Inspection on 04/05/06 for Green Trees

This inspection was carried out on 4th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 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 08/07/2008.

CARE HOMES FOR OLDER PEOPLE Green Trees 21 Crescent East Hadley Wood Hertfordshire EN4 0EY Lead Inspector Karen Malcolm Key Unannounced Inspection 09:30 4th & 5th May 2006 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.V291201.R01.S.doc Version 5.1 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.V291201.R01.S.doc Version 5.1 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 lanarhnrn@aol.com Mr Brian Colin Haydon Mrs Laraine June Haydon, Mr Simon John Kidsley Mrs Laraine 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.V291201.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 7th November 2005 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 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 beautiful landscaped garden situated at the rear of the house. 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. 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 are from: - £500 to £550 per week. Hairdressing, newspapers and magazines are included in the overall fees. Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection took place over two days. The duration of the inspection was approximately fourteen hours. Caroline Mitchell one of the Regulation Inspectors accompanied the lead inspector. The manager/provider, one of the providers and the assistant manager, assisted the inspectors throughout the inspection. The other staff on duty were two carers, the activity person and the cook. There were fifteen service users in the home. At present the home has one vacancy. The inspector was able to speak to a number of service users during the inspection, who were very positive about the home. The inspection involved sampling four care plans, examining records, completing a tour of the building, the inspector speaking to service users, observing the afternoon medication round, speaking to carers, speaking to the activity worker and hairdresser and observing the interaction between staff and service users, which was friendly. Feedback was given to the registered manager/provider, one of the providers and the assistant manager. It is the view of the inspectors that the feedback session at the end of the inspection was quite challenging. Although the inspectors found the whole process of inspecting open and helpful, in parts, during the feedback session it was evident that the registered persons were not in full agreement with the number of requirements made and sought to challenge each point at length. It is evident from this inspection that the matter needs further discussion outside of this inspection process. 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 DS0000010646.V291201.R01.S.doc Version 5.1 Page 6 What has improved since the last inspection? What they could do better: This inspection has identified thirteen areas of improvement and four recommendations. While it’s evident that the staff are experienced and competent, the home has failed to ensure that service users needs are consistently being supported, recorded, reviewed, monitored and up-dated appropriately. It is therefore required that the registered person submits an action plan to the Commission for Social Care Inspection (CSCI), which describes how they will address these matters. The summary of findings is that the registered person is to ensure that service users healthcare needs are recorded appropriately, so that there is a clear audit trail in place. The two service users whose care needs are deemed as bordering on nursing care are to have their care needs reviewed with a relevant professional. The registered person is to ensure that a full assessment of needs is undertaken by the home prior to a service user moving into the home, evidence of this is to be on file. Care plans are to be reviewed at least once a month. A record of any change in needs with regards to an individual care is to be kept on file and reviewed accordingly. The restraint policy is to be updated. Service users with cot sides, those service users who Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 7 are deemed high risk from falling and those who have swallowing difficulties, are to have a risk assessment completed by a relevant professional. The specific service user with MRSA and pressure area is to have a detailed guidance note from the district nurse with regards to the home continuing treatment in their absence. The manager and the activity person are to be indicated clearly on the weekly rota. Staffing levels are to be reviewed with regards to annual leave and sickness. Care staff are to undertake training in falls management, pressure care and continence promotion preferably external training. All voluntary workers are to have in place prior to starting employment satisfactory enhanced Criminal Records Bureau (CRB) certificate. The recommendations addressed in the table at the back of this report are deemed good practice. 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 DS0000010646.V291201.R01.S.doc Version 5.1 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.V291201.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3&5 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. Prospective service users are admitted to the home after a full assessment of needs. However, this is not always completed to the guidance of the home’s policy and procedures and therefore service users may be potentially inappropriately placed or at risk from harm. Service users can be confident that the home is able to meet their day-to-day needs. However, this is not always monitored and reviewed consistently. EVIDENCE: The home can support up to sixteen older people of mixed gender, who may also have dementia care needs. At present there is one vacancy. From the discussion with the manager/provider, all the service users have some form of dementia care needs as part of their overall care package. Staffing records were examined, and on speaking to care staff it was evident that in-house dementia training has been undertaken. Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 10 At present there are fifteen service users residing in the home and one vacancy. One of the registered providers informed the inspectors that since the previous inspection, two service users had moved in, one over the weekend prior to this inspection. Three service users have died, two service users have moved to other care homes. At present there has been no new referral/s. In discussion with the one of the providers it was evident that a number of service users are placed by at least five different local authorities and the rest are self-funding. Assessments prior to individuals being admitted into the home are completed by one of the providers. The last service user to move into the home was self-funding. It was evident that no record of an assessment was in place, although a thorough assessment was completed by the previous care home. One of the registered providers stated that he had completed the assessment on this specific service user alongside the previous home’s assessment, which was thorough. In further discussion with the registered persons they stated that the service user is still under the home’s six weeks trial period of establishing their care package. A care plan will then be completed. A copy of a three-month assessment care format was in place on the specific service user’s file. Evidence of this format was only present on this particular service users file. The manager explained that she is in the process of introducing this format to all care plans. The inspectors identified that at least two of the service users care and support needs may be bordering on nursing care. For example, one service user is diagnosed with Parkinson disease, is unable to mobilise, and remains in bed for long periods of time, although at times is supported out of bed at specific intervals. The service user has a swallowing problem, however, is supporting with feeding and has all food served pureed. The manager stated that the home is able to manage the specific service user’s care. However, it is the view of the inspectors that there were some concerning issues and it was advised that the home must seek appropriate professional input with regards to the service user’s care. This issue was discussed at length during the feedback session at the end of the inspection. From the discussion, it was evident that the registered persons were not in agreement with the inspectors overall assessment that two service users may now need a higher level of care (i.e. nursing care). Outside of the meeting the inspectors discussed issue this further with the Local Authority and it was advised that Social Services could be asked to undertaken a needs led assessment even though the service users are self-funding. Normally this would be done via a social worker in the Older peoples team, obviously the referrer would need to explain the situation. The home has clear guidance in place with regards to ensuring prospective service users are able to visit/s the home prior to moving in. The manager informed the inspectors that the newly admitted service user relatives viewed, the home on their behalf, prior to moving in. Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 11 The home does not supply intermediate care. Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 12 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 adequate. This judgement has been made using evidence gathered both during and before the visit to this service. While care plans are in place these are not consistently monitored or reviewed. Therefore the information recorded is likely to be inadequate and may not reflect the current care or support needs of the individual living at the home. Therefore service users may not be receiving appropriate care. EVIDENCE: Four care plans were examined. Care plans were completed, covering all aspect of each service users’ individual care. The manager stated that she is introducing a new care plan format that encompasses a more holistic aspect of care around individuals’ needs. A copy of the new assessment format was shown to the inspectors. The inspectors made positive comments with regards to the format. However, it was reminded that any document in place, is good as long as it is used appropriately, through constant reviewing and monitoring. The current care plans in place were last reviewed in January 2006. It is reminded that the registered manager must ensure that all service users’ plans are reviewed by care staff at least once a month, updated to reflect changing needs, and Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 13 current objectives for health and personal care. It was also evident that the daily care notes for the new admitted service user, although in place, were not specific to the individuals, overall needs since being admitted into the home. For instance there was no detailed account recorded of how the individual actually settled in, as on the second day the individual had appeared to settle into the home. It was recommended that the registered persons should ensure that a detailed account of newly admitted service users, care and support needs are recorded in detail for at least a week in the daily care notes, to give care staff some guidance and assistance when finally drawing up the individual’s care plan after the trial period. Healthcare notes are combined with individual service users’ daily