Inspection on 15/06/06 for Greenacres

This inspection was carried out on 15th June 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 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

Greenacres 07/07/07

Greenacres 22/02/06

Greenacres 17/08/05

Greenacres 18/09/04

Greenacres 14/04/04

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

CARE HOMES FOR OLDER PEOPLE Greenacres Green Lane Standish Wigan Greater Manchester WN6 0TS Lead Inspector Lindsey Withers Key Unannounced Inspection 08.15 15th June 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 Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenacres Address Green Lane Standish Wigan Greater Manchester WN6 0TS 01257 421860 01257 472133 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) www.clsgroup.org.uk CLS Care Services Limited Mrs Joy Louise Hogarth Care Home 40 Category(ies) of Old age, not falling within any other category registration, with number (40), Physical disability over 65 years of age (8) of places Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. Within the maximum numbers registered there can be up to 40 OP, and up to 8 PD(E) The service should at all times employ a suitably qualified and experienced Manager who is registered by the CSCI. 22nd February 2006 Date of last inspection Brief Description of the Service: Greenacres Care Home (part of the CLS Group) is registered to provide accommodation and personal care and support for up to 40 individuals over the age of 65. Within the total number of 40, up to 8 residents can be accommodated who have a physical disability. Bedrooms are located on the ground and first floors. All rooms are offered on a single occupancy basis only four bedrooms have en suite facilities. Greenacres is situated in a residential area, close to Standish centre and the amenities of supermarket, shops, restaurants and community services. Car parking at Greenacres is limited, but street parking can be found close by. The current scale of fees for the home is from £312.42 to £380.00 per week. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of this inspection was to look at the main “key” standards in order to assess the level to which Greenacres meets the needs and expectations of residents. Part of this inspection involved an unannounced site visit to the home on 6th June 2006 from 8.15 a.m. to 2.45 p.m. Part of the time was spent looking at the paperwork that the home needs to keep to show that it is being run and managed properly, and part of the time looking around the home and watching how staff care for residents. In order to get a wider view of life at Greenacres, as well as speaking to residents and staff at the home during the site visit, the inspector has taken account of any comments cards that had been returned to CSCI from residents, relatives, and health and social care professionals. In making the judgements contained in this report, the inspector has also considered previous inspection reports, and any other visits that were made to the home. What the service does well: What has improved since the last inspection? The notes of meetings are being made available more quickly, so people can see what was said and what decisions were made. Redecoration of the premises is continuing and there have been some changes to the way that indoor space is used, which residents say is better and gives them more space. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 6 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. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 3. Standard 6 is not applicable to this home. Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents are admitted only after a thorough assessment, which forms the basis of the plan of care. The home can meet the assessed needs of the residents, and brings in specialist services when they are needed. EVIDENCE: The inspector looked at the records for the three most recently admitted people to the home. A full assessment had been carried out prior to admission to assess each persons ability, and showed where the person would need extra help and support, for example, dependence on a walking stick or zimmer frame when moving around, or problems arising because of arthritis or hypertension. Areas of independence, for example dressing or bathing, or where there would be significant dependence on staff or other health or social care professional, for example, occupational therapy, had been identified. The persons medical history had been recorded. Where arrangements for admitting a person had been arranged by a social worker, a plan of care had been proposed and a copy of it had been put in the person’s file. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 9 The Inspector spoke with two residents who had transferred from another CLS home that had closed. Both had visited the home, had made a tour of the home and seen their proposed bedrooms, had had a meal, and spent time with other residents. They said they were not rushed to make a decision. Both residents said they had found the process emotional at the time, but that they had settled down well to life at Greenacres. Another resident said that they had been unsure at first about moving into the home, but that they felt they had adjusted well. This persons family said that the admission process had been managed well. One comment card was received by CSCI from a resident. The person said they received enough information about the home before they moved in, so they could decide if Greenacres was the right place for them. