occur with larger planned trips to places such as Southport etc occurring through the summer months. In the recent past those residents who wish, have been supported to attend short break holidays. Residents comments included” I like doing this” and “ I like going out” The service provides a choice of nutritious food. The lunchtime meal was observed and residents were supported to eat in a dignified manner. Staff (including kitchen) understands the need to present food in an attractive manner and this includes the provision of soft diets, which could otherwise appear bland and unappetising. Comments received included” Its very tasty”, “ I like the food” and “ they try hard to give her something that she will enjoy” The service is well maintained and domestic staff work hard to provide a very good standard of cleanliness. The service provides staff in ample numbers to meet the resident’s needs. Staff were observed to respond quickly to requests for help and were able to support residents in a patient manner, which is important for this client group. The service has robust recruitment procedures, which greatly reduces the risk of the residents receiving care from staff who are not suitable. This means that relatives can build trust and vulnerable residents are supported to be safe. The service manages small amounts of monies on behalf of some residents and these were seen to be managed safely with clear paper audit trails showing proof of all transactions. The manager has been in post for approximately twelve months. She has settled into her role and has identified improvements to develop the service further. Staff commented positively on her abilities and leadership qualities. One staff member stated that “ she had turned the place around” with another saying” she always supports me if I need something she gets it for me”. Some small shortfalls were evidenced in relation to Health and Safety but generally the service acts responsibly by carrying out weekly audits and ensuring all equipment is regularly serviced and maintained. This means that the service tries to ensure that service is a safe place to live and work. What has improved since the last inspection? Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 8 A number of requirements and recommendations were made following the last inspection. These have been addressed. This means that care plan documentation is being regularly reviewed and up dated so that staff have access to up to date instructions about the residents care. A number of improvements have occurred in the management of medications, which helps to reduce the risk of a mistake occurring. A weekly audit is undertaken to monitor medicine management and administration, which helps to identify any bad practise. Care staff have had training on the administration of creams and giving of thickened fluids for those residents who have swallowing difficulties. Advice that was received from the fire department regarding magnetic closures has been actioned so that the building complies with Fire regulations. A new residents handbook has been produced, which explains expectations in clear plain English. The service aims to introduce a new care plan template in September so that information within the plans is more accessible. New menus have been introduced with recipes in plain English so that if the cook should be absent , somebody else can cook the meal using the same ingredients, which provides consistency for the residents. A new housekeeping manual has been introduced which contains pictures of completed rooms and areas so that staff can clearly understand the standard expected by the service. Approximately half of the bedrooms have been redecorated and plans are underway to redecorate the remaining rooms. Names/ memory boxes have been fitted to those bedrooms, which are occupied and contain small personal effects and nameplates of the occupier. These help those residents who become disorientated with their surroundings. Staff have undertaken a variety of training on a number of subjects, which are appropriate to the residents needs since the last visit. Plans have been developed to employ a training coordinator for the home and its sister home in the near future. The organisation has produced an on line computer induction for new staff to complete. Staff are given time away form the workplace to complete this and the manager is able to monitor their progress. The manager felt this was beneficial as it enabled staff to complete it at their own pace. Quarterly relatives meetings are occurring to enable relatives/representatives to be more involved in the progress of the service. What they could do better:
Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 9 Some care plans showed that resident’s health was being monitored by observing their weight. However not all plans showed that this was happening regularly. The manager was aware of this and had reminded staff how important this was. This should continue to be monitored. Efforts have been made staff to include residents/ representatives in the formulation of some care plans. It was explained that not all relatives visited regularly so sometimes this was difficult to achieve. All efforts made by staff should be recorded so that written evidence exists to show that staff have attempted to consult with residents and relatives about the delivery of care. Staff had correctly identified that one resident was at high risk of developing a pressure sore. Although correct equipment was being used to ensure that the risk of sores occurring had been reduced no written instructions were contained within the care plan. This must be addressed. Medications are generally managed safely on the unit however some medication records did not contain signatures to show that dressings had been re applied. This should be addressed. On some occasions staff were handwriting instructions of medicine labels on to the medication administration records. Staff should be reminded that this should be carried out by two staff to reflect good practise and reduce the risk of mistakes occurring. Activities are provided on a weekday basis within the home. Some staff provide activities at the weekends but this depends on their level of enthusiasm. The manager was aware of this and staff had been reminded that this was part of care delivery. This should continue to be monitored. Plans have developed to redecorate the remaining bedrooms on the unit. This work should be carried through. Some pictures have been added to the corridors to add interest and the manager expressed her intention to add more to make the corridors an interesting place to walk. This should be carried through. The corridor carpet has been replaced within the last year. However it appeared to have dark patches in places, which looked like stains, and this should be explored and rectified. Although staff have received a lot of training in recent months and new staff receive training on Dementia Care, it was identified that not all existing staff had