Inspection on 21/07/05 for Green Trees

This inspection was carried out on 21st July 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 Trees 28/10/08

Green Trees 08/04/08

Green Trees 12/12/07

Green Trees 10/07/07

Green Trees 04/05/06

Green Trees 07/11/05

Green Trees 24/01/05

Green Trees 03/06/04

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

CARE HOMES FOR OLDER PEOPLE GREEN TREES 21 Crescent East Hadley Wood Hertfordshire EN4 0EY Lead Inspector Karen M Malcolm Unannounced 21 July 2005 @ 1.00 pm 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 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 TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION Name of service Green Trees Address 21 Crescent East, Hadley Wood, Hertfordshire, EN4 0EY Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8449 6381 Mr Brian Haydon, Mrs Laraine Haydon and Simon Kidsley Mrs Laraine Haydon PC Care Home 16 beds Category(ies) of OP, DE(E) registration, with number of places GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 17 January 2005 Brief Description of the Service: Green Trees home is a detached house in a residential area of Hadley Wood registered to provide services for 16 older people. The home has 12 single and 2 double rooms available on two floors. There is an eight person shaft lift. There is a lounge, which is decorated to a high standard, and a dining room. There are two bathrooms, both with hoists, a shower room with toilet and a ground floor toilet. There is a garden that is currently inaccessible to service users due to work being carried out. Mrs Haydon is one of three providers and she has managed the home for approximately thirteen years. The other two registered providers are Mr Haydon and Mr Kidsley. The home’s stated aims and objectives are to make the resident’s stay as comfortable as possible, giving high quality care to enable the highest level of independence, choice, privacy, dignity and fulfilment that individual abilities will allow. GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was completed over one day. The duration of the inspection was approximately four hours. The manager/provider and one of the other providers assisted the inspector throughout the inspection. The rest of the staff on duty was a carer and senior carer. There were fourteen service users in the home and one service user was in hospital. At present the home has two vacancies. The inspector was able to speak to a number of service users and two relatives who were visiting. Feedback given was very positive about the home, the staff and care and support. The inspection involved sampling a number of care plans, records, a tour of the building and observing the interaction between staff and service users, which was friendly and caring. The inspector also observed the afternoon handover with staff. It was evident that all carers are aware of individual needs. Staff interviewed were asked about their role and responsibilities. Feedback given was staff were aware of their roles within the team. The inspector found the manager and the rest of the staff very open and helpful throughout the inspection. The Commission received a number of comment cards. These were from the care managers, GP, relatives and friends and service users. The general comment received is that the service users are well cared for, treated with respect and all are satisfied with the overall care provided by the home to the service users. What the service does well: Green Trees is a family run business, which is comfortable, warm with a homely atmosphere. A number of the service users who reside in the home are diagnosed with dementia or are confused at times. Interactions observed between the staff and the service users are supportive and friendly. The inspector was able to speak to a number of the service users in the home privately. The overall feedback from the service users was positive with particular praise for the manager and the staff in the home. The best feature commented upon was that a number of bedrooms have en-suite facilities, which is an added bonus. GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 6 What has improved since the last inspection? What they could do better: 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 TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 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 Standards Statutory Requirements Identified During the Inspection GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 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 standard(s) 3 Service users prior to moving into the home are assured that their needs will be met, therefore receiving appropriate care to meet individual’s care needs. EVIDENCE: Documentation outlining the terms and conditions of services provided at the home was seen and these had been signed by the service user or their representative together with a representative of the home. There was also clear evidence indicating the date on which service users or their representatives had been given copies of their terms and conditions and the service user guide. The home does not supply intermediate care GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 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 standard(s) 7, 8, 9 & 10 The registered person has failed to ensure that service users’ healthcare needs are reviewed and monitored consistently, when any changes occur. Therefore ensuring service users receive the appropriate care and support. The home has improved their procedures for administering medication. Therefore service users can be confident that their medication is well managed. EVIDENCE: All service users have care plans in place. At the previous inspection it was required that the new care plan format being introduced should be followed through on all the care plans, and healthcare information should be recorded on individuals’ care plans separately. It was evident that these recommendations were not in place. The manager stated that the organisation is revamping the care plans. However, they are in the process of looking for a care plan system suitable for the home that includes a section to record healthcare needs & information. One service user has been diagnosed with dementia. However, it was not clear from the care plans examined if individuals are supported appropriately, for example clinical psychiatric nurse (CPN) or physiotherapist input and daily care needs. It was advised that each service user’s care plan must contain specific details of individuals care needs and how this is supported. Monthly GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 10 reviews are completed however they are not consistently maintained and those completed were not consistently signed. Upon examining the care plans it was evident that the monthly service users are weighed by the home. However, it was concerning that a number of service users charts indicated weight loss over a couple of months and no follow-up had been made with regards to this. It was advised that appropriate nutritional screening must be