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 10 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, and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence, including visits to this service. Each resident has a plan of care that sets out the person’s health and personal needs, and makes some reference to their social care needs. However, improvements must be made to ensure records are consistently maintained so that the home can demonstrate all residents are offered the same quality of care. It would be better if all written entries were recorded as if expressed by the resident. If audits of the paperwork were conducted thoroughly, these shortfalls could quickly be eradicated. Residents have access to the quality of care that is appropriate to them, including community and hospital services. Risk assessments are in place that ensure residents are kept safe. On the whole, medication is managed properly, but the written records must be fully and accurately completed. Care must be taken to keep proper account of what medication is being stored. Residents can be assured that they will be treated with respect and dignity, and that their right to privacy will be upheld. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 11 EVIDENCE: The home has a history of poor care planning that has meant a lot of monitoring by CSCI. The last inspection in February 2006 showed that care planning was better, with only minor errors and omissions in evidence. It was the inspector’s expectation that these should have been eradicated if audits had been done, in accordance with the CLS policy. The inspector looked at care plans for three residents and found that they had been developed from the initial assessment. The plans set out the action that members of staff would need to take to meet the aspects of health and personal care that were appropriate to each resident. For example, assistance with personal hygiene, sleeping habits, maintaining a safe environment. A risk assessment was in place on each file that related to the prevention of falls. Care plans had been reviewed monthly and had been updated to reflect changes to the persons needs or wishes. For example, one person had shown aggression shown toward staff and so a mental health assessment had been arranged. One of the three care plans was written in first person (known as ‘person-centred’) style, for example: I suffer from ..., If there was a fire I would need a member of staff to direct me to safety. Two were written in the third person: X has ..., Y can .... However, staff completing reviews had written entries in the third person - so there is no continuity to demonstrate the person-centred approach that the Manager states is the way that care is provided at Greenacres. Some care plans did not show how a person would be supported to achieve anticipated goals, for example, to meet emotional needs. A further sample of care plans was selected as files in the initial sample did not contain the same documentation. This second sample showed similar discrepancies. The Manager was confused about which were the current documents. She said she was carrying out regular audits of care plans, but these discrepancies suggest that the audits are not thorough enough. This finding is supported in a report dated 17th May 2006 by a CLS senior manager, who wrote, Care plan documentation has been greatly improved but further work is required to ensure a comprehensive, up to date and relevant case note is maintained. For one person there was good evidence to confirm that care is provided day and night - including cups of tea, a jug of water, chicken sandwich - provided at different times when the resident was restless and unable to sleep. Four residents told the inspector about the different health care services that they had seen in recent months, including the GP, District Nurse, Practice Nurse, and chiropodist. Two people described health and personal care services provided to them as still very good. The records showed where arrangements had been made for residents to be referred via the GP for Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 12 specialist services, for example, for a mental health assessment or occupational therapy. One person enjoying the sunshine in the garden was unable to form verbal responses to questions put to him by the inspector, but showed by their expression that they were generally happy to be at Greenacres and satisfied with the care provided. Changes were being made to the medication and treatment room at the time of the site visit. Staff said that the renovations should make the room a better place to work and provide better storage for medication and clinical supplies. The supplying pharmacy had made an inspection in May 2006. Their report states that all systems in place and OK and two recommendations had been made: one to provide a new medicines trolley, and one to advertise smoking cessation and weight management clinics. The new medicines trolley had been delivered. The home was moving to a new packaging system for the medication which staff said should be lighter to handle and easier to use. Looking at the medication paperwork during this site visit, it was seen that there were numerous gaps in the recording. No one individual Care Team Leader (CTL) was responsible for the gaps and the Care Team Leader assisting with the inspection said she would raise the matter at the next CTL meeting. The quantity of some tablets did not match the quantity that were on the record sheet (for example, 10 calcium tablets too many), and the reasons for this were discussed with the Care Team Leader. It is a possibility that refused medication had lead to extra tablets being available, but that these had not been taken into account when new medication arrived. Stock control was not, therefore, accurate. The Manager was informed of the discrepancies. One person takes responsibility for their own medication. A risk assessment had been done and was available on the care plan. In discussion, the resident confirmed what medication was prescribed, when it was to be taken, and the arrangements for receiving the daily dosette box and keeping it securely stored in the persons room. There was good evidence to confirm that residents are treated with respect and dignity, and that their right to privacy is upheld. Staff were heard speaking to residents in a respectful way, for example, trying several different ways to ask the same question so that the resident was able to make their own decision about something. The records for one person showed the level of privacy that they wished to maintain. Staff called some residents Mr. X or Mrs. Y, and other residents by their first or pet name, as preferred by the person. There was one minor shortfall in that residents’ underwear was seen to be drying on handrails near the laundry. The Manager said she had had not seen this, and when told by the inspector, took immediate action. 