Inspection on 28/10/08 for Green Trees

This inspection was carried out on 28th October 2008.

CSCI found this care home to be providing an Good service.

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

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 21/07/05

Green Trees 24/01/05

Green Trees 03/06/04

Extracts from inspection reports are licensed from CQC, this page was updated on 29/01/2009.

CARE HOMES FOR OLDER PEOPLE Green Trees 21 Crescent East Hadley Wood Hertfordshire EN4 0EY Lead Inspector Jane Ray Unannounced Inspection 28th October 2008 08:30 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 Trees DS0000010646.V372725.R03.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 Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Green Trees Address 21 Crescent East Hadley Wood Hertfordshire EN4 0EY 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) 020 8449 6381 020 8449 2008 admin@greentreescarehome.co.uk www.greentreescarehome.co.uk Mr Brian Colin Haydon Ms L June Haydon, Mr Simon John Kidsley Ms L June Haydon Care Home 16 Category(ies) of Dementia - over 65 years of age (0), Old age, registration, with number not falling within any other category (0) of places Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd June 2008 Brief Description of the Service: Green Trees is a small family owned residential care home specialising in the holistic care of the frail elderly and those who suffer from dementia. Green Trees home is a detached Edwardian property located in a residential area of Hadley Wood registered to provide care and support for 16 older people. The home is near to local shops. The home has 12 single and 2 double rooms available on two floors. Ten of the single bedrooms have en-suite facilities. There are two bathrooms, both with hoists, a shower room with toilet and a ground floor toilet. The home has a lift. The home has a spacious lounge and dining room. The attractive rear garden is designed to be accessible for the residents. Mrs Haydon is one of three providers and she has managed the home for approximately fourteen 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 happy and 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. Inspection reports produced by the Commission of Social Care Inspection (CSCI) are available upon request from the registered manager/provider. The current scales of charges range from £500 to £575 per week. Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The inspection took place on the 28 October 2008 and was unannounced. The inspection took seven hours to complete. Two inspectors Jane Ray and Peter Illes carried out the inspection. The inspectors looked around the home and spent time speaking individually or in groups to the people living in the service. They also interviewed two of the care staff who work in the home as well as four relatives who were visiting at the time of the inspection. We also looked at all the relevant records including service user records, staff files and health and safety information. The home had also just updated their self–assessment (AQAA) and this was handed to the inspectors during the inspection. The inspection is the second key inspection this year and the aim is to look at how well the service is meeting the key National Minimum Standards for Older People. The inspectors also looked at the progress the home was making in meeting the requirements from the previous key inspection. The inspector would like to thank the service users and staff for their assistance with the inspection process. What the service does well: Many of the service users and their relatives were full of praise about their lives at Green Trees and the care they receive from the staff. One resident said during the inspection “This really is a lovely home and they take good care of me”. The atmosphere in the home was friendly, with the residents enjoying each other’s company and chatting with the staff. The home is a family run business and this provides continuity of care and a more informal approach. One relative said that the care provided by the home “is like an extended family” and “we wouldn’t want our relative to go anywhere else”. Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 6 The individual staff were observed to be providing a high standard of personal care. The staff were very positive about their work and when they spoke to the residents they demonstrated a good knowledge of their individual needs and a caring approach. They take care to promote the residents privacy and dignity at all times. The home was tidy and homely and residents are encouraged to bring personal items with them to make their bedrooms familiar and comfortable. The home has an excellent cook and the lunch that was served during the inspection was tasty and nutritious. Residents are encouraged to follow their preferred routine. The home also provides a range of enjoyable activities within the home to stimulate the residents. The staff quickly identify when residents are not very well and arrange healthcare input. They also keep relatives informed about what is happening. What has improved since the last inspection? The home has worked hard to meet the requirements and recommendations from the previous inspection. The home has improved all the care plans and these are now more comprehensive and reflect the current needs of the residents. The home has also arranged for all the residents to receive dental input. Whilst the home at the moment cannot provide same gender care it has consulted with all the residents or someone who can act on their behalf to ensure the current arrangements are acceptable. They have worked with one of the relatives in the home to arrange a monthly communion service to help meet peoples spiritual needs. The medication systems in the home have improved in line with all the requirements from the pharmacy inspection and the provider is auditing medication on a weekly basis. The home is free from offensive odours. They have organised a hand held alarm so that if the waking member of staff at night needs help they can contact the sleeping in member of staff without having to leave the resident. The home has also made significant progress in areas of staff management and development. The staff team have completed first aid training, moving and handling and food hygiene refresher training. Safeguarding training has been booked through Enfield Social Services to update the staff. Staff meetings have started to take place and individual supervisions are being implemented. Information on local training has been accessed and staff are being booked on relevant courses. The staff have also thought about their manner and approach and are now managing to be warm and friendly without shouting or being raucous, which is far more professional. The views of residents, relatives and care professionals have been sought through the quality assurance exercise and the results collated and made available as part of the statement of purpose. Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 7 The home has also ensured that where residents are admitted to hospital or there are other serious incidents that as well as informing relatives and Commission is appropriately notified. 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. The summary of this inspection report can be made available in other formats on request. Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 8 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 Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 9 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 2,3,4 and 5 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who use this service can be assured that the home will consider their assessment as part of their admission process to the home. Information about the home is available to help them decide if the service is right for them. EVIDENCE: “Our prospective residents or family are given our brochure, together with our statement of purpose and residents handbook, which contain full information regarding the home and the services it offers, including a copy of our contract / statement of terms. They are offered an opportunity to visit the home, at a time to suit them without the need to make an appointment. If required a full day can be set aside and meals provided at no cost”. (Extract from the AQAA prepared by the home) Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 10 “I chose this home as it offers personal attention and it is like being with a family”. (Quote from a relative) The statement of purpose and service user guide were inspected prior to the inspection. Both of these documents were in a user-friendly format and were clearly written, accurate and contained all the necessary information. The home also has a useful website. Only one resident has moved into the home since the previous key inspection. We spoke to this person’s relative who explained that they visited on behalf of their relative as they were in hospital prior to their admission to the home. We also checked the case notes for the most recently admitted resident and these contained appropriate assessments prepared by social services. The manager explained that a contract / statement of terms had been prepared and passed to the family to sign. We discussed the current needs of the people living in the home with the care staff and observed the care they were receiving. The staff felt confident that they were meeting the needs of the residents and this was reflected in the care that was observed. Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 11 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7,8,9 and 10 were inspected. People using this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported to access personal and healthcare treatment based on their individual needs. The home has an effective medication procedure supported by procedures that staff follow appropriately. Not all residents have written guidance in place for administering medication that is given “as required”. The staff respect the privacy and dignity of the residents. EVIDENCE: “Our residents are treated with respect and dignity and we pride ourselves on our end of life care”. (Extract from the AQAA prepared by the home) Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 12 “Mum always looks well turned out”. (Quote from a relative) We looked at the care plans for four people living in the home. These documents had been developed further since the previous inspection and covered all the areas where care and support were needed. They provided a useful overview of each resident that was written in a “person centred” manner. The care plans provide guidance to staff on what action they needed to take to meet each person’s needs and were holistic covering both physical and emotional needs. The care plans had all been reviewed on a monthly basis and it could be seen that where a persons needs had changed this was reflected in their care plan. One relative said that he had been shown the care plan and consulted on aspects of it. Most relatives had signed to say that they did not wish to be involved in the care planning documentation. Is was noted in two files that out of date care plans and risk assessments were in the file as well as the current documentation. It is recommended that old documentation is archived to avoid confusion. At the time of the inspection one of the residents was having their review meeting with their reviewing officer. The provider said that other review meetings had been taking place. We spoke to the management team in the home and they acknowledged that they had not yet implemented the key-working system in the home as they had been focusing on a number of other areas. They said they would be working on this over the coming weeks. This recommendation is outstanding from the previous three inspections. The case notes that we inspected showed that areas of risk were assessed. These included moving and handling, nutrition, infection control and pressure care. The home also keeps a record of each persons weight on a monthly basis. The risk assessments covered areas of specific risk, for example one resident had a risk assessment linked to his wandering. At the time of the inspection the manager explained that none of the residents had a pressure sore. It was observed that residents at high risk of developing pressure sores had a pressure-relieving mattress on their beds. The manager also explained that no residents were receiving input from the district nurse. The deputy manager said that some district nurses can hand over doing dressings to the home staff. He said this was “put in writing by the district nurse”. The inspectors reminded him of the importance of ensuring that residents get the healthcare input they need. The case notes showed that the home has a separate record of healthcare appointments for each resident. These showed that the residents were receiving primary healthcare input and being referred for specialist input as needed including a psychiatric service for mental health issues. The relatives who were spoken to also confirmed that they felt the home were obtaining Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 13 healthcare input very promptly and that they were kept informed of any illness. It was also very positive to note that the home has managed to access an NHS domiciliary dental service and everyone has had a dental check. The home also arranges a private chiropody service every six weeks. We looked at the medication system in the home. Since the last inspection the home has changed the medication administration system and now administers