Inspection on 26/07/07 for Greenacres

This inspection was carried out on 26th July 2007.

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

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

Other inspections for this house

Greenacres 03/10/06

Greenacres 12/12/05

Greenacres 11/07/05

Greenacres 15/12/04

Greenacres 02/07/04

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

CARE HOMES FOR OLDER PEOPLE Greenacres Pighue Lane Wavertree Liverpool Merseyside L13 1DG Lead Inspector Mrs Julie Garrity Key Unannounced Inspection 26th July 2007 10:12 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 DS0000025108.V346767.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 DS0000025108.V346767.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenacres Address Pighue Lane Wavertree Liverpool Merseyside L13 1DG 0151 259 7899 0151 2592802 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) Mr Ilam Chaudhry Miss Lynn Williams Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 3rd October 2006 Brief Description of the Service: Greenacres is a residential care home providing 24-hour personal care and accommodation for 42 older people. The home is a purpose built single storey building, which was opened in 1996. There are two lounges, a seating areas and a dining room. Bedroom accommodation is 40 single bedrooms and one double bedroom all with en-suite facilities. There is also a central courtyard area that provides outdoor space for residents. Parking is available to the front and the side of the building. The home is next to a nursing home that is also owned by Mr Chauhdry. The manager Lynn Williams has worked in the home for nearly two years and is registered with CSCI. The home is located in a residential neighbourhood of the Wavertree area of Liverpool. It is within easy access to bus routes and train stations, which are approximately 5 - 10 minutes walk away, churches, shops and local amenities in the Edge Hill and Old Swan shopping centres. The city of Liverpool is approximately 20 minutes away by car. There are also major motorway links within 10 minutes drive. Fees for accommodation vary depending on the assessed needs of the residents but are in line with those paid by Liverpool Social Services. Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was carried out over one day site visit starting at 10:12 and finishing at 18:43. The inspector spoke with a total of 14 residents, 6 staff, 2 relatives, the administrator, two senior care staff, the deputy manager (via the phone the following day) and the homeowner. The inspectors reviewed the records available in the home, sent to the commission by the manager and the commission’s offices. These included care plans, accident records, medication records, staff rotas, staffing files, maintenance records, menus, activities programme, audits in the home, staff training and information given to residents. Observations of staff interactions with the residents took place over the day and lasted for just under an hour, in particular over mealtimes. The inspector followed an inspection plan written before the start of the inspection to make sure that all areas identified as in need of review were covered. All of the Key standards were covered in this inspection, these are detailed in the report. Feedback was given to the senior carer, the deputy manager and the homeowner during, at the end of the inspection and over the phone the following day. Feedback covered all the areas detailed in this report, the senior carer took notes to give to the deputy manager and the manger on her return from her holidays. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the ways that the home used to determine individual needs, promote independence and support to residents to make informed decisions in line with their individual choices. What the service does well: Pre admission assessments are carried out so that staff can determine if they can meet the specific needs of residents. Care plans for each individual resident were in place, all had been reviewed and updated recently. There was a homely, relaxed and welcoming atmosphere during this visit and all residents spoken to in the home spoke highly of the staff and management support. Comments such as, Staff do try hard to keep us happy. I like living here”, they are really nice staff. Helpful and caring, cant ask for more and “it’s a comfortable place to be” were made. Residents spoken with said that they could approach staff with any concerns and that they would be listened to. All feedback from people living in the home Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 6 indicated that staff treated them well, and that they listened and responded appropriately. Residents are supported to develop and maintain contact with family and friends and too keep in touch with them. Relatives spoken with were confident that their relative was well cared for and they were able to visit at any time. The home is all on one level and supports residents to get to their own rooms independently. All the bedrooms have ensuite facilities, which suits the needs of residents who prefer to spend their time in their own rooms. There are two lounges, a dining room and a seating area that provides residents with a variety of different areas in which to spend their time. The arrangements for the evening meal for the residents is particularly good as they are offered a wide variety of choices and they enjoy this meal a great deal. What has improved since the last inspection? What they could do better: Communication systems in the home are in need of development staff frequently rely on their own memories and what another care staff tells them about the care of a resident. This runs the risk of staff confusing information and getting it wrong and the knowledge that a staff member has about residents being lost if they are on leave, sick or cease working in the home. Although care plans and medications have improved there are still areas in need of further development, this includes better and clearer instructions to staff both in the care plans and on medication records. This would support staff to provide care and support in a consistent way and in line with the residents wishes. Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 7 The residents do not influence the routines in the home, including activities, mealtimes and menus. Information to residents is not always available and where information is available it is not always available in a form that meets the residents needs. Staff recruitment and training is in need of development it is not always possible to determine that staff have had the correct training, records for staff recruitment show that some staff did not receive the correct checks before they started working in the home. This actions does not safeguard the residents and does not promote the development of a skilled staff team. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 were reviewed. Standard 6 is not applicable to the home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. All residents are assessed before they move and gives the staff the opportunity to decide is they can meet the individuals needs. However arrangements for residents wanting to move into the home are not sufficent to support the residents to make an informed choice and determine if the home is where they would like to live. EVIDENCE: The home is meant to provide a document know as a service users guide, this provides information to the residents on the services that are to be provided. A copy of this was not available in the home at all. A resident s spoken with said, No, Ive not seen anything that tells me about the home. Nobody gave my any information, I just moved in was shown to this room, but I like it. A relative said, We saw so many people before mum moved in so I’m not sure who came to see us. We did not have anything sent or given to us about the Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 10 home. I came to look around and thought its clean and tidy and near to where I work.” Another document know as the statement of purpose which should explain what the homes services are such as the specific needs that the home can support for and health and safety arrangements was out of date, inaccurate and did not give full information. Residents spoken to said, I came from my own house but I didnt come and look around, my daughter did, she liked it. I didnt know I could come and look round, it doesnt matter anyway Im happy here A review of resident’s records showed that an assessment of residents individual care needs is done before they move into home. Doing an assessment before someone moves makes sure the staff team are able to plan the care they need to deliver in order meet the residents needs. The home makes sure that they have other assessment information such as social services available to help plan each resident’s care. Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There have been improvements in the management of medications, however a number of areas that will further reduce errors and protect the residents remain in need of improvement. Written instructions to staff has also improved but is not always individual to the residents and in some cases do not cover all the residents’ needs. The lack of a clear way to communicate to staff how to support the residents appropriately will prevent staff from being aware of and able to meet the residents individual needs at all times. EVIDENCE: Four care plans were viewed. The plans looked at health and personal care needs and those viewed were up to date. The details in these have improved since the last inspection. In all cases there was examples of good individual details such as “likes tea with two sugars”. However this level of detail was not available in other plans, some essential information was missing in three care plans viewed, this included an assessment that said the resident was at high Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 12 risk for developing pressure ulcers but there was no plan for this, a resident that was receiving input from district nurses for wound care, but there was no details of this in the care plan. Several of the care plans viewed were identical from one resident to another. Staff spoken with said that they rarely read the care plans but do tell each other all information about the residents. There was no evidence that residents had been involved in writing and been given an opportunity to agree with the care that was being provided. Residents spoken with said,Not seen a care plan for me., Do they keep records, no Ive no idea whats in them. and Not been asked if Im happy with the care or if I want anything changed. But thats okay. Like I said they are great here, Im comortable and think the staff are lovely. A relative spoken with said, No Ive not seen my mums care plan. I would like to see as there are lots I know about her that they might not know. But they are good so I imagine its fairly accurate All of the residents spoken to during the inspection confirmed the staff treated them with respect and dignity at all times and particularly when carrying out personal care. Medications were checked the management of this has improved. All staff that give