4 comment cards were received by CSCI from relatives, all of which contained positive comments and expressed the persons satisfaction with the service being provided. Comments included: VERY satisfied with overall care provided. Mum is looked after well at Greenacres. Im confident Mother is Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 13 being well looked after. One negative comment was recorded: Carer who looks after X doesnt carry out the things on the care plan. This person also said they were not consulted with about decisions. One comment card was received by CSCI from a resident: the person said they always receive the care and support needed. They said they were, Weighed weekly and questions asked daily to check health. In a comment card, a health professional confirmed their overall satisfaction with the care services provided to residents at Greenacres. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 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, 14, and 15 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. There is an activities programme that, for the most part, meets individual and group needs. Evidence needs to be made available to show that residents are being encouraged to maintain skills and helped to follow their chosen leisure activity for as long as they would wish. Visitors are made welcome and can call or telephone at any time. The records need to be better if the home is to demonstrate conclusively that all residents are helped to exercise choice and control over their lives. Residents are offered a healthy, nutritious diet that respects individual preferences. Residents are helped to ensure they take sufficient food and drink. EVIDENCE: There are three members of staff at the home who have some responsibility for activities. The days activities are displayed in the main corridor between the two dining rooms, and the list the excursions that are planned is also displayed here. One member of staff takes a few of the male residents crown Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 15 green bowling (and a pint!) on one afternoon each week, and another spends time with residents on a one-to-one basis. Two of the female residents said they go out to the shops in Standish so they can pick up things they would like. A member of staff was getting married on the Saturday following this inspection, and several residents were looking forward to going to watch the church service. Residents said they had already been to Southport this year. Other excursions for the remainder of the year included Rivington Barn, Botany Bay and Blackpool (for the illuminations). Southport was a particular favourite of several residents and another trip was being planned to return there. A number of residents spoke about going out with family and friends. The Manager said there have been some problems in arranging transport to places of worship. There are three churches of different denominations in close proximity to the home. One resident in particular was finding it very difficult to think they could not go to church regularly. The Manager said that they have been working on this, but there was nothing in the records to demonstrate this. Apart from one unsuccessful attempt to get the person to church the resident was not aware of the effort of the home; neither were the family. For this resident too, there was nothing recorded to show that the home was making efforts to give the person opportunities to follow their personal interest. The Manager and a care worker have attended a recent training day arranged with the National Activities Providers Association (NAPA). The Manager said that they came across some good ideas during the day, which the staff responsible for activities were looking to introduce. Meals are very much enjoyed by residents at Greenacres. All who expressed their opinion said food was good and plentiful. The records showed that changes had been made, for example, to the hot breakfast choices, to accommodate individual preferences. A second small dining room has been opened along the corridor from the main dining room. Here, those residents who are more independent, can enjoy meals together. Residents using this dining room knew what the lunch-time menu was. Residents using the main dining room were provided with assistance as it was needed. Specialist diets were catered for, including low fat and diabetic. The Manager said that she was taking advice from a Manager colleague about introducing marvellous meals, where the kitchen is open 24 hours a day, a lot more choice is offrered, and the cook and care staff eat with residents. Catering staff will receive training in order to deliver this extended service. A Spanish theme day is being held in July. The catering staff had arranged the food with the suppliers ready for a food tasting evening, to include rice, meat, and chicken dishes. Residents had been involved in the planning for this event. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 16 The records showed that residents can get drinks and snacks through the night, if they wish. In a comment card to CSCI, a resident said that there are always activities the person can take part in. The person loves the food and often has seconds. Greenacres DS0000005736.V294331.R01.