Inspection on 22/02/06 for Greenacres

This inspection was carried out on 22nd February 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 15/06/06

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 Unannounced Inspection 22nd February 2006 08.20 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.V269891.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. Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 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 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.V269891.R01.S.doc Version 5.1 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. 17th August 2005 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. Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection took place over 5 hours on one day and was unannounced. One monitoring visit had been made to the home in-between the two inspections. The focus on this occasion was to look at those key standards that had not been inspected, so that all were covered over the two inspections. Part of the time was spent with the Manager and the Administrator, looking at the records that the home needs to keep to show it is being run properly. Part of the time was spent in conversation with two members of staff, six residents, and two prospective residents, and looking at the way that staff go about their work. What the service does well: What has improved since the last inspection? What they could do better: Three recommendations have been made within this report, which would improve the quality of the service for residents. It would be better if the notes of meetings could be produced quickly so that people could see what was said Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 6 and what decisions were made. Once the staff annual appraisal programme is complete, the Manager should re-introduce the staff supervision sessions as these make sure staff are still doing their work properly. To make sure residents’ needs are met through the night as well as through the day, consideration should be given to increasing the number of staff working on the night duty rota. 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.V269891.R01.S.doc Version 5.1 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.V269891.R01.S.doc Version 5.1 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 and 5 People do not move into Greenacres without first having had an assessment to determine their needs. This means that only people whose needs can be met by the home are admitted. Prospective residents are given opportunities to visit the home, and time to decide whether Greenacres will be suitable for them. EVIDENCE: At the last inspection, the standard of assessment prior to admission had not been consistently satisfactory. On this occasion, those files that were looked at showed that improvements had been made. A thorough assessment had been carried out, including for one person moving in on a temporary basis. Two residents were visiting from another CLS home that had announced its closure. They were treated very well by Greenacres staff, enjoyed a tour of the building, a look at their prospective bedrooms, and tea in the lounge where other Greenacres residents were present. Staff and residents passing by the lounge greeted the visitors. The residents’ families had already visited Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 9 Greenacres to determine suitability. Both residents said they felt they would be comfortable at the home. Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 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, and 9 The standard of care planning has improved and is now satisfactory. Residents can be assured that their needs will be identified and can be met by the home. This includes arranging access to specialist care as it is needed. The home has good systems for handling medication and staff have been trained. Residents can be certain, therefore, that their medication will be properly and safely managed. EVIDENCE: Care planning was much improved on that seen at the last inspection, with good evidence to show that a person’s individual needs and expectations are identified and acknowledged. Risk assessments were in place, some that were general to all residents, and some that were more relevant to an individual resident. Reviews had been carried out on a regular basis to show that changes had been identified, a written record made, and appropriate action taken. A good example of this related to one person who had a history of fall, which raised concerns for the person’s continuing personal safety and wellbeing. The resident had been referred to the Falls Clinic and supplied with hip protectors. Monitoring of the person’s general condition continues. Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 11 The majority of the records looked at were written in first person style: “I like to ...”, “I prefer to...” This is a good indication that staff had spent time with the resident when developing the care plan and writing up the paperwork. All the residents spoken to during this inspection said they were satisfied with the standard of care that they received. Two residents described at length what staff do for them to make sure their health and personal care needs are attended to. It was clear that their views and comments were taken into consideration. One person said he was “happy and well looked after”. The Inspector joined the Care Team Leader for part of the morning medication round. Medication is properly stored and kept in tidy, clean condition. The Care Team Leader paid attention to keeping medication locked up when she was away from the trolley. The administration process was thorough. The medication for each person was checked and double-checked, and the Care Team Leader stayed with each person until she was sure the medication had been taken. Records were then signed off to confirm administration. Medication is only administered by staff who have been properly trained. The GP makes an annual review of medication for each resident. The Pharmacist makes an annual visit to review practice. The Pharmacist provides additional information on medication as it becomes available, for example, the most recent being in relation to the absorption of Adcal. One resident said he liked staff at the home to manage his medication; it was something less for him to worry about. Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 12 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): EVIDENCE: This section was not assessed on this occasion. Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 13 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. Anyone raising a concern or making a complaint can be sure it will be dealt with and changes made, if appropriate. Staff are properly trained in the protection of vulnerable adults and put residents first. This means that residents live in an environment where they will be safe and protected from harm. EVIDENCE: There is a formal complaints procedure that is widely advertised. The home maintains a “Customer Feedback File” in which all complaints, concerns and compliments are recorded. Since October 2005, three complaints had been received. Two had been made on behalf of residents. One related to care issues that linked to choice and independence, and the other about the resident’s bedroom. Meetings had taken place to look at the issues and satisfactory outcomes had been arrived at, which had been recorded in writing. The third complaint had been made by a resident and related to housekeeping. Again, the Manager had looked into the issues that had been raised, made some changes, and provided a written response. She had also made a promise to consult more with residents. No complaints had been received at the CSCI that related to Greenacres. The home has a policy and procedure that relates to the protection of vulnerable adults, which had been re-issued by CLS in August 2005. Staff receive training in this topic during induction and periodically throughout their employment through supervision. Training courses and awareness raising Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 14 sessions are offered regularly, which all staff are expected to attend. Additional information is available to support the home’s policy and procedure, including the Wigan local authority’s own guidelines, and “Abuse Matters” from Action on Elder Abuse. A training package has been purchased from ADSS on the subject of Safeguarding Adults. The Manager said this package will be included in the new training programme. In conversation, those residents who expressed an opinion said that they felt that staff treated them very well and that they felt safe. Residents said they would not hesitate to raise their concerns. One member of staff expressed her views on what constituted good care and emphasised the resident’s right to be protected. Observation of working practice indicated that residents are treated respectfully and their safety maintained. Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 15 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): EVIDENCE: Not assessed on this occasion. Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 16 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, 28, 29, and 30. Generally there are sufficient staff on duty to meet the needs of residents, but consideration should be given to providing extra staff on the night rota. Staff are properly trained so that they are able to do the work they are employed to do. The recruitment process is good and only people who are suitable to work with elderly, vulnerable people are employed. EVIDENCE: The home has been maintaining a staffing level sufficient to care for a total number of 30 residents and taking into account their dependency levels. Additional staff have been employed, for example, if a resident has been unwell and needed individual care. One care worker said staff try to cover all the rotas themselves so there is less need to bring in agency workers. The care worker thought this was better for residents as they are cared for by people they know and are familiar with. At the time of this inspection, several residents were likely to be transferring from another CLS home that had announced its closure. The Manager had already begun to reassess the staffing that would be required for an increasing number of residents. Through the night, the home continues to employ two staff on duty and this rarely changes. A number of residents are active late into the evening and a few through the night. Staff do make drinks and snacks for residents through the night. The Manager is looking to improve staffing hours overnight and was preparing a feasibility study to discuss with CLS management. Given the activity and dependency level of residents, a recommendation is made for CLS to support this proposal. Some changes Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 17 have been made to the hours that are available and dedicated to activities, which means that organised and individual activities can be delivered more frequently and at different times of the day and evening. Alongside the National Vocational Qualification in Care at levels 2 and 3 or the National Vocational Qualification in Buildings and Cleaning level 1, staff have attended training in a range of subjects, including infection control, moving and handling, food safety, assured safe catering, fire prevention, and nutrition. One care worker is continuing with her computer training so she can develop her skills in administration. One Care Team Leader had attended a training course relating to dementia care. CLS is arranging training for its Managers in a range of subjects appropriate to the position, including managing change, leadership, conflict resolution, and handling stress. The plans for training for staff at Greenacres in life long living and foot awareness, etc. discussed at the last inspection, have not yet come to fruition and no names appear yet against these courses on the training schedule. Staff appraisals have been taking place, the outcomes from which will help to form the training programme for the coming year. Training courses for Care Team Leaders will be available relating to appraisals. A sample of personnel files was looked at, comprising three sets of records for long serving members of staff. There had been no new starters in the period since the last inspection. The records were found to be in order showing good recruitment practice and adherence to good employment practice. Disciplinary issues had been properly followed through, with evidence of the home arranging additional training and supervision to help a member of staff become more competent. One person had a high level of sickness absence that had been managed through an occupational health specialist. Staff are not allowed to commence employment at Greenacres until such time as satisfactory checks have been made with the Protection of Vulnerable Adults list and the Criminal Records Bureau, and two satisfactory references have been received. Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 18 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, 35, 36, and 38. There are different methods by which residents and their supporters, staff, and other interested parties can make their views known about the home. Evidence shows that action is taken, as appropriate. The home has systems to make sure residents’ financial interests are safeguarded. Staff are supervised but there needs to be a more consistent and regular approach. Residents and staff can be sure their health, safety and welfare will be promoted and protected. EVIDENCE: The home has a number of ways to identify whether or not it is providing a good service. There is an annual audit by an external organisation – RDB – who measures the quality of the service on behalf of the company. There are internal audits of the records, such as care plans, resident’s monies, accidents, etc. and audits by CLS to make sure the home is being run properly. There are regular meetings for staff and for residents and their supporters, and diarised entries were seen to confirm this. Up until recently, a written record Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 19 had been kept of these meetings but the file had not been kept up to date. The Administrator was unable to retrieve any notes of recent meetings from the computer. A recommendation is made for minutes of meetings to be produced quickly after the event and made available to interested people. The feedback file showed that people had taken the opportunity to express their views and concerns. Residents said they could express their opinions on a daily basis to a member of staff or the Manager, as well as more formally at meetings. The records relating to residents’ money were looked at and a sample was checked against individual funds. All were found to be in order. Personal money is kept on behalf of residents usually in small amounts for hairdressing, sweets, additional toiletries, etc. One or two residents look after their own financial affairs with help from family or social worker. The majority of residents have handed over the responsibility for financial matters to their families or other supporter. Care Team Leaders take responsibility for advising families when a resident’s funds are running low. The records looked at during this inspection showed that staff do not consistently receive regular supervision. Some members of staff had attended more formal supervision sessions than others. The Manager was aware of this shortfall and said that once the annual appraisals had been completed, she would re-start the supervision programme. It is recommended that this intention be followed through, and a written record be maintained in order to demonstrate that staff are properly supervised. The home has good systems that relate to health, safety and welfare of residents and staff. There is a health and safety policy with a set of procedures for dealing with different situations and activities. Staff are trained in safe working practices such as moving and handling, fire safety, first aid, food hygiene, and infection control, and attend regular update sessions. Staff were seen to working in ways that showed they had received proper training. A very good example of this was witnessed during this inspection when the fire alarm activated. This was not a test. Staff quickly took up their positions and set about reassuring residents. Residents were contained behind closed fire doors and were supervised by staff. The Fire Brigade visited but found nothing on fire or smouldering, and recorded a false alarm. The fire alarm engineer called to the home shortly afterwards and attended to the system. The whole episode was managed well and with the minimum of fuss. The records showed that systems used within the home are checked on a regular basis, serviced annually, and repaired as required. Risk assessments are in place that relate to safe working practices, for example, relating to the wet cleaning of floors. Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 20 Accidents, incidents and injuries are recorded and reported appropriately. A review of the records for January and February showed that a small number of residents have regular falls. Their care plans were checked. The care of the residents had been reassessed because of the falls and steps taken to reduce the risk or remove the problem. This included referral for specialist consultation. Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 21 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 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 X X X X X X X X 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 X X 3 X X 3 X 3 Greenacres DS0000005736.V269891.R01.S.doc Version 5.1 Page 22 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. Standard Regulation Requirement Timescale for action 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 2 3 Refer to Standard OP27 OP33 OP36 Good Practice Recommendations Consideration should be given to increasing the numbers of staff working overnight. Records of meetings should be written up quickly and made available to interested people. Staff supervision sessions should be re-introduced, carried out consistently and regularly, and a written record made. 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