Inspection on 07/11/05 for Green Trees

This inspection was carried out on 7th November 2005.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Green 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 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 Unannounced Inspection 7th November 2005 13.00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 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.V257952.R02.S.doc Version 5.0 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st July 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 DS0000010646.V257952.R02.S.doc Version 5.0 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 five hours. The manager/provider assisted the inspector throughout the inspection. The staff on duty were a carer and senior carer. There were fourteen service users in the home. At present the home has two vacancies. The inspector was able to speak to a number of service users who were very positive about the home, however, it was not possible to obtain clear information since a number of the users have dementia. The inspection involved sampling a number of care plans, records, a tour of the building, the inspector completing a fire risk assessment, speaking to service users, observing a member of staff completing afternoon medication and observing the interaction between staff and service users, which was friendly. Feedback was given to the registered manager/provider a senior carer and one care staff. One relative was visiting during the inspection, but the inspector was unable to communicate with the relative due to the language barrier. It was observed that the home had provided the relative with lunch and they were assisting the service user with their lunchtime meal. The inspector found the manager and the rest of the staff very open and helpful throughout the inspection. What the service does well: What has improved since the last inspection? Since the last inspection there were thirteen areas for improvement. One areas of improvement has been met at the time of this inspection relating to the offensive odour in the hallway. This was concerning as a number of areas Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 6 of improvement from the previous inspection related to the service users care needs and these had not been addressed. What they could do better: This inspection has identified twenty-three areas of improvement, ten of which have been restated from the previous inspection. It is therefore required that the registered person submit an action plan to the Commission for Social Care Inspection (CSCI), which describes how they will address these matters. The registered person is to ensure that: • The activity worker is to undertake training with relating to appropriate stimulating activities for service users with dementia • The registered person to ensure that the specific service user who has recently moved into the home has all their personal details recorded on their care plan. • Current photographs of service users are to be on individuals care plan files. • The registered person is to complete an environmental and fire risk assessment, which is to be reviewed annually. • Weekly activity programme to be displayed. • Records of all activities participated by service users are to be on individuals’ files. • The registered person is to seek advice from a dietician or GP regarding the specific service user who may have diabetes. Records of this must be kept on file. • The registered person to make an appointment for a specific service user whose care needs is addressed under ‘Health and Personal Care’. • All individual healthcare needs or any changes must be recorded on individual’s files. • All individuals healthcare needs must be supported or addressed either highlighted on individual’s daily care notes or recorded separately on individuals’ care plans, evidence of this is to be accessible. • All care staff must wash their hands prior to administering any medication to service users. • Records of all admission and discharge are to be kept on file • Records of all visitors to the home are to be made • The garden works must be completed and a clear and appropriate sign must be in place beside the pond stating ‘Pond - danger deep water’. • All records required under Regulation 17 maintained must be accessible. • Fire drills must be completed and a record to be made. • Records of supervision must be kept on file • All staff to undertake dementia, food hygiene and adult protection training. • Quality assurance review policy is to be in place. • Suitable locks for individual bedrooms are to be sought • The registered person to consult with service user or their representative on their behalf whether or not they prefer care by a male or female carer and a record of this is to be kept on individuals file. • And the carpet in the lounge areas is to be cleaned or replaced. Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 7 It is evident from this that a number of requirements from the previous inspection had not been met. It is therefore a matter of concern. Any further failures may result in the Commission taking appropriate enforcement action. 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.V257952.R02.S.doc Version 5.0 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.V257952.R02.S.doc Version 5.0 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 The registered persons have failed to ensure those service users who move into the home have their assessed needs met. Therefore receiving appropriate care to meet individual’s care needs. EVIDENCE: The home support older people of mixed gender who may also have dementia care needs. The manager stated that all care staff had undertaken in-house dementia training. It was not evident whether the training undertaken by the care staff accurately cover all the areas of dementia care. The registered manager/provider stated that she is qualified to train care staff in dementia care. During the inspection it was observed by the inspector care staff interaction with a number of service users was not always appropriate and this needs reviewing through training. Two service users who recently moved into the home care plans were examined. One of the care plans examined did not have the relevant information regarding the service user’s current profile and both files did not have any current photographs of the users. Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 10 It was also evident that the manager has no clear record of who has been admitted or discharge from the home since the last inspection. The records of this could not be found on individuals care plan files and it was evident that the manager was unable to access this information easily. This was also discussed at length. The home does not supply intermediate care. Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 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 do not receive the appropriate care and support. The home has a robust medication policies and procedures, however, the registered person needs to review some of the practical procedures with care staff with regards to appropriate administration of medication. Service users rights are not always respected. Therefore service users could be unfairly treated with regards to how their personal care is met by the home. EVIDENCE: Three care plans were examined. Two of the three care plans examined were of the service users who had recently moved into the home. A number of the service users who reside in the home are diagnosed with dementia. The manager stated that the home employs an activity person for three days a week to provide activities for the residents. There was no evidence of what activities are provided or participated by the service users. Individual’s daily Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 12 logs sheets or care plan examined had no information recorded. It was also difficult to ascertain from the service users spoken whether or not they participated or enjoyed the activities provided, due to their confusion or dementia care needs. This was discussed with the manager who stated that the service user’s needs changes from day to day and it was not always evident what activities they may wanted to participate in, some service users may only enjoy verbal discussion others a five minute massage on their hands. It was advised that any activity must be recorded and monitored appropriately, depending on individual’s needs. The healthcare needs of two service users were discussed with the manager. One service user whose blood sugar levels check prior to moving into the home was bordering on positive. The manager stated that the hospital doctor asked the home to monitor the service user regularly, however no records were found either by the manager or the inspector. The service user’s key worker stated that due to the service user’s blood sugar levels remaining stable this was now longer being checked by the home and the GP is aware of this. This was concerning as no records or the GP’s recommendation was recorded. It was advised that the registered person must arrange with the specific service user’s GP a full medical. This is to include a blood sugar level check. Evidence of the medical, plus any action made must be recorded separately on the specific service user’s healthcare notes stating how this will be monitored and reviewed. The other area of concern is regarding records made in the daily log sheets for another specific service user who has recently moved into the home. This specific service user’s care needs are complex. The main areas of concern are that the service user has a language barrier, continence issues, presents challenging behaviour at times and is diagnosed with dementia. Recorded on the service user’s notes on the 3/08/05 was ‘blood was found in the service user’s pad’ and on the 9/10/05 ‘urine was offensive’. There was no indication of what happened next or if any medical intervention was made. This was discussed at length with the manager and the care staff. It was advised that all healthcare needs or any changes must be followed up and evidence of this must be recorded on the individual’s care plan and monitored accordingly. It was also advised that all healthcare needs must be recorded separately or clearly highlighted on the daily records. Important information regarding healthcare needs must be easily found on the individual’s care plans. The medication administration records charts were examined. A part of the inspection involved the inspector observing a senior carer administering medication to service users after lunch. The senior carer interacted well with the service users, however, a major concern was that the senior carer did not wash their hands prior to administering medication, especially when administering eye ointment to one specific service user. This was discussed at length with the senior member of staff at the time of the inspection. Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 13 At the previous inspection it was required that the registered person consults 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. It was evident that the service users who had recently been admitted into the home this was not discussed. Therefore this requirement is restated. Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 14 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 The home provides weekly activities for the service users. However, the home has failed to ensure that the activities provided suit all the needs of the service users, particularly those with dementia. Service users are able to maintain contact with family and friends contact, however, records of visitors are not consistently recorded. Therefore service users cannot be sure that appropriate contact with relatives and friends are maintained, due to individual care needs. EVIDENCE: One of care plans examined related to specific service user who had recently moved into the home, who had a number of care needs. One area of need related to the service user ethnicity and that their first language was not English. The manager was asked how the care staff effectively communicate with the service user. The manager stated that the main point of contact regarding any care issues is through the service user’s daughter who visits regularly. The service user’s wife also visits but her first language is not English. The issue of appropriate activities for the service user with dementia care needs has been addressed under ‘Personal and Healthcare.’ At the previous inspection and this inspection it was evident that there were no other records made in the visitor book apart from the inspector. This was Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 15 discussed at length and the manager who stated that the home has several accesses into the home and it is not always possible to account for all the visitors. It was advised that under Regulation 17(2) Schedule 4(17) that a record of all visitors to the care home is kept. Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 16 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 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. EVIDENCE: The inspector was unable to examine the complaint logbook at the time of the inspection. The manager stated these records are kept in another office and the other registered provider is responsible for the upkeep of these documents. It was advised that the registered person/s must at all times be able to access all documents required for inspection with regards to the running of the home and this is a part of the management role and responsibilities. Upon examining one of the care plans a record was made by one of the care staff regarding a complaint made by a relative. This was discussed with the manager and the care staff. The action taken at the time of the complaint was discussed, however, the manager stated this was not recorded in the complaints logbook. In was also evident from the discussion that the manager and care staff did not see the record made as a complaint but a concern. It was advised that concerns must be responded to in the same way as a complaint and the appropriately action is to be followed through. Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 17 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, 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: 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. 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. It was evident that the works on the garden have not been fully completed. The sign at the previous inspection which stated ‘Pond Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 18 danger deep water’ was now not in place. The registered provided stated that this would be completed in the warm months to enable the service users to access the garden. The manager stated that the service users when asked refuse at times to access the garden. It was advised that the service users should have the opportunity to access all parts of the home including the garden, but due to the works not being completed, has not been possible. At the previous inspection it was evident that an offensive odour present was present, at this inspection this was eliminated. The home was found at the time of the inspection to be reasonably cleaned however, the lounge carpet was in need of a thorough clean or needed replacing. It was also required at the previous inspection that the registered persons ensures that suitable locks are provided on all bedroom doors. The registered person to ensure that the service users are provided with a key should they request unless a risk assessment indicates otherwise. It was evident at this inspection this has not been met. This requirement relating to the garden has been restated from previous inspections. It is therefore a matter of concern that there is continued failure to ensure that an appropriate clear sign is in place, the building maintenance of the garden remains uncompleted and suitable locks are provided on all bedroom doors. Any further failure may result in the Commission taking appropriate enforcement action. Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 19 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): The registered person has failed to ensure access to staffing records are available at all times. Therefore service users cannot be confident that they are in safe hands. EVIDENCE: Staffing records were not examined due to the registered manager/provider not being able to access the records. A requirement regarding records and accessibility is made in this report. Staff training was discussed and it was evident that the registered manager/provider must review each member of staff training and development needs. Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 20 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): 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 health, safety, welfare and future are not being regularly reviewed and monitored. Therefore, the manager has failed to fully protect service users with regards to health and safety procedures. EVIDENCE: Staff supervision records were not accessible at the time of this inspection. Therefore the requirement relating to supervision addressed in the previous inspection will be restated in this report. Part of the inspection process included the inspector completing a fire risk assessment whilst touring the building. The purpose of the fire risk assessment Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 21 was discussed with the manager. It was identified through the fire risk assessment that there were a number of good practices and some areas of concern. All the fire extinguishers are in place and the means of escape is clear all fire doors have magnetic door closures in place. It is advised that the manager must complete a environmental and fire risk assessment which is reviewed and monitored annually. The inspector was unable to examine a number of records due to the manager not being able to access them. Therefore the previous requirements addressed in the previous inspection relating to records of fire drills and quality monitroring will be restated in this report. Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 22 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 X X HEALTH AND PERSONAL CARE Standard No Score 7 X 8 2 9 2 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 X 2 X X X X 2 X 2 STAFFING Standard No Score 27 X 28 X 29 X 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X X 2 X 2 Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 23 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 18(1)(c) (i) Requirement The registered person must ensure all care staff undertake appropriate dementia care training. Records of the content of the training must be kept on file and who attended. All training must be reviewed accordingly with care staff. The registered person must ensure that the activity worker undertakes the training on dementia based on appropriate activities for service users with dementia care needs. The registered person must ensure that the specific service user who has recently moved into the home has all their relevant details recorded on file. The registered person must ensure all service users have on file a current photograph. The registered person must complete an environmental risk assessment that includes a fire risk assessment. This is to be reivewed annually. DS0000010646.V257952.R02.S.doc Timescale for action 28/02/06 2. OP3 17(1)(a) Sch3(2)& 3 30/12/05 3. OP38 13(4) 28/02/06 Green Trees Version 5.0 Page 24 4. OP12 16(2)(n) & 17 The registered person must ensure that a weekly programme of activities provided by the home is displayed . 30/12/05 5. OP8 12(1)(a) 6. OP8 17(1)(a) Sch3.3(n) 7. OP8 17(1)(a) Sch3.3(n) The registered person must ensure all activities particapated by service users must be recorded in individual care plan. Risk assessments must be updated to reflect service user activities needs and what support are needed to aid individuals. The registered persons must refer to a dietician via individuals 30/12/05 service users GP with regards to obtaining appropriate support, advice and guidance on how to support service user/s who are diabetic and others with specific dietary needs. A record is to be maintained on each individuals care plan file. (Previous timescale of 30/09/05 not met.) The registered person must 30/12/05 make an appointment with the GP for the specific service user whose needs have been addressed under ‘Health and Personal Care’. Records of the GP appointment must be recorded with any action or follow-up treatment made. The registered person must 30/12/05 ensure all healthcare needs or any changes must be followed up and evidence of this must be recorded and monitored accordingly. The registered person must either highlight on the daily care notes or record separately all individuals’ service users healthcare needs. Evidence must be accessible. Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 25 8. OP9 13(2) & 13(4) 17(1)(a) Sch3.3(d3) 17(1)(a) Sch 3.3(l) 9. OP3 10. OP12 11. OP13 17(2) Sch 4.17 12. OP19 13(4) & 23(2)(o) 13. 14. OP38OP16 OP38 17 17(1)(a) Sch 4.17 The registered person must ensure all care staff wash their hands prior to administering medication to service users. The registered person must have in place clear and comprehensive records of all admission and discharge. The registered person must ensure that appropriate action is taken to address the linguistic needs of specific service user and that a record is kept in the care home that details the communication needs of specific service user and the methods in place to meet these needs. The registered person must ensure that a record of all visitors to the home, including the names of the visitor/s and date. The registered persons must ensure that the works in the garden area are completed, as the uncompleted works are deemed as a hazard at present. A clear bold and appropriate sign is 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. (Previous timescale of 20/10/05 not met) The registered persons must be able to access all the records required for an inspection. 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. DS0000010646.V257952.R02.S.doc 20/12/05 20/12/05 30/12/05 20/12/05 30/10/06 30/12/05 20/12/05 Green Trees Version 5.0 Page 26 15. OP36 18(2) 16. OP33 18(1)(c) (i) 17. OP33 24 18. OP24 23(2)(b) 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. (Previous timescale of 15/09/05 not met.) 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. (Previous timescale of 20/09/05 not met.) 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 20/10/05 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 October 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 30/09/06 not met.) DS0000010646.V257952.R02.S.doc 30/12/05 30/01/06 30/01/06 30/01/06 Green Trees Version 5.0 Page 27 19. OP33 13(6) 21. OP10 15(1) 14(1)(c) 22. OP8 17(1)(a) Sch 3 23. OP30 23(2)(d) 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 must be available for the purpose of inspection. (Previous timescale of 20/10/05 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. The service user’s preferred choice is to be recorded on their care plan. (Previous timescale of 20/09/05 was not met.) The registered persons must ensure that service users records clearly indicate the admissions to the Accident and Emergency department are recorded in individuals’ care plans. (Previous timescale of 20/09/05 not met.) The registered person must ensure that the carpet in the lounge area is either cleaned or replaced. 28/02/05 30/12/05 20/12/05 30/01/06 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 Green Trees DS0000010646.V257952.R02.S.doc Version 5.0 Page 28 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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