undertaken regarding monitoring; reviewing service users’ food and drink intake; and a dietician is to be involved. One service user was recently discharged with a request for the home to carry out weekly blood monitoring. It was evident that this specific service user had no information recorded in their care plan with regards to what appropriate support is needed to support this individual. At the previous inspection there were a number of requirements relating to medication. These were: • The registered person to cease the practice of decanting medication into the small medication pots at night, • Ensure all care staff undertake appropriate medication training and to ensure that the medication trolley is secured to the wall when not in use. The practice of decanting medication into small pots has now ceased. The medication trolley is now secured to the office wall when not in use. The manager stated that she undertakes all the training for staff in the home. The inspector and the manager had a long discussion with regards to training. Medication charts and cabinets were checked and found to be in good order. It was also required that that the registered person consults with each service user or their representative as to whether or not they prefer being supported with personal care by a male or female carer. The manager stated that she has completed this line of questioning on admission. The inspector was unable to inspect the last service user who was admitted into the home care plan, as the service user’s relative had this care plan in their possession. It was advised that: • Service users care plans must remain in the home at all times • This area of concern relating to personal care, must be reviewed with the service users or their relatives or friends on their behalf. GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 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 standard(s) 13 &15 Service users are able to maintain contact with family and friends contact. The meals in this home are good offering both choice and variety catering for special dietary needs. EVIDENCE: A visitor’s book is in place, however, it was evident that the last entry recorded was the inspector’s last visit. The manager stated that many visitors that enter the home by the side entrance do not usually sign in. It was advised that under Regulation 17(2) Schedule 4.17 it states clearly that ‘a record of all visitors to the care home, including the names of visitors’ must be kept. The inspector was able to speak to two relatives. Feedback given was positive and they felt the staff were very good and supportive, especially with regards to their relative, who now no longer lives in the home, due to changes in care needs. Food labelling has improved since the previous inspection. Cereals box are now kept in their original packaging rather than being decanted into plastic containers. Service users spoken to stated that the food was very good and they always enjoyed meal times. GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 12 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 & 18 The home has a satisfactory complaints system with some evidence that service users feel that their views are listened to and acted upon. However, this is not consistently recorded. Therefore service users are not confident that all their views are acted upon appropriately by the home. Service users are protected with the knowledge that some staff are trained and understand the procedures with regards to abuse. However, not all staff are trained, therefore service users cannot be fully confident that the home can protect them. EVIDENCE: The home has in place a complaints policy. No complaints were recorded since the last inspection. At the previous inspection it was required that all verbal or written complaints are recorded. This relates to a complaint made by one of the service users during the last inspection. A discussion with the provider and the manager regarding what is a complaint and concern arose. It was advised that a system must be placed with regards to recording all complaints including verbal complaints. The manager must discuss complaints with the care team regarding monitoring and recording all complaints and concerns appropriately. At the previous inspection it was required that the registered person ensures that all care staff undertake protection of vulnerable adults training (POVA). Three staff personnel files were examined. Two care staff files contained certificates that training had been undertaken. It is required that all staff must undertake POVA training. GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 13 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19 24 & 26 The home is comfortable, homely and safe, therefore providing service users with a pleasant environment to live in that they can call their home. However, the registered person has failed to ensure that the outdoors communal facilities are safe for service users to access at any time. Therefore service users cannot enjoy this area especially during the summer months. EVIDENCE: GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 14 A tour of the home showed that it was a very pleasant and comfortable environment. The lounge is large and comfortable and has access to the garden area and the dining room. All bedrooms are decorated and furnished with individual’s personal items. A number of the bedrooms have en-suite facilities. The home’s garden has very extensive grounds. At present some works are being carried out in the garden. The pathway is being re-paved and a large pond with a rockery surround is being built and also has a safety rail alongside the pathway. At the previous inspection it was required that the works in the garden area are completed, as the uncompleted works are deemed as a potential hazard. A clear bold sign was to be put in place beside the pond areas stating ‘Pond - danger deep water’. The pond area is to be risk assessed alongside the home’s environmental risk assessment, which is to be completed yearly. It was evident that a sign was in place, however, the works had not been completed. Therefore service users have been unable to access the garden area during the summer months. The laundry room is adequately sized for the home with a washing machine and dryer in place. As the inspector entered the home it was evident that there was an offensive odour present. This was addressed with the manager and provider during the feedback session. Staff training records examined showed that infectious control was undertaken. GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27 & 30 Staff have a good understanding of the service users’ support needs. EVIDENCE: On shift were the manager, one senior carer, one carer and the cook. This was reflected in the rota. The manager showed copies of the home’s in-house training manual. These included medication, manual handling, food hygiene, POVA and a comprehensive induction programme. One staff member completed an inhouse questionnaire assignment. The score received was fifteen and half out of