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 inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The home has a complaints procedure, details of which are given to residents and their relatives on admission. The home has a policy and procedure for dealing with allegations of abuse. Care practice protects residents from harm. EVIDENCE: The CLS complaints procedure is advertised at the entrance to the home. This information is included in the Service Users Guide, a copy of which is given to new residents when they come to live at Greenacres. The home keeps a complaints and compliments book (known as the Customer Feedback book). No complaints had been received at the home since the last inspection, and two compliments had been received, along with small gifts of biscuits and sweets for residents and staff to share. One comment card had been received by CSCI from a resident, who said that they knew how to make a complaint. Five comment cards were received by CSCI from relatives. Four people said they knew how to make a complaint but had had no need to. The 5th person said they did not know how to make a complaint and had not made one. The person had recorded several areas of discontent but there was no evidence to confirm that this person had raised the issues with the home. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 18 In order to ensure that residents are protected from neglect or abuse, it is CLS policy new staff only start in post once they have been cleared by the Protection of Vulnerable Adults (PoVA) list and by the Criminal Records Bureau (CRB). New staff receive PoVA training on commencement, and all staff attend refresher training periodically throughout their employment. A new CLS policy had been introduced in March 2006 and the records showed that staff had attended training. There has been no new recruitment since 2003. Looking at the way staff went about their duties, it was clear that they were considerate towards the residents. Staff spoke calmly and evenly with residents who were anxious or agitated, and so prevented difficult situations arising. Greenacres DS0000005736.V294331.R01.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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. Residents live in a comfortable home, that is clean and generally wellmaintained. However, the redecoration of the outside of the home must be completed, as this would give a better impression to people visiting the residents. Revarnishing or repainting of bedside cupboards will make residents’ bedrooms look better. There is good attention to working practices to prevent the spread of infection. EVIDENCE: Prior to this visit, the Manager had answered a pre-inspection questionnaire, in which she confirmed that there had been no changes to the private accommodation provided for residents. Some changes had been made to the communal space in that the Smokers lounge and small dining room had been swapped around. This means that the Smokers lounge is bigger and more airy, and caters for a larger number of people. The location of the second Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 20 dining room, seating 8-10 people, which is used by more independent residents, is along the corridor from the main one, and so is closer to the kitchen, which is better when staff are serving meals. There was evidence of some general maintenance and redecoration. A member of staff said the activities lounge on the first floor was scheduled to be redecorated. During a tour of the premises, the inspector noticed that there were several bedside cupboards that were scratched on the top and which now need to be revarnished or repainted. The outside redecoration of the building remains outstanding: this now needs to be completed. Residents made lots of comments about the garden, saying how much they enjoyed being able to sit out in the sunshine. They spoke about the colours of the plants, and the shade that the trees provide. The Manager reported that the archive store on the ground floor was being relocated to another part of the building to create space for a much-needed wheelchair store. Located close to the main lounge and dining room, the wheelchair store will be a welcome improvement and a good use of available space. The dryer in the laundry had over-heated and cut out during the night previous to this site visit. The inspector noted washing on the hand-rails in the corridor leading to the laundry, including items of underwear (which affects the privacy and dignity of residents), and asked the Manager to make alternative arrangements for the washing to be dried. The Manager said she had told staff they could finish drying towels and sheets there. The Manager showed that she had made arrangements to get the dryer replaced, which she expected would be within the day. The home was clean and fresh throughout during this site visit. The domestic assistant responsible for the first floor explained the cleaning routine for the month, which included bottoming out residents bedrooms on a regular basis, so that they were thoroughly cleaned at least once each month. There are set days for cleaning skirting-boards, hand-rails, windows, mirrors, etc. The routines for cleaning bathrooms and toilets, including tiles and fittings, are rigorous. The domestic assistant showed that the cleaning routines take account of minimising the spread of infection. Bedrooms are aired daily, unless the resident expressly requests that their bedroom door is kept locked. Other examples of minimising the spread of infection were also in evidence: staff wore protective aprons and gloves, and kitchen staff wore full overalls and hair coverings. Laundry and clinical waste was moved in appropriate containers. One comment card was received by CSCI from a resident, who said that the home is always fresh and clean. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 21 One comment card was received by CSCI from a relative, who said bed linen was not changed frequently enough. This person also said that the residents clothes were often creased and not clean enough. The inspector mentioned these comments to the Manager, who said that no-one made a complaint about cleanliness or laundry. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 22 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): 26, 27, 28, and 29 Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The home has an appropriate number of staff who have a range of skills. The Manager ensures sufficient staff are on duty at all times. However, additional staff should be brought on duty overnight if the dependency needs of residents change. The home has nearly 100 of care staff with NVQ level 2 or above in care. Staff are aware of the quality of care that they must provide. The CLS recruitment process is robust and only people who are suitable to work with older people are employed. The home has a low turnover of staff which means that residents know and are familiar with the people who care for them. Training is arranged to ensure all people caring for the residents are competent. EVIDENCE: A weekly rota is maintained for each of the staff groups. The Manager said that one person had resigned her post on the night shift. Otherwise, there were no staff vacancies. The Manager has authority to bring in agency staff, if necessary, but gaps in the rota tend to be covered by existing staff, in order to provide continuity of care for residents. In the eight weeks prior to this visit, Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 23 agency staff had been used for a total number of 19 hours. The practice of retaining two members of staff on duty overnight continues, which would not be sufficient if highly dependent residents were accommodated, or if a number were unwell. While it is accepted that staffing levels are reviewed in line with good practice guidelines set down by Investors in People, the recommendation to constantly review this overnight staffing level is brought forward from the last inspection report. Staff were seen to be effectively employed, and did not appear to be task orientated. Staff spent time with residents and did not pass by without speaking. Residents were not rushed, but were given as much time as they needed or wanted. The age range of the staff employed at the home is varied from younger to the more mature person, and in terms of equality and diversity, appeared to meet the race and cultural breakdown of the residents accommodated at the time of this visit. However, all care staff are female. As this does not reflect the make-up of the residents accommodated at Greenacres - of whom a good proportion are male - a recommendation is made for the Manager to bear this in mind at the time of any recruitment to vacant posts. It should be noted, however, that those male residents who expressed an opinion did not convey any dissatisfaction or discomfort about being cared for by female staff. The personal files for three members of staff were looked at. One person had transferred from another CLS home that had closed. One person had a lengthy employment history with the home, and one person was a more recent recruit. There has been no recruitment at the home for several years. The only new starters have been those who have transferred as a result of the CLS re-organisation. Files were in order, and were up to date. The records show that good employment practice has been followed when a person transfers to the home, in that they are offered a period of time to settle in before being made permanent to the post. One member of staff said that it took a while to settle in after transferring, but that it had been less of an upheaval because several members of staff and residents moved together, and that they had supported each other. Another member of staff said that the Manager had been very supportive and patient, and that she had tried to accommodate each persons requirements in terms of the hours that they could work. A full record of training undertaken by staff was provided to CSCI by the Manager with the pre-inspection material. The training record lists all the courses that each person has attended: some that are mandatory (for example, fire awareness, first aid, food hygiene, and moving and handling), and some that will help the member of staff to do a better job (for example, falls prevention). Planned training for the coming year includes continence management, moving and handling, pressure damage awareness, fire safety, assured safe catering, and continuation with the National Vocational Qualifications in care and in cleaning building interiors. In the pre-inspection Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 24 material, the Manager recorded that 20 members of staff at the home had now been awarded the National Vocational Qualification level 2 or above in care. She anticipates that all care staff will have achieved the award by the end of 2006. This exceeds the minimum 50 expectation set down in the National Minimum Standards for Older People. One resident returned a comment card to CSCI. This person wrote that, Staff are proactive as well as reactive. All the carers are lovely and pleasant and very helpful. Nothing is too much trouble for any of them. Five relatives returned comment cards to CSCI. Four were very satisfied with standard of care provided by staff and said that it was their opinion that there were always sufficient numbers of staff on duty. Additionally, one person wrote that, I would just like to say ... how caring the staff are. The staff are great - nothing is ever too much trouble for them. They are always cheerful, helpful and welcoming. Another person praised the Excellent staff. One relative wrote that they were dissatisfied with the carer, but had not made a complaint. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 25 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): Quality in this outcome area is good. This judgement has been made using available evidence, including visits to this service. The home is managed by a person who is properly qualified in care and management. Residents’ needs and preferences are the focus of the service that is delivered. The systems for managing residents’ personal funds are robust. Residents and staff are protected by the home’s policies and procedures, which ensure safe working practices. EVIDENCE: The Manager has now completed her NVQ level 4 training in both care and management, and received her award in January 2006. The Manager’s training in the past year has primarily focussed on the NVQ level 4, but she did attend a training course in relation to Dementia, and has recently completed a four day First Aid course. The Manager was able to demonstrate that she had day-to-day control of the home, for example, bringing in additional or agency Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 26 staff, arranging purchases for the benefit of residents, and making decisions about the best use of the premises. A number of areas were looked at to see how effective the homes quality monitoring and feedback process was. The different staff groups have regular meetings, and the minutes were available to show what was discussed. For example: a senior staff meeting was held in February 2006 that related to the security and management of residents finances; a cooks meeting in March 2006 discussed the management of cooked breakfast items, the timing of the lunch-time meal, residents requests in the afternoons, and the fact that dining tables were not being set properly and residents were having to ask for things. Residents meetings have been held in January, February, March (beginning and end), and May 2006. The minutes are highly detailed and record residents group and individual wishes. 12 residents attended the last meeting in May, and 4 staff from different areas of the home, for example, kitchen, domestics, attended to seek residents views. A local councillor also attended this meeting. There is an CLS annual satisfaction summary that is handed to all residents for them (and/or their supporters) to complete, and the home is assessed annually by an external and independent company (RDB) as to the quality of the service provided. A person from the CLS senior management team visits the home on a monthly, unannounced basis and makes a report on the service being provided. A copy of the report (known as a ‘Regulation 26’ report) is sent to CSCI for information. The reports give a good indication as to the progress that the home is making, and records where areas for improvement have been identified. The most recent report recorded action points relating to care plans, building maintenance, and staff supervision, training and development. The money kept on behalf of three residents was checked. Any money that was kept was properly recorded, and the balance was correct. Some residents do not have money kept for them at the home. The Manager said that relatives make sure they have enough for their needs, for example, for personal shopping or excursions. In the pre-inspection material, the Manager had confirmed the dates when equipment and services had been checked. A sample of certificate dates were checked during a tour of the premises (for example, fire equipment, hoists). The home employs good, safe working practices which staff are well-practised in using, for example, locking up cleaning products after use, and keeping walkways clear, so that the risks to the health and safety of residents and staff are minimised so far as possible. Accidents, injuries and incidents had been recorded and reported appropriately. This included making note of the event in the residents care plan and noting any additional care that was required. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 27 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 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 X 3 X 3 X X 3 Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 28 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 2 Standard OP7 OP7 Regulation 15 15 Requirement Care plans must be consistently and accurately maintained. Care plans must contain better information to show that all residents’ needs are identified, including emotional needs, and action planned to meet those needs. The administration of medication must be accurately recorded. Evidence must be available to show that all residents are encouraged to maintain skills, and are helped to follow chosen leisure activities. Evidence must be available to show that all residents have been helped to exercise choice and control over their lives. Timescale for action 31/07/06 31/07/06 3 4 OP9 OP12 13 12 31/07/06 31/07/06 5 OP14 12 31/07/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Greenacres Refer to Good Practice Recommendations DS0000005736.V294331.R01.S.doc Version 5.2 Page 29 1 2 3 4 5 Standard OP7 OP7 OP9 OP27 OP29 To demonstrate ‘person-centred care’, it would be better if records were written as if expressed by the resident. This includes reviews. It is good practice to audit care plans regularly in order to identify discrepancies, errors and omissions. It is good practice to check stocks and record totals when new medication is received. Additional staff should be brought on duty overnight if the dependency level of residents changes. At the time of any recruitment, consideration should be given to recruiting male carers in order that staffing reflects the make-up of the residents. Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenacres DS0000005736.V294331.R01.S.doc Version 5.2 Page 31 - 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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