received dementia care training. This must be addressed so that all staff have had the necessary training to meet the residents needs. The manager is planning to ensure that all staff on the unit achieve an NVQ qualification. This should be followed through Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 10 Relatives confirmed during discussions that they knew how to complain. The home has a document called “ Care standards Act 2000” displayed in the foyer advising people how to do this. The title of the document does not reflect its content and the service should consider changing its name so that it is clear to the reader. The responsible individual needs to support the manager to develop a file, which proves her fitness to manage for future inspections The organisation surveys resident’s staff and relatives once a year as part of their quality assurance system. A copy of the published outcome must be sent to CSCI. Fire fighting equipment is regularly checked to ensure that is working correctly. However it is some time since practise evacuations occurred. Advice must be sought from the fire officer to determine what is an appropriate practise evacuation for this client group and the advice obtained followed through. 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.V302301.R01.S.doc Version 5.2 Page 11 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.V302301.R01.S.doc Version 5.2 Page 12 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 Quality in this outcome area is good. This judgement has been made using available evidence, including a site visit to the service. The home ensures that it has information about a persons needs, likes and dislikes before admission takes place and provides newcomers with information about the service and what they can expect. EVIDENCE: The service does not provide intermediate care therefore standard 6 was not assessed. A discussion was held by telephone with someone whose relative had recently moved into the service.The experience had been positive and he had been provided with written information about the terms and conditions of residency and the CIC handbook, which describes what new comers can expect of the service. This relative was particularly impressed with the relaxed routine and how his relative was able to “ do as she pleased” with staff support.
Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 13 Three care plans were viewed. All of these showed that a nurse from the service had carried out a full assessment before admission had taken place. This had also been confirmed during discussion with the relative. The assessment documentation showed that consideration is given to a persons likes and dislikes as well as their physical and mental needs. Other assessment information was also available. Other health care professionals outside the home such as Social Workers, District Nurses, Community Psychiatric nurse etc had completed this. A new handbook has been developed since the last inspection. This is presented in large print, in an easy to understand format and includes a break down of key policies such as, How to complain, finances and confidentiality. Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 14 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): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to the service. Staff have access to clear written instructions which gives a very good pen picture of each individuals needs, choices, likes and dislikes. Staff generally support residents to remain well. Relatives believe residents are well cared for. Medicines are managed safely. Residents are supported to maintain their dignity and staff respect their privacy EVIDENCE: Four care plans were viewed. These had been written as though the resident was voicing his or her needs, likes and dislikes which gave a very clear pen picture of each individual. The plans contained clear details of the resident’s personal history on admission. This gave a snap shot of what was most important to the resident and major events that had affected their lives. Each plan contained detailed instructions of the residents needs under headings, which matched usual daily living skills. Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 15 The plans viewed covered communication, personal hygiene, memory, dressing, elimination needs, eating and nutrition, sexuality and spirituality. Within these sections support plans had been developed which specified more complex needs when required. I.e. specific health needs. Efforts had been made to offer residents choice by including tick boxes identifying where they would prefer to keep their plan i.e. office or bedroom. Efforts had also been made to seek agreement from representatives/ relatives and residents about their care, however this was missing from one plan as the residents relatives lived some distance form the home and visited infrequently. Within the plans sections had been included which showed consultation about choice. These included Room care and laundry requirements. An example of this was that one plan stated that the resident would like staff to wash and iron clothes however her family would carry out any necessary repairs to her clothes. Discussions with staff showed that staff were aware of this and they confirmed that this was followed through. Each plan also contained detailed risk assessments. Assessments had been developed around manual handling, aggression and intervention where appropriate, nutritional status, Falls risk assessments and waterlow scores, to identify whether a resident was at risk of developing pressure sores. Each plan was reviewed monthly and any special equipment that the resident required had been identified and included within the plan. The plans also contained details of the resident’s burial wishes. The plans contained information about the residents specific health needs and staff had produced records, which showed how residents were supported with this. Records of G.P. visits and other health care professionals such as Dentists, Opticians and Chiropodists were viewed. It was evidenced that some residents had undertaken health checks, which were age-appropriate e.g. breast screening and that residents were also supported to attend hospital visits. Where appropriate staff had made contact with specialised health care professionals for advice and guidance should a decline occur. One resident had been identified as being of high risk of developing pressure sores and although skin integrity had been identified on the plan of care there was no mention of the high waterlow score. This resident was highly dependant on staff to meet her needs. On the day of the visit she was viewed in bed and appeared clean, comfortable and well cared for. At the time of this visit the manager stated that none of the residents had pressure ulcers and staff confirmed this to be true. One resident had developed a fracture during her stay and records showed that she had received appropriate care and the fracture was now healed.
Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 16 Staff had created individual records for those residents who need more support with specific needs. This included support required to manage challenging behaviour and specific needs such as epilepsy. These records were found to be detailed with clear instructions. Discussions were held with two relatives who acted as representatives. Both commented positively on the service and believed that their relative’s health needs were fully met. One agreed that he was always informed of any changes in his relatives care and that he felt he could approach the staff at any time if he needed advice. During the visit two staff were observed to reassure and act appropriately when one resident became very distressed which resulted in her exhibiting challenging behaviour. Some issues were identified around resident’s weights. Staff do weigh and record residents weights. However one residents weight appeared to have fluctuated however weighing had not occurred since May 06. Another set of records showed that staff had recorded that the scales were broken therefore they had been unable to carry out the procedure. The manager stated that she was aware of this and had spoken to those staff concerned as a further set of scales are available at the sister home which is on site. Medication systems and storage were viewed as part of the visit. It was evidenced that the requirements made by the pharmacy inspector earlier this year had been addressed and sustained. The service has two medication trolleys. Each was found to be tidy and organised. It was evidenced that the majority of medications are dispensed from a monitored dosage system, which is provided by a pharmacist. Staff record amounts of medications received on a medication administration record. Unwanted medications are recorded in a separate bound book and disposed of via an outside contractor who specialises in the removal of clinical waste. A copy of this contract was viewed which was current. Since the last inspection weekly medication audits have been developed. This means that senior staff are monitoring staff practise and are able to identify any concerns at an early stage. The controlled drugs cabinet was viewed. A sample of stock was viewed which was correct and matched the records of stock held within the controlled drugs book. The resident’s medication administration records were viewed. A photo of the resident was available on each sheet and a declaration of the resident’s wishes had been completed. Some medications had handwritten instructions on how and when to give medications, however two staff did not always sign to say
Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 17 that these instructions were correct. Generally the medication records were completed to a good standard however it was noted that staff had not recorded that one resident had received her dressings. This was discussed with a staff member who felt that the omissions might have occurred as new qualified staff had recently been employed who were not yet familiar with the homes practises. During the visit staff were observed to knock on bedroom doors before entering. Some residents were seen to be supported to remain dressed appropriately. Staff were seen and heard to call one resident by the name of her choice, which was not her christened name. The manager confirmed that during induction training new staff are instructed on how to maintain residents dignity and respect their privacy. Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 18 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 14 15 Quality in this outcome area is Good. This judgement has been made using available evidence, including a visit to the service. Residents are offered fulfilling activities and are supported to access the local community . Residents are supported to continue religious beliefs and visitors are welcome to visit when they choose. Residents are offered choice around daily routines. A variety of nutritious food is provided in a way, which is appropriate to residents needs. EVIDENCE: Four care plans were viewed and an activities file. The service employs two activities organisers every weekday. On the day of the visit an activities rota was displayed on the unit. The activities organiser stated that this often changes according to resident’s wishes and mood. Some activities occur at the weekend but it was explained that this depends on the enthusiasm of the staff on duty. Care plans contained information about residents past interests. The activities organiser explained that he tries to meet with relatives and representatives and residents shortly after admission. He explained that due to changing mental health needs, residents often no longer wish to continue past hobbies. Records showed that their level of interest and participation in activities is monitored so that staff are able to decide which activity provides the greatest enjoyment.
Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 19 The activities office was viewed and this was found to contain a variety of board games, videos, music etc for the resident’s entertainment. Records and a discussion with the activities organiser showed that a budget is available for the provision of activities and that management recognise the importance of providing stimulation and support the activities staff with any ideas they may have. A staff file was viewed and a discussion held which showed one activities organiser had undertaken training with occupational therapy staff to enable him to fulfil his role. Following this, this member of staff developed training for other activities organisers within the organisation. The service shares transport with its sister home, which is in close proximity. Trips out to places of local interest include Southport, Blackpool, Chester zoo, and barge trips. On a regular basis a weekly trip out to a ten-pin bowling alley followed by a pub lunch occurs. Memberships with the local library have been obtained and regular trips to the libraries picture show occur. Care staff also take residents out on a one to one basis. The activities organiser explained that recently regular trips to a local farm café and shopping at a local supermarket also occur. In the past staff have taken and supported residents on short break holidays away from theservice . Plans were made to support a relative to spend holidays with a resident with staff support but these plans have been delayed due to ill health. This was also confirmed during discussion with a relative. Relatives are welcome to attend days out with the residents if they wish. Two relatives confirmed that they could visit whenever they chose and that staff were always welcoming. Records and a discussion with the activities organiser and the manager also showed that one resident is supported by staff to go home twice a week. Local clergy visit the home and offer religious support to those who wish to receive it. The visitor’s book showed that visitors are received at a variety of times every day. Examples of autonomy and choice being offered were available through out the different sections assessed during this visit. Menus and care plans showed that a choice of food is available at each mealtime. Discussions with the activities organiser showed that activities are provided according to resident’s wishes and interests and records reflected this. Representatives and relatives are involved in most cases in the formulation of care plans. Residents are offered the choice of where they would like the plan kept. Housekeeping menus showed that residents are consulted about how and when they would like their room cleaned and whether they
Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 20 preferred for certain objects to be left untouched or whether they wished and were able to participate in the process. Records also showed that residents are consulted about how they would like their clothing cared for. Discussions with two staff showed that preferences of clothing are always considered however staff do encourage residents to wear clothing that is appropriate to the time of year for their comfort. Indirect observation of staff showed that residents are called by names of their choice. The relative of a new resident confided that the level of flexibility around daily routines was very good which meant that his relative was no longer agitated by being pressurised to conform to usual daily routines (as had happened prior to admission to the service).This had benefited her mental health. The provision of meals was assessed during this visit. The service has a dining area, which on the day of the visit had tables with tablecloths and condiments. Staff were observed to provide support to the residents who required it. Staff chatted to residents whilst support was being given and offered choices around the meals provided. Copies of menus were viewed which showed that a variety of meals are offered which are nutritious. New menus have recently been formulated along with recipe sheets for staff to follow. Positive comments were made about the provision of meals from two residents and a relative. The cook stated that due to changing needs a large number of residents require a soft diet and this is presented using moulds and specialised dishes so although the texture is soft, but different flavours are provided with good presentation. On the day of this visit the lunchtime meal was viewed which appeared attractive. Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 21 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): 16 18 Quality in this outcome area is Good. This judgement has been made using available evidence, including a visit to the service. Residents and relatives concerns are listened to and acted on. Staff have the skills and knowledge to protect vulnerable residents from abuse. EVIDENCE: Evidence gathering for this section of the report showed that no residents are being restrained and that requirements, which were made following the last inspection, have been addressed. On the day of the site visit a summary of the complaints procedure was displayed in the homes reception area however this had the title “Care Standards Act 2000” and did not draw the reader’s eye to the fact that it was information on how to complain or raise a concern. The information provided within the document summarised the organisations main procedure and did meet the national minimum standards but the manager agreed during discussion that the title could be changed so that the content was clearer. Since the last visit one complaint has been made to CSCI about the service, which was investigated by the manager. The outcome was that a thorough investigation had taken place and that no breaches had occurred in the Care Home Regulations 2000. Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 22 Minutes of meetings and a discussion with the manager evidenced that relatives meetings were held every quarter at the relative’s request. The manager agreed that this was used as a vehicle for small concerns. As the manager is responsible for two sites and the head office for the organisation is based off site, the manager completes a “ movement” sheet so that relatives are aware of where she is during the day. Discussions with two relatives evidenced that they believed that they could approach the manager at any time and that they felt as though she listened to their concerns and acted on them. Since the last visit all staff have undertaken training on Protection of Vulnerable Adults. The organisation has a comprehensive policy on abuse awareness and staff also have access to the local guidelines on what to do if they suspect abuse has occurred. This is held in the main office. Since the last visit the manager identified a potential abuse situation and referred this to the police, which was eventually unfounded. The manager dealt with the concerns appropriately and cooperated with both the police and Social Services until the situation was resolved. The manager also ensured that CSCI were aware of the situation by completing a regulation 37-notifiable incident form. Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 23 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 26 Quality in this outcome area is Good. This judgement has been made using available evidence, including a visit to the service. Residents live in safe comfortable home, which has a very good level of cleanliness EVIDENCE: A tour of the environment was undertaken. Discussions were held with the manager and the maintenance officer. Maintenance records were viewed. It was identified at the last site visit that a lot of effort had been made to redecorate all communal areas to promote a more homely atmosphere. This work had been continued and since the last visit a large number of bedrooms have been redecorated. The manager explained that the intention is for this work to continue so that in the near future all bedrooms will have been redecorated. Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 24 Name boxes have been added to bedroom doors since the last visit and these were found to contain small items, which the occupier would recognise to help them identify which was their room. Some pictures have been added to corridors but some areas although nicely decorated appeared bare and uninteresting. Four bedrooms were viewed (those of the four residents case tracked). These appeared very homely and had relevant personal effects, which were important to each resident. All areas viewed were very clean and tidy, smelt pleasant and presented as comfortable places to spend time. It was noted that the main corridors carpet looked dark in places as though it was stained. The manager explained that this carpet had been replaced within the last year. A maintenance officer is employed by the service and is available each weekday to carry out small repairs and decorating. Viewing the off duty and a discussion with the manager showed that Domestic cover is provided each day from 9 am until 5 pm. The manager stated that each domestic had achieved an NVQ in housekeeping. Since the last visit the service has developed a housekeeping book. This covered all areas and included photographs of areas that had been cleaned and tidied so that all staff would be aware of the standards expected by the service. The laundry room was viewed. This was found to be clean and tidy with clean linen being stored separately from dirty. Staff have supplies to deal with foul linen and hand washing facilities and liquid soap were available. . The laundry was fitted with industrial washing machines and dryers Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 25 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): 27,28,29,30 Quality in this outcome area is Adequate. This judgement has been made using available evidence, including a visit to the service. Staff are provided in ample numbers to meet residents needs. Not all staff hold an NVQ qualification however staff have undertaken a variety of training to enable them to meet most of the residents needs. Staff are experienced in supporting people who have dementia but not all have had formal training on this subject. Robust recruitment procedures exist to ensure residents are in safe hands. EVIDENCE: Copies of off duty viewed showed that ten staff are available from 8 am until 8pm and that six staff are available from 8pm to 8am. The home was providing care to 43 residents on the day of the visit. The day shift includes two qualified nurses (sometimes three) and a qualified nurse is available over night. The service has recently employed two Registered mental health nurses. There is a clear structure in place headed by the manager, then the assistant manager then the “ lead nurse”. A discussion with the manager and viewing staff files evidenced that 10 staff are employed who have achieved NVQ qualifications or equivalent and that a further six were undertaking this training at the time of the visit. She commented that the service had not quite achieved its full quota but that they were close to achieving.
Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 26 Staff files were viewed and a discussion was held with the manager. An on line induction programme has been introduced since the last inspection. This enables new staff to learn their role at their own speed. The induction appeared thorough and covered organisational policies as well as mandatory training including Dementia Care. The manager is able to access staff portfolios on line so she is able to monitor staff progress. New staff are given supernumerary time on a weekly basis whilst they undertake this training. Viewing four staff files showed that all necessary checks are undertaken before a new member of staff is offered employment. Staff were observed supporting a resident who was very agitated and presented with challenging behaviour in a calm and appropriate manner. Training files were viewed which showed that staff have undertaken a variety of training since the last inspection. This included training on administering thicken fluids, moving and handling, Cardiac Pulmonary Resuscitation, Abuse awareness, Fire prevention, Protection of Vulnerable Adults Awareness, mentorship training, phlebotomy, Diabetic foot care, Psychosocial intervention, and falls risks assessment. Viewing staff files evidenced that some existing staff have not undertaken training on Dementia awareness. The manager confirmed this and explained that in the near future the organisation intended to employ a staff member who would become the training coordinator for both this and the sister home. The manager stated her intention to address this once this post had been filled. Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 27 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): 31,33,35,38 Quality in this outcome area is Good. This judgement has been made using available evidence, including a visit to the service. The manager is fit to manage and manages the service well. The service consults representatives but doesn’t always inform CSCI of outcomes. Service users monies are safe. The service acts responsibly in maintaining Health and Safety. EVIDENCE: A discussion was held with the manager and her application to be the registered manager with CSCI was viewed. The manager was unaware of the need to keep a file on the premises that would prove her “ fitness “ to manage the service. She explained that information of this nature would be held by the Head office of the organisation. Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 28 Viewing the application showed that the manager is a qualified nurse who has undertaken further training since achieving registered nurse status. This included BA Health care management, Diploma in the care of Older People, Certificate in Dementia Studies and several ENB qualifications in continence care, and care of older people. The manager has also achieved awards enabling her to assess NVQ candidates and has past experience of managing care homes. Discussions were held with two relatives and two members of staff. All commented positively on the manager’s abilities. It was evidenced that all requirements made following the last inspection had been addressed. A discussion took place with the manager regarding quality assurance. The responsible individual undertakes regulation 26 visits and copies of these were viewed. The manager has introduced audits covering medication management, care planning and health and safety. Quarterly relatives meetings are held for consultation. The organisation sends out a yearly survey to relatives, residents and staff. An external source correlates the information from the surveys into a report and action plans are developed from these where appropriate. The manager was unaware of the need to send CSCI a copy of this document. The service has had outside quality assurance assessments undertaken and one had been performed prior to the visit. The outside of the building showed that four stars were displayed and the manager explained that this was an improvement on their last score of three stars. Documentation relating to residents personal allowances and the homes accounting system was viewed. A discussion was held with the manager. The manager explained that she carries out audits on resident’s personal allowances and associated paperwork and a copy of the most recent audit was viewed. The records viewed were clear and contained details of income and expenditure. The manager explained that small amounts of money are provided by families who are appointee so that residents have access to some money at all times. The manager and administrator confirmed that resident’s personal allowances are kept in an interest bearing account, which is separate to the organisations accounts, and residents receive interest proportionally. The manager explained that the organisation operates a cold harbour computer system so up to date statements can be obtained for residents at any time. A tour of the environment was undertaken and no concerns relating to health and safety were identified. It was evidenced that past requirements relating to
Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 29 Fire safety had been addressed. The home has a fire risk assessment and this was viewed but will require reviewing in the near future. Copies of weekly audits were viewed which are used to monitor Health and Safety within the home. These had been developed further to include areas of maintenance, which required attention such as redecoration. Records were viewed which showed that the fire alarm is tested weekly to ensure it is working. Staff attended fire lectures at the end of last year as part of their mandatory training. A discussion with the maintenance officer showed that practice evacuations have occurred in the past but that these have not happened for some time. Records showed that water temperatures are randomly tested to ensure temperatures remain at a safe level and maintenance is undertaken to ensure that the water system is cleansed. A decorating schedule was viewed which identified works so far and outstanding works still to be completed. An emergency response file was viewed which covered actions to be taken and people to be contacted in all emergency situations including outside contractors. Contracts were viewed which showed that hoisting equipment is serviced regularly. Portable appliance testing was carried out in March 06 and up to date stickers were viewed on small electrical appliances. Copies of contracts for disposal of clinical waste and pest control were also viewed. The service had recently had a gas safety test but no certificate was available. However three different staff confirmed that this had occurred. An up to date NICEIC certificate was viewed which showed that the electricity supply has been tested for safety. Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 30 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 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 3 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 X X 3 Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? no STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP8 Regulation 12. (1)(a) Requirement The manager must carry through her intention to ensure that residents are weighed regularly and that information produced from risk assessments (waterlow scores) are included within the written instructions for staff to follow. The manager must ensure that her intention to deliver Dementia Care training to existing staff is carried through The organisation must ensure that outcomes of future internal annual quality assurance audits are forwarded to CSCI. Timescale for action 15/09/06 2 OP30 3 OP33 12. (1)(a) 18. (1)(a)(c) (i) 24. -(2) 31/10/06 31/10/06 Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 32 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 OP7 Good Practice Recommendations The manager should ensure that staff record any efforts made to involve residents/representatives in the formulation of care plans if signed agreements are not available. The manager should ensure that two staff sign medication administration records to show that handwritten instructions have been checked and are correct. The manager should ensure that staff sign medication administration records to show that dressings have been administered. All Staff should be encouraged to continue the provision of fulfilling activities at the weekend. The document, which tells people how to complain, should have the title changed so that the reader understands its purpose. The manager should ensure that the intention to make the corridors more visually interesting is carried through. The manager should explore the dark patches on the corridor carpet and if necessary deep clean. The manager should follow through her intention to offer NVQ training to all staff. The responsible individual should ensure that the manager’s staff file is available within the home to prove her fitness for future inspections. The manager should explore and consider re introducing practice evacuations following consultation with the fire authority. 2 3 4 5 6 7 8 9 10 OP9 OP9 OP12 OP16 OP19 OP20 OP28 OP31 OP38 Green Heys DS0000017237.V302301.R01.S.doc Version 5.2 Page 33 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
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