out medications have received training and audits are being done on a monthly basis, however these audits do not look at relevant areas such as are the instructions to staff clear as an example. Without looking at the quality of the management of medications improvements may not happen as strengths and areas to develop will not be identified. The records for medications were not maintained in a consistent manner. This included unclear instructions to staff as to the amount and when to give the medications for several medications. This had resulted in the staff not always giving out medications at the right time and in accordance to the prescription. All medications were logged into the home properly and this leaves a clear audit trail that helps the home check that medications are being given correctly. Most of the medications checked had been given out correctly with the exception of three, an antibiotic for one resident, a liquid medication that needed to be accurately measured and a medication were staff had taken the medications from the wrong box effectively giving one residents medications to another. Fortunately is was an identical medication with exactly the same strength and amount to be given. However this is practice that does not safeguard residents as many medications can be in different doses and staff run the risk of giving the medication out to the residents incorrectly. A policy and procedure was available in the home. This has not been updated for some time and does not reflect the actual practice in the home. Staff need a clear policy in order that they can give out medications safely at all times. Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 13 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff do not have enough information that informs them of residents personal preferences and choices. This means that staff rely on verbal discussions and run the risk of not being aware of residents personal preferences EVIDENCE: An activity organiser is employed in the home for eight hours per week, however the activities co-ordinator was on leave at this site visit and no regular activities were being provided in her absence. Good practice was occurring for special events and the day after the site visit a party for a birthday had been planned. Activities tend to consist of bingo and quizzes, which the same residents join in. Some of the residents have memory issues and confusion at times there are no activities in place that meet those needs. There are no records in place that determine what each resident’s choice, preferences and need for activities, daily routines or feed preferences are. Residents spoken with said, . We go out rarely, sit in the courtyard a bit on Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 14 occasions but its not that nice. We have occasional entertainment, but I do get bored, theres the telly and not a lot else. Staff are aware of the need to support and look after residents they perceive this as to do the majority task for them, such as managing all their medications, this does not support the residents to be independent or maintain their sense of purpose. One resident wanted to keep her own inhalers. Staff had said she couldn’t, as she wasnt able to take it properly the resident said I get breathless I like to know I have my inhalers, I cant always wait for the staff. A number of residents confirmed they had their own routines with regard to daily activities and were free to go about their day as they wished. However staff have no written records for residents personal preferences for daily routines such as time they like to get up, what they like to do with day etc. They rely entirely on memory and the knowledge that each member of staff has about each resident. Relying on staff’s memory runs the risk of getting residents preferences wrong and of losing that knowledge about the resident if the staff member leaves. An example of this includes residents cigarettes being limited without explanation, some staff thought that it was due to health reasons or financial limits but had not gained agreement from the residents or detailed how this was to be managed. There are menus displayed in the dining room, each day is written down, however 4 weekly printed menus were totally different to the food provided. The cook explained that he decides the menus daily based on what he knows about the residents. This is not good practice as it does not keep residents informed of their choices. Observations over the lunch showed that all but one resident was served exactly the same meal all on small side plates, with the exception of two residents who needed help to eat, their meals were provided to then in small bowls. In the evening time there was plenty of choice with about eight different meals served. However this did not occur at lunchtime, breakfast and suppertime. There was also no up to date menus that included specialist diets such as diabetic diets. Several of the residents can read the chalkboards that have information on about the day’s main meal and evening meal. Four could not read it the writing is too small, bit scruffy, they dont always remember to write it up. Residents in their bedrooms did not have a menu to review, also those who eat in the lounge area. Comments from residents also included No idea what’s for lunch, but do get asked what we want for tea. Others said, Loads of choice in the evening, none at lunch time, its usually tasty. Yes I would like my dinner on a bigger plate. Little plates are for children. Im not that hungry at lunch time as Ive usually not long had my breakfast. I would prefer the big meal at tea time. I would like the evening meal a little later. Staff give us a supper but its usually toast, I prefer a later meal and a bigger supper.” The food is tasty. I enjoy what we have. It’s well cooked, the cook is a nice man. He tries very hard. Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 15 Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents do not have all the information they need to raise concerns, however they believe that they will be listened too. Staff in the home do not always identify that a concern has been raised and as such do not inform the manager to support her to address concerns or complaints raised. They do have a good understanding of how to safeguard residents. There have been several concerns raised in questionnaires that have not been dealt with. EVIDENCE: Staff have received training in protecting vulnerable adults and were aware of how serious concerns of this nature would be dealt with. A policy regarding how to raise concerns is available in the office, however staff spoken with had not read this. Social services are responsible for dealing with all major concerns that are in relations to abuse or potential abuse. No complaints of this nature have been made against Greenacres. However the policy that is in place from Social services that all care homes must follow is out of date. Staff will not be able to raise concerns appropriately and vital concerns may be missed should they arise. Information to the resident on how to raise concerns is not available, discussions with staff also showed that they did not pass on concerns to the manager unless it was in writing from a relative or a resident, they do not see Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 17 their own concerns as something that needs reporting to the manager. A complaints procedure is available but is out of date and unread by staff. They have no clear instructions on how to raise any concerns. Without a clear understanding of who is responsible for addressing concerns in the home all concerns whether serious or minor run the risk of not being dealt with. Residents spoken with said, There are problems at times but the staff fix it. Laundry is a big problem, often get the wrong clothes. The staff are really kind, they try to make things right and Its lovely here, nothing to complain about. They are really nice staff, bright, happy to help and so kind. CSCI has not received any complaints regarding the service they provide from Greenacres. A review of the records in the home showed that there were no records of any complaints. However recently questionnaires have been sent to relatives and residents, the replies for this showed three concerns regarding the laundry service and missing clothes or incorrect clothes in residents bedrooms. There were also two concerns regarding the courtyard area. There is no evidence that these have been looked at and steps taken to address them. Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 20, 21, 22, 23, 24, and 26 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There has been some investment in making Greenacres a more homely environment. This has improved the main lounge and the corridors. Residents are supported to bring in familiar items and to make their bedrooms their own. Areas of the home need reviewing in order to make sure that they fully support the diverse needs of the residents living there and can support them to be independent. EVIDENCE: There are two large lounges, a dining area and a seating area on a main corridor. The corridors of the home are dark, several of the ceiling lights were not working and had not been fixed although staff have written this down for the handyman to address. The carpets in the main corridors and the largest Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 19 lounge have been replaced, this has eliminated the offensive smells that were noted at the last inspection. The home used to have a smoking area but in light of the changes in smoking in public places this has ceased to exist. All residents are instructed to smoke in the courtyard area, which does not provide any shelter, the home does not provide arrangements that meet the residents preferences and needs. In general Greenacres looks clinical, there are very few pictures available, although these have been increased. Additionally there is a notice board that provides some information but this is in the main entrance of the home and not in an area frequented by the residents. All of the corridors, bedroom doors and bathroom doors are identical there are no “signposts” that would help residents with visual or memory impairment to find their way around. The homes own information says that it accepts residents with “confusion and dementia”, but has not adapted its environment in order to support them to be more independent. Some of the residents have made their bedroom space very personal and one resident said, My bedroom is very nice. In general the home was clean and tidy and systems were in place to prevent the spread of infection, such as gel at the front door that all visitors were asked to used. However over lunch a member of staff was supporting a resident to eat, then went to assist residents from the bathroom and returned to assist the resident to eat, the apron they were wearing was not replaced during these activities and presented a risk of the spread of infection. Appropriate laundry facilities are provided, however a number of concerns have been raised regarding this service that has not been addressed. Residents spoken with said, I dont like the big lounge its too noisey and I cant see the televison in there. The toilet is near the lounge, but lots want to use it, I have one in my own room but thats a long way away and The lounge is nicer Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standard 27, 28, 29 and 30 were reviewed. Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staff are not all appropriately checked before they start working, this practice does not safeguard the residents. Staff training is not sufficiently monitored in order to determine that they have the skills needed to appropriately meet the resident’s individual needs. EVIDENCE: Discussions with staff and residents detailed that in their opinion there was sufficient staff available although certain times could be very busy. A duty rota showed that when staff were absent or sick they were replaced and were possible additional staff were made available for support to the residents attending healthcare appointments. During the site visit the manager was on leave the activities co-ordinator was on leave and for three days there was no laundry support. The home had not provided extra staff to accommodate the additional laundry, management and activities placed on the care staff. Subsequently services such, as activities had not been put in place. In the event of staff who provide essential services not being available it is not good practice that these activities become the responsibility of care staff additional to their caring role. A resident said, Sometimes have to wait but not for long. Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 21 Staff files were viewed, of the six staff files viewed only one had all the appropriate checks in place. Two staff had no references and no police check, the home had an old police check from another employer, but this is not allowed as all new staff must have a police check for their place of work. One police check had an offence detailed that the home had not risk assessed to determine if the member of staff could work in the home, additionally the member of staff had worked in the home for several months before they received the police check. It is not good practice to allow staff to work in the home without a police check, in exceptional circumstances this can occur but the member of staff cannot work on their own and must be supervised until the police check is in place. There was no evidence that this had occurred for staff starting work without a police check. Staff training records were viewed, each member of staff had a record of the training that they had undergone. However this was not updated and a number of staff appeared to have received very little training based on these records. There was also no plan as to what training staff needed to have in the future. Staff spoken with said that they had received half a days training in dementia, all spoken with said that they would like more training in this area. Staff observed during the day struggled to communicate effectively with residents less able to communicate and to support resident to eat appropriately over lunchtime. Additional training in this area would be of benefit to the residents. Residents spoken with said, they are really nice staff. Helpful and caring, cant ask for more. They all do it differently. Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Staff and residents feel that they are supported by the manager and the management team in the home. The home has started to audit and check on areas of practice, this has helped increase the quality in some araes. However the arrangements for increasing the quality of the service in line with the residents views need to be increased. Health and safety in the home is need of reviewing in order that risks can be identified and minimised. EVIDENCE: Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 23 The manager is registered with CSCI and residents, relatives and staff spoke highly of her. Comments included, staff are great, senior carers are really approachable both the deputy and manager are great. I can always go see the manager shell listen and I like living here. The manager is lovely, welcoming and kind. Staff spoken with made the following comments, “We can raise our concerns anytime we want. Its easy to discuss any issues”. “Shes a great manager” and “The Deputy and the manager are very supportive”. The home manages the funds of very few residents. Their money is retained in a non-interest account, however this information is not available to the residents. Records for resident’s finances were clear with receipts kept for all the money that the residents spent and records of funds received. These arrangements safeguard the resident’s funds. The manager has started a quality assurance system to determine resident’s views so far there are five questionnaires from residents available, the handwriting is identical, on all. Where possible residents should have the assistance of their relatives or complete questionnaires independently. Questionnaires from relatives had also been returned, as yet none of this information has been used to plan how to increase quality in the home. The deputy manager has started to audit areas in the home such as medicines, care plans and falls, this is good practice and will assist in the promotion of a quality service. There are no minutes of residents meetings and the last staff meetings minutes are for last year. As such neither staff nor resident’s views were being used to influence the running of the home. Monthly visits from the homeowner or his representative that reviews residents views were not available this is an essential opportunity to determine the quality of the service