twenty. The percentage score given was 95 . The course was for food hygiene. A lengthy discussion arose with regards to training completed inhouse and the induction format. It was advised that the manager must ensure that all statutory training (this includes food hygiene) is provided an appropriately by qualified trainer. As outlined in the National Minimum Standards for Older people, all new staff must undertake induction training within six weeks of an appointment and records maintained on file with dates. GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 33, 36 & 38 The home fails to consult and seek service users views with regards to the services provided. Therefore service users cannot be confident that the home is run in their best interests. Staff are supervised, however, this is not consistently recorded. Therefore service users are not confident that the care they received is monitored appropriately by home. Service users are assured that their health and safety is promoted and protected, however, this is not always consistent. EVIDENCE: Obtaining service users’ views was discussed. It was advised that the home must produce a quality assurance monitoring system to obtain views of service users, their family and friends and stakeholders in the community. One section is to include complaints and concerns. The inspector observed afternoon handover with staff. After the handover staff were interviewed and feedback given was positive. This included the home GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 17 and the management team. The staff felt well-supported and received monthly supervision. However, staff records examined showed that supervision notes were not consistently recorded. Staff were knowledgeable about the service users needs and how they support individuals on a daily basis. One member of staff stated that the home is in the process of revamping the care plans. It was evident that no records had been kept of fire drills in the home for a number of years. The manager stated that a number of service users found the fire alarm quite distressing due to their frailty and confusion. It was advised that comprehensive risk assessments must be completed for each service user with regards to fire drills. This is to include what support is needed for each and how this is supported by the home. GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x x 3 x x x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 x 13 3 14 x 15 3 COMPLAINTS AND PROTECTION 2 x x x x 2 x 2 STAFFING Standard No Score 27 3 28 x 29 x 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 2 x 2 x x 2 x x 2 x 2 GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 19 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard 8 Regulation 14(2) Requirement The registered persons must ensure that all service users who have dementia have in place a comprehensive risk assessment on their care plan with regards to the individual care needs. This must be reviewed regularly and updated if any changes occur . The registered person must ensure the specfic service user who is being regularly montoried by the home has in place clearly guidance for staff this is to be kept on file and reviewed accordingly if any changes occur. The registered persons must ensure that individual service users records clearly indicate the admissions to the Accident and Emergency department are recorded in individuals’ care plans. (Previous timescale of 28th February 2005 not met.) The registered persons must consult with each service user or their representative on their behalf whether or not they prefer being supported with personal care by a male or female carer. Timescale for action 30th September 2005 2. 8 12(1)(b) &15(2)(b) 30th September 2005 3. 8 13(1)(b) 30th September 2005 4. 10 15(1)14 (1)(c) 30th September 2005 GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 20 5. 18 13(6) 6. 16 17(2) 7. 19 13(4) 8. 26 23(2)(d) 9. 38 23(4) The service user’s preferred choice is to be recorded on their care plan. (Previous timescale of 30th March 2005 was not met.) The registered persons must ensure all care staff that work in the care home undertake adult protection training which is in line with the local authorities procedures. Evidence of this msut be available for the purpose of inspection. (Previous timescale of 30th April 2005 not met) The registered persons must ensure that all complaints whether verbal or written is recorded and addressed appropriately. The registered persons must ensure that the works in the garden area are completed. The pond area is to be risk assessed alongside the home’s environmental risk assessment, which is to be completed yearly (previous timescale of 16th April 2005 partially met.) The registered persons must ensure that the home is free from offensive odours throughout the home. The registered persons must ensure that fire drills are completed at least four times a year, these are to be completed at different times of the day. A record of all fire drills undertaken must be maintained and reviewed accordingly. The registered person must ensure that on each service users care plan is a detailed risk assessment of needs with regards to fire checks, fire drills and evacuation procedures. 20th October 2005 30th September 2005 20th October 2005 30th September 2005 16th September 2005 GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 21 10. 36 18((2) 11. 30 13(4)(c)1 8(1)(c)(i) 12. 33 24 13. 24 23(2)(b) The registered persons must ensure that all staff receive regular recorded supervision meetings at least six times a year in addition to regular contact on day to day practice. The registered persons must ensure that all staff that prepare or handle food undertake food hygiene training in the last three years. Once completed a copy of each individual certificate are to be placed on their personnel records. (Previous timescale of 30th March 2004 was not met). The registered persons must make sure that a quality assurance policy is drawn up and that the views of service users, relatives, representatives and other stakeholders in the home are obtained. The views to be analysed to determine whether the aims and objectives of the service are being met(Previous timescale of 30th April 2005 not met). The registered persons must ensure that suitable locks are provided on all bedroom doors. The registered person must ensure that the service users are provided with a key should they request unless a risk assessment indicates otherwise. (Previous timescale of 30th April 2005 not met.) 20th September 2005 20th October 2005 30th October 2005 30th September 2005 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 22 GREEN TREES 1. GREEN TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 23 Commission for Social Care Inspection Solar House 1st Floor, 282 Chase Road Southgate, London N14 6HA 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 TREES G59 S10646 Green Trees V232436 21.07.05 Stage 4.doc Version 1.30 Page 24 - 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. 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