care notes. It was advised that the information must be clearly accessible. The manager was adamant that this is recorded appropriately and evidence of this is clearly documented on daily care notes in RED pen. Upon examining the care plans it was difficult for the inspectors to find a clear audit trail of healthcare information. Some were completed in red and others in blue or black coloured pens. Therefore the previous requirement with regards to healthcare information being easily accessible is restated. It is also recommended that healthcare information should be logged separately to ensure a clearer audit trail of information. The manager informed the inspectors that three service users’ have cot sides in place. ‘Safety Restraint’ letters were on each of the care files examined. These were signed and dated by the service user or their next of kin on their behalf. In discussion with the manager and one of the providers, it was evident that the ‘Safety Restraint’ letters were in place to ensure that the home has taken the correct step to make sure individual’s safety is being appropriately safeguarded. The inspectors asked, if the manager had sought any other professional advice with regards to using cot sides. It was evident from the discussion, that the decision making process was completed by the manager, in consultation with the specific service user’s relatives and that potential advice had not been sought. The home has its own supply of cot sides on site. It was advised that the registered persons must make a referral to a relevant professional with regards to ensuring that the cot sides in place are appropriate and safe. It was also evident that the home’s current restraint policy needs to be updated to be in line with current legislation. A number of falls were recorded since the previous inspection. A falls analysis was completed. Although falls are recorded, there were no clear audit trails, as to how falls prevention is managed. It was advised that the manager must seek advice from the local falls clinic with regards support on fall prevention. A Manual Handling (Sandex) assessment format was in place on all care plans examined. None were completed. The registered manager stated that this format is no longer being used by the home. It was recommended that these should be removed if not used. Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 14 Service users spoken to at lunch stated that they are treated with respect and dignity at all times. Their rights and privacy is upheld. The inspectors observed this. During a brief tour of the home it was evident that individual’s personal clothing is hung-up appropriately. Individual bedrooms are presented differently. Shared bedrooms are provided with appropriate screening to ensure individuals’ privacy with regards to personal care and privacy at any time. Medication Administration Records (MAR) were examined. These were found to be in good order. The inspector observed the manager completing the afternoon medication round. Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 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 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 evidence gathered both during and before the visit to this service Service users maintain family contact and participate in various planned in house activities. Culture needs are met either through social and family needs. The meals in this home are good offering both choice, variety, and catering for special needs. However, those service users who are prone to swallowing difficulties may need additional support. EVIDENCE: Service users have easy access to the telephone if they so wish and one service user informed the inspectors they have their own private line. Service users clothing was found to be appropriately stored. Medical examination and treatment are conducted in individual’s room when necessary. During day one the GP visited one service user who was ill. Service users who share are provided with screening to ensure their privacy is not compromised when personal care is being given or at any other time. It was observed that service users were treated respectfully and communication dialogue was deemed appropriate. The hairdresser visited on day one and stayed for most of the day, cutting and styling service user’s hair. The hairdresser stated that she visits the home at least once a fortnight and has attended to the service users at Green Trees for Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 16 over two years. It was evident that hairdresser is well known to the service users. The activity worker is a volunteer and works three days a week. At the previous inspection it was required that the registered person has a weekly programme of activities provided and all activities particapated by service users is to be recorded on individual care plans. An activity file was in place, which listed all the activities that could be participated in by service users. In discussion with the activity worker it was evident that service users are given the opportunity of stimualtion through leisure and recreational activities mainly in-house, to suit their needs, preferences and capabilities. Particular consideration is given to service users with dementia and other cognitive impairments. Records of activities participated in are recorded. The programme of activities in place included pet therapy - stroking cats and dogs, looking at the fish and beachball tossing. The inspectors commended the registered persons on the activitiy file as it was excellent. The manager stated that at present there is only one service user who is Jewish. None of the service users require any particular cultural requirement such as food, religious or social activities. The garden area is landscaped. There is a large pond on site with a variety of fish. At the previous inspections it was required that a clear sign is put in place near the pond area to ensure service users , their relatives and staff are aware of the deep water. In discussion with one of the providers it was evident that a sign had been ordered, a copy of the invoice was shown. A temporary sign is now in place until the new sign is erected. Access to the garden was discussed. The lounge door is always locked. The staff stated that the service users did not like the lounge doors or windows open, due to the draft and often asked to have them shut. However on the days of this inspection the weather was hot and the windows were open, but not the door accessing the garden. At lunch, accessing the garden was discussed with several of the service users. From the discussion they were all in agreement that they can’t have the lounge door open, as some individuals may wander out without support. However, service users did state that they do if they so wish go around the front of the home from time to time. Service users are able to have visitors at any reasonable times and they are able to access the local community with support if they so wish. At the previous inspection it was required that the registered person ensures that a record of all visitors’ to the home, including the names of the visitor/s and date is kept. At this inspection a visitor’s logbook was in place. There was a clear notice stating all visitors must sign in and out and records were now being maintained. Service user’s personal monies are handled either by their relatives or the placing authority on their behalf. The registered provider stated that they do Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 17 not handle any service users personal monies. Purchases such as hairdressing, are paid for by the home, then invoiced to the appropriate individual for payment. The home is registered with the Data Protection body. The menu plan was inspected. It was evident that service users receive a varied, appealing,wholesome and nutritous diet, which is suited to individual needs. On the second day the inspectors had lunch with service users. The discussion around the table related to the meals, how well they were prepared and presented, the garden, a personal breavement and moving into the home. All service users whom were seated at the table ate well and particpated in the dicussion. It was obseved that one service user who was in the lounge was supported by one of the carers. It was evident from the observation, that the service user was informed of what was on their plate, they were not hurried and given sufficient time to eat. The home supports five service users with swallowing difficulites. The home supports the individuals by ensuring all foods served are pureed. It was evident that the manager has not sought any professional support or advice for these specific service users. Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 18 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, 17, 18 Quality in this outcome area is good. This judgement has been made using evidence gathered both during and before the visit to this service. Service users know that their views are listened to. Staff have a good practical knowledge and understanding of adult protection issues, which protects service users from abuse. EVIDENCE: The home has a satisfactory complaints system with some evidence that service users feel that their views are listened to and acted upon. No complaints were recorded on file. However, the discussion with regards to complaints and concerns was discussed with the registered persons during the inspection. Service users were asked during lunch if they had voted at the recent local election. All stated no, but that, if they wanted to, they could with the support from the home. Staff have undertaken Protection of Vulnerable Adults training. Evidence of the training completed were on staff members files Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 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 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 adequate. This judgement has been made using evidence gathered both during and before the visit to this service. The home is comfortable, homely and safe, therefore providing service users with a pleasant environment to live in that they can call their home. EVIDENCE: A tour of the home showed that the home is very pleasant and comfortable. The communal areas consist of a large lounge with access to the garden and the dining room. This garden door is always kept locked due to individual safety. The garden area is kept, reasonable safe and well maintained. One of the registered providers is the person responsible for the maintenance of the home. Each bedroom has en-suite facilites and decorated to individual taste and style. The assistant manager informed the inspectors that he was re-decorating the only vacant bedroom, on the request of one of the service users, who wants to move rooms. Service users are able, if they so wish to bring in their own furnishings and this is recorded on the relevant care file. One service user, Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 20 showed the inspector around their room, which they were very proud of. The bedroom looked very homely, comfortable and cosy. All bedroom doors have magnetic closures. The home was found across the two days were found to be reasonable clean and hygienic. Bedrooms are individually ventilated and all rooms have central heating control. Legionella was discussed and it was evident tests were completed. The home has a control of infection policy in place. One service user has MRSA and a pressure area. The home follows the correct procedures with regards to ensuring the health and safety of the service user, the other service users and carers are kept safe. However, the manager did state this is difficult, at times due to the specific service user’s confusion and them not always following the safety guidance. The manager stated that local district nurse team support the home. The district nurses re-dress the service user’s pressure area once a week and if any other dressings are needed the manager completes this. On the district nurses file there were records of the treatment given by the nurses. However, there were no records in place with regards to district nurses giving the manager, permission, guidance or training for the home to continue the treatment in their absence. Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 29 & 30 Quality in this outcome area is adequate. This judgement has been made using evidence gathered both during and before the visit to this service. Service users are confident that a competent and effective staff team is in place. However, service users are not fully protected from all staff employed as the home has failed to ensure that the appropriate checks have been undertaken and staffing levels reviewed. Therefore service users care might be potentially put at risk of harm. EVIDENCE: The care staff morale within the team is good resulting in an enthusiastic workforce that works positively with service users to improve their whole quality of life. The home staff team consist of a registered manager, an assistant manager, a senior carer, three full time carers, four part time carers and a cook. Two carers are rota’d on shift each and one waking night staff covers nights. The manager stated that she is on duty each day, however, there was no evidence of this on the rota seen. Ten care staff records were examined. It was evident that all care staff have been employed by the home for a number of years. The last employee to leave was approximately a year ago. On the days the cook is off duty the, assistant manager works as the interim cook. From the current rota seen, it was evident that during the week Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 22 beginning the 15th May, the cook is off on annual leave for a week. Covering this, is the assistant manager, who is also rota’d to cover the care hours at the same time. It is advised that the registered person must review the staffing levels in the home during period of annual leave and sickness. Over 50 of the staff team have undertaken NVQ level 2 or above. Other courses undertaken are Moving and Handling, dementia care, POVA, Health and Safety, Food Hygiene, basic first aid and infection control. Many of the courses undertaken by care staff are via Oakland College, which is a distance learning college. On the second day of the inspection a number of the carers were undertaking in-house fire awareness training with an external fire contractor. It is the view of the inspectors that a number of the training completed by the home is mainly in-house. It is recommended that the registered provider review the training programme and seek sought training external to the home, to ensure that care practices within the team does not become insular and to encourage carers to network with other organisation and share current practices and legislation. The training shortfalls identified were falls, pressure care (tissue viability) and continence promotion. The activity person’s employment was discussed. It was evident that the member of staff is voluntary, and works three days a week. However, she is not indicated on the rota and no Criminal Record Bureau (CRB) certficate was in place. Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 36 & 38 Quality in this outcome area is good. This judgement has been made using evidence gathered both during and before the visit to this service. Service users are confident that the home is run to the best of their interest. Service users are confident that staff are appropriately supervised and therefore competent to meet the needs of the service users whom they care for. Service users health and safety is regularly reviewed and monitored. Therefore, service users are fully protected and safeguarded. EVIDENCE: The manager/provider stated that her style of management is, hands on, holistic and intuitive. It is of the view of the inspectors that the manager/provider feels that there is a too many systemically interventions being introduced, that undermined the main reasons for care. Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 24 The question was asked if the home is run to the best interests of service users. The manager’s response was ‘yes they do’ through the home’s caring and supporting approach; the carers and management team back this up. Service users spoken to at lunch felt that ‘ home is home’ they also stated that they are treated with respect and dignity at all times. The service users named a number of care staff that are committed to their works practices. The ethos of the home was open and transparent. Supervision notes were seen and all were in good order. At the previous inspection it was required that the registered persons makes 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. At this inspection the registered provider informed the inspector that he has drawn-up a questionnaire called ‘Living at Green Trees and Admission to Green Trees – Quality Assurance Questionnaires’ which has been sent to service users and their relatives. Copies of the questionnaires were given to the inspector. However, the provider stated none have been received back. It was evident that the questionnaires had not been sent to stakeholders or care managers. Health and safety certificates were examined. Gas, electrical installation, call points, lift, fire extinguishers, hoist & bath chair and emergency lighting checks were all in place. However, no Legionella certificate was present. At the previous inspection it was required that the registered person ensure that fire drills are completed. Records showed that the last completed fire drill was recorded 3/03/06. The information recorded reflected the time and date. It is recommended that a list of staff and service users present at the time of a fire drill practice should be recorded. The fire contractor was on site on day two of the inspection, completing Portable Appliance Testing (PAT) followed by in-house fire training for carers. Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 25 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 2 X 3 X HEALTH AND PERSONAL CARE Standard No Score 7 2 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 3 18 3 3 X X X X X X 2 STAFFING Standard No Score 27 2 28 X 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X X 3 X 2 Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP3 Regulation 14(1)(a) Requirement Timescale for action 20/06/06 2. OP3 14(2) 3. OP7 15(2)(b) 4. OP8 17 The registered person must ensure that the specific service user who recently moved into the home has a full assessment undertaken by the home to ensure that the home can meet this individuals care and support needs. Evidence of this must be on file. The registered person must 30/07/06 [provide the Commission with a detailed care plan for the 2 specific service users identified during the inspection. This must include details of their needs including any healthcare needs and how these are met. 20/06/06 The registered person must ensure the care staff review each service user’s plan at least once a month. These are to be updated to reflect any change in need, current objectives for health and personal care, and actioned if necessary. The registered person must 30/06/06 ensure that the home practice of recording healthcare information in RED pen is monitored and DS0000010646.V291201.R01.S.doc Version 5.1 Green Trees Page 27 5. 6. OP8 OP8 17 17(1)(a) Sch 3.3 (m)(o)(p) reviewed regularly to ensure that any discrepancies can be addressed at the time. The registered persons must 30/07/06 ensure that the restraint policy is updated accordingly. The registered persons must 30/06/06 ensure that the home kept a clear record of falls, treatment and any intervention. The registered person must seek advice and guidance from the relevant professional with regards to managing service users who are deemed high risk of falling, those who have cot sides in place and those who have swallowing difficulties. Evidence of this is to be kept on file. Any changes must be reviewed accordingly. The registered person must ensure that the specific service user, who has MRSA and a let ulcer, has in place on their care plan clear instructions by the district nurse as to how treatment is continued in their absence. Only care staff that are trained can continue the treatment. List of all trained care staff and deemed competent is to be placed on the front of the specific service user’s care plan with the dates of training undertaken. The registered persons must ensure that the manager and the activity person shifts are clearly indicated on the weekly rota. The registered person must ensure that the staffing levels in the home are reviewed. An action plan of how this is addressed is to be submitted to the Commission. This is to include a contingency plan with DS0000010646.V291201.R01.S.doc 7. OP26 17(1)(a) Sch 3.3(n) 30/06/06 8. OP27 17(2) Sch 4.7 18(1) 20/06/06 9. OP27 30/07/06 Green Trees Version 5.1 Page 28 10. OP30 18(1)(c)(i ) regards to sickness and annual leave cover. The registered person must ensure that all care staff undertake training in falls prevention & management, pressure care (tissue viability) and continence promotion. The registered person must ensure that the activity worker undertake training in dementia care based on appropriate activities for service users with dementia care needs. The registered person must ensure all staff employed, such as volunteers, have in place before commencing work in the home an Enhanced Criminal Record Bureau (CRB) check that has been completed by the home. A record of this is to be kept on file. The registered person must ensure the water supply (water Fittings) Regulation 1999 with regards to Legionella is in place. The registered person must also obtain the views of stakeholders including care managers with regards to the quality of care the home provides for service users they place. 30/07/06 11. OP29 19 Schedule 2.7 20/07/06 12. OP38 13(4) 30/06/06 13. OP33 24 30/07/06 Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 29 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 It was recommended that the registered persons should record in the daily notes an account of newly admitted service users care and support needs for at least a week to give care staff some guidance and assistant when drawing up the individual’s care plan after the trial period. It is good practice for the home to record healthcare information separately on individual care plan file. It is recommended that the registered person should consider seeking external training courses for carers. To ensure that the training completed is not insular and encourage care staff to network with other organisations It is recommended that records of fire drills include a list of all carers and service users who were present at the time. The record also indicates any difficulties experienced and any remedial action undertaken. 2. 3. OP8 OP30 4. OP38 Green Trees DS0000010646.V291201.R01.S.doc Version 5.1 Page 30 Commission for Social Care Inspection Southgate Area Office 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. 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