from the original labelled packaging rather than using dossette boxes for some of the medication. The home has medication administration charts. These include a photo of each resident and these help to ensure the medication is administered correctly. The medication received in the home is recorded on the medication administration record (MAR) and there is a separate book for medication returned to the pharmacy. An audit trail for the medication is available. The MAR sheets were all completed correctly. Four residents medications were checked in detail and the instructions on the packaging reflected the instructions on the MAR sheet. One resident had PRN medication and no written guidelines were available to say when this should be administered. No residents were taking any control drugs and the record of control drugs showed that previous medication had been returned to the pharmacy. The home has also fitted a cupboard for control drugs attached to an outside wall. The manager explained that a lockable box had been made available should any medication need to be stored in the main fridge. The last pharmacy inspection had identified a medication with specific handling instructions. These had been highlighted on the MAR sheet and the medication policy revised. Also since the last inspection the home has obtained a new copy of the BNF and purchased a product designed to safely clean up any blood spillages should this occur. The staff training records were inspected for seven staff and they had all received medication training from the home manager. The provider also explained that the pharmacist will be visiting the home four times a year to provide update training for the staff. They are still waiting for the date of the first session. The home has also introduced a weekly medication audit. Throughout the inspection the staff were observed supporting the people living in the home with their personal care, meals and moving around the home. This was done in a manner that respected the residents’ privacy and dignity. All the relatives spoken to at the inspection said they were very satisfied with the standard of personal care provided by the staff in the home. Since the last inspection all the residents have been asked if they are happy to receive their personal care from a carer of either gender. If the resident has not been able to say a relative has been asked on their behalf. Their wishes are recorded in the care plan. The provider said they are planning in the future when staff changes occur to offer a female carer on all the nights of the week. It was observed that the staff were very aware of the mood and comfort of the residents and responded to any sign of distress, including non verbal indications. It was also positive to observe that since the last inspection the staff team have thought about their manner and approach and the Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 14 communication between staff has become much calmer, quieter and more professional. This not only improves the atmosphere in the home, but enables the residents to express themselves more easily. Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 15 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12,13,14 and 15 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. Residents are supported to make choices in all areas of their daily lives. People who use the service are able to enjoy a stimulating lifestyle and can enjoy the activities that are available. The meals are balanced and nutritional and form an important social event in the day. EVIDENCE: “This is “home” to our residents, not an institution and to the best of our ability we make it that. We meet most of our resident’s social, cultural, religious and recreational interests, given their individual abilities. Families and friends are encouraged to visit and maintain contact by having no fixed visiting hours, and they are welcome to stay for meals if they wish”. (Extract from the AQAA prepared by the home) Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 16 “Dad really enjoys the entertainer – he sings along with the music”. (Quote from a relative) “They have lovely wholesome fresh food”. (Quote from a relative) We were able to observe the staff supporting the people living in the home throughout the inspection. The residents are able to exercise choice in terms of when they want to get up and eat breakfast. One relative talked about how her father likes to go to bed later and the staff sit and chat to him. It was also observed that drinks are offered throughout the day, although residents can request a drink whenever they want. Residents are also encouraged to maintain or improve their independent living skills. One relative said, “my mother is actually better now than she was in her own flat”. Another relative said how the staff encourage her father to feed himself and be more independent. The home provides a range of activities for the residents. An entertainer visits the home on a three-weekly basis and once a week a physiotherapist comes to hold a gentle exercise class. The residents spoke very enthusiastically about both these activities. The staff in the home, also arrange additional activities including arts and crafts, bingo, quizzes and music sessions. We looked at the records of these activities and also observed an activity session taking place. The residents also enjoy the fortnightly visits from the hairdresser and beautician. It was observed that residents who spend time in their rooms are encouraged and supported to participate in activities. Since the last inspection the home has acquired two cats and these were observed to give the residents a lot of pleasure. It was also possible to see that residents who wish to spend time in their rooms are able to do so. The manager explained that the residents who choose to practice their religion are either Church of England or catholic. One of the relatives is a vicar and holds services for both faiths in the home. They are planning a special service on Christmas Eve. The records of activities show that unless residents were taken out with relatives, they had few opportunities to enjoy community-based activities. The recommendation to develop these opportunities is restated from the previous inspection. The four relatives spoken to during the inspection all said how welcome they feel in the home. One relative said, “we can visit at any time and are always welcomed by the staff and someone will offer us a drink”. The home has a cook and during the inspection lunch was prepared. All the food was home made and used fresh produce. The meal was healthy and nutritious and enjoyed by the residents. Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People living in the home are able to access an appropriate complaints procedure and the residents feel able to express their views. The residents will be better protected from abuse by the staff attending further training, which has been booked on safeguarding vulnerable adults. EVIDENCE: “The home is run in an open and transparent way, and all residents and families are aware that both staff and management are easily approachable to discuss any areas that may concern them”. (Extract from AQAA prepared by the home) “If I was worried about anything I would just tell the staff”. (Quote from a resident) The complaints procedure is available in the service user guide and includes details of who complainants can contact. Two residents spoken to during the inspection said they would speak to the manager if they had any complaints. The provider said there had been no recorded complaints since the last Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 18 inspection. It is hoped that complaints are being recognised, as it is very unusual in a home for there, to be no complaints. Since the last inspection there has been one adult protection investigation linked to an allegation made by a resident in the home. Whilst the allegation was not substantiated it was positive to note that the home participated in the safeguarding process and followed up on recommendations made as a result of the investigation. It has also been noted that the home has continued to report serious incidents to the Commission as required in the Care Home Regulations. It is also positive that the home has made links with Enfield social services and is now accessing training that is provided. Some staff are booked to attend safeguarding training and it is hoped this will help to ensure their practice is updated. The manager explained that the home does not hold any money or valuables on behalf of the people living in the home. All the residents have relatives who help them with their finances. One relative explained that the home contacts her if her relative needs any new clothes and she buys them for him. Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19,20 and 26 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. People who live in the home have access to an environment that is clean and comfortable. EVIDENCE: “Individual rooms are decorated to the residents choice and they are able to bring any of their own furniture or other things to make their room homely”. (Extract from the AQAA prepared by the home) “The room is always clean and tidy”. (Quote from a relative) Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 20 We did a tour of the home. The building is very spacious and there is access through the lounge to an attractive rear garden. The home is well maintained and rooms are redecorated on a rolling programme. All the equipment was in working order. There were no unpleasant odours in the home and there is a cleaner who is keeping the environment clean and tidy. Since the last inspection the home has purchased a large screen television that is fitted on the wall in the lounge. It was however observed that the chairs in the lounge were lined up, which did not create a very homely atmosphere. It is recommended that the lounge is made more homely. Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28,29 and 30 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in the home are supported by a small stable team of staff, and staffing levels are meeting the needs of the residents. Ongoing training and supervision enables the staff to work to an appropriate standard. EVIDENCE: “The staff have the patience of a saint and we know them all and they are very friendly” (Quote from a relative) “We retain our staff, most of them having worked for us for a minimum of three years and some for seventeen years”. (Extract from the AQAA prepared by the home) The inspection started at 8.30am. At this time two care staff were working and were gradually helping residents to get up. The manager arrived just after 9am and the newly appointed cleaner also started her shift. We were satisfied there Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 22 were enough staff available. The relatives who were interviewed all said there are always enough care staff working. One relative in a completed quality assurance questionnaire said she needed to take her relative to the toilet as there were no staff available to help, but this does not appear to be a regular occurrence. Since the last inspection another full time care staff has been appointed. The management team commented on how long it can take to find the right staff and complete the recruitment checks. It is recommended that the home employ’s a few bank staff who can work when there is sickness or annual leave and who may be interested in permanent posts if a staff member leaves. Following on from an adult protection investigation earlier in the year, the home has reviewed how staff can call for assistance at night. A hand held alarm is now available so that if the waking night staff needs assistance from the staff member who is sleeping in, they can press the alarm, which rings a bell in the staff bedroom and calls for help without having to leave the resident they are supporting. The AQAA prepared by the home states that four of the eight care staff have an NVQ in care and one is enrolled to take the qualification. The recruitment checks for the two new staff were inspected and all the checks were in place including a criminal record disclosure, identification and two written references. The new carer has completed an induction that covers all the Skills for Care core induction standards. This does not however include a checklist of all the essential things they need to know about the home itself. It is recommended that an induction checklist is prepared to use for all staff when they start working in the home. The home is now accessing ongoing training provided by Enfield Social Services with Skills for Care. There a number of relevant training courses coming up including training on dementia. The management team are attending training on medication audits. Two staff meetings took place in September but none since then. Staff explained that this provided an opportunity to discuss any concerns about working in the home or ideas for improvement. It is recommended that these meetings take place regularly. Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 23 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33,36 and 38 were inspected. People who use this service experience good outcomes in this area. This judgement has been made using available evidence including a visit to this service. The people living in this home benefit from stable management arrangements and the manager with the support of the provider has improved the quality of life for the residents, whilst delivering a more professional service. Heath and safety measures in the home help to keep the residents safe. EVIDENCE: Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 24 “We offer quality care in a quality environment with a homely atmosphere and residents who are looked after by staff who care”. (Extract from the AQAA prepared by the home) “I am fortunate to have found the home”. (Quote from a relative) The manager has been in post for fourteen years. She has a number of appropriate care qualifications but no management qualification and therefore needs to undertake a Skills for Care qualification in management and care. Since the last inspection she registered with one company for the training but they went out of business as confirmed through documentation that was shown to us. She has also requested to enrol with two other training organisations and is waiting for this to take place and the training dates to be confirmed. The manager will need to inform the Commission when this enrolment process is completed and training dates are confirmed. The manager has a good understanding of the care needs of the residents and has a positive relationship with both the residents and relatives. She is obviously well liked. The inspectors were however concerned about the negative attitude she can sometimes display, especially when discussing ways of improving the service. The manager is quick to comment that suggestions are not appropriate for residents at Green Trees or have been tried in the past and failed. The suggestions made by inspectors are based on good practice often observed in other services that they have visited. It would be nice to feel that the manager could develop a more positive approach to change as this can lead to better outcomes for the residents. The rest of the management team have demonstrated a strong commitment to improve the service and the input from Mr Haydon has helped to develop better systems within the home. The assistant manager who is Mr and Mrs Haydons son will probably become the manager in the future when his mother decides to retire. The investigation earlier in the year, recommended that it would be helpful if he developed his skills by having some experience of working in another service. It is recommended that opportunities are explored as part of his personal development. Since the last inspection the views of the residents, relatives and other care professionals associated with the home had been sought using questionnaires as part of a quality assurance exercise. These results had been collated and made available in the homes statement of purpose. The staff supervision records were inspected. The supervision is being carried out by the provider with the support of the assistant manager. Some supervision sessions had not taken place for over two months and it is recommended that they take place regularly. The record of the supervisions would also benefit from having a note of any action agreed so it can be Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 25 followed up at the next supervision. The staff confirmed the supervision sessions were taking place. The current certificates were available to confirm the maintenance for the portable electrical appliances, electrical appliances, gas appliances, fire alarm and extinguishers, lift, hoists, nurse call and water system. Some of these were due to expire and an appointment was available for the systems to have their annual check. The weekly fire alarm checks and quarterly fire drills are taking place according to the fire safety records. The health and safety training records were inspected for all the staff. The manager had provided refresher food hygiene training and an external trainer had provided moving and handling training. Staff were able to describe what they had learnt and how their skills had been updated. It was also positive to note that the home had received an inspection from the Environmental Health Officer with good results. Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 26 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 3 3 3 3 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 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 3 x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 x x x 3 x 3 Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 27 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 OP9 Regulation 13(2) Requirement The registered person must ensure that guidelines are in place stating when “as required” medication should be administered. Timescale for action 30/11/08 Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 28 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 registered person should archive old care plans and risk assessments to avoid confusion about what is the most current guidance on support and care for the residents. The registered person should operate a key-working system to ensure the needs of each resident are fully met. This is restated from the previous three inspections. The registered person should try to offer opportunities for more activities in the local community. This is restated from the previous inspection. The registered person should rearrange the furniture in the lounge to create a more homely environment. The registered person should recruit some bank staff to help cover staff sickness, leave and to be potential permanent staff for the future. The registered person should hold staff meetings on a regular basis to allow operational issues relating to the home to be discussed with the staff team. The registered person should develop an induction checklist to ensure new staff all essential aspects of working in the home. The registered person should inform the Commission of when the manager is enrolled on the management training course and the date the training will commence. The registered person should support the assistant manager to develop his skills and experience but obtaining experience from a different work environment. The registered person should support the manager to develop a positive attitude towards developments in the home to enable the service to continue to develop and improve for the benefit of the residents. The registered person should ensure all the staff are supervised regularly and that a record is kept of any agreed action so that this can be followed through at the next session. 2. 3. 4. 5. 6. 7. 8. 9. 10. OP7 OP12 OP20 OP27 OP27 OP30 OP31 OP31 OP32 11. OP36 Green Trees DS0000010646.V372725.R03.S.doc Version 5.2 Page 29 Commission for Social Care Inspection London Regional Office 4th Floor Caledonia House 223 Pentonville Road London N1 9NG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 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 DS0000010646.V372725.R03.S.doc Version 5.2 Page 30 - 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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