provided that is being missed. The homes certificates for gas, electricity and other maintenance areas were up to date. Maintenance records that checked fire alarms as examples were also up to date, however there are no records that the emergency call systems have been checked monthly and no maintenance plan that informs residents of when redecoration will be happening. However portable appliance tests to determine the safety of items such as vacuum cleaners, televisions as examples could not be located. Risk assessments for the home such as environment, fire risks and individual residents were either out of date or not available. This included items such as arrangements for residents who smoked, bedrails and residents who have had a number of falls as examples. Staff need to identify and address any potential risk in order to minimise the potential risk. These need to provide clear instructions to staff and be agreed by the residents involved in order that they can understand any restrictions in place. Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 24 Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 2 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 2 2 2 3 3 x 3 STAFFING Standard No Score 27 2 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 2 x 3 x x 2 Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIRE9MENTS 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 OP1 Regulation 4 (1) (c) Requirement A copy of the statement of purpose needs to be in place that reflects the service provided it needs to fully explain all the areas detailed in schedule one of the care homes regulations 2001 A summary of the above needs made readily available to all residents as part of the service users guide with a copy available for residents in a format to suit their needs. All medications need to have clear instructions available to the staff to make sure that they can give them out correctly. Staff must maker sure that they are giving the medications to the resident whose name is on the medication box and not use one residents medications for another. The policy and procedure needs to be updated to include all aspects of medications management from ordering to auditing and shared with the staff in the home responsible for giving out medications. DS0000025108.V346767.R01.S.doc Timescale for action 26/09/07 2. OP9 13 (2) 26/08/07 Greenacres Version 5.2 Page 27 3. OP14 4 4. OP16 5. OP29 6. OP27 Residents individual personal preferences and choices need to be determined and recorded so all staff can be aware of what residents choices are. Their opinions need to be used to influence individual daily activities and the running of the home. In such areas as mealtimes, menus and activities in the home as examples, 22 (1) (2) All complaints and concerns need (3) (4) to be investigated and action (5) (6) taken to resolve any issues. Staff (7) (8) need to pass on all information even if it is not in writing to the manager so that she can address any concerns raised. The policy and procedure in the home needs to be updated and staff given relevant information from this as to how to raise concerns and what action will be taken by the manager to resolve any complaints. 19 (1) (a) All staffing files need to be (b) (i) (ii) reviewed to make sure that all (iii) (c) staff have been checked before (2) (3) they start work. This includes (5) (a) (b) two relevant references, (c) (d) (i) preferably one that is from the (ii) (iii) previous employer and verified as genuine. A CRB and POVA in place prior to starting working. As CRB’s are not transferable the home must undertake its own. In exceptional circumstances staff can be commenced with a POVA, references and constant supervision before a CRB is obtained. Where gaps have been located a plan needs to be developed with timescales that details how the home will bring all staffing files up to date. 18 (1) (c) All staff training needs to be (i) (ii) reviewed and updated to determine if staff training is up DS0000025108.V346767.R01.S.doc 16 (2) (i) (m) (n) 26/10/07 26/08/07 12/09/07 26/09/07 Greenacres Version 5.2 Page 28 7. OP33 to date and supports the staff to develop the skills necessary to care for the residents in the home and meet the criteria outlined in the homes statement of purpose. A training plan needs to be developed with time scales that will make sure that training is available and appropriate. 24 (1) (a) The homeowner or his (b) (2) (3) representative needs to undertake a monthly visit to the home and determine the quality including the opinion of the residents. A written report needs to be given to the manager and used to influence the quality of the service that the home is to provide. Outstanding from 03/02/07. 26/08/07 8. OP38 13 (4) (a) (b) (c) Risk assessments for the building, individual activities and individual residents need to be in place and updated regularly. These need to inform staff how to reduce any risks to residents, visitors and themselves. Risk assessments need to be updated and reviewed in order that they are always up to date and accurately reflect the actions need to be taken. Outstanding from 03/01/07. 12/09/07 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 DS0000025108.V346767.R01.S.doc Version 5.2 Page 29 1. Standard OP7 Care plans would be more use if they included detailed information that described exactly how staff were to meet the individual needs of the residents. Consideration needs to be made for maintaining all medications at the same level of security. The temperature of the medicines room needs to be reduced, the air conditioning in the room needs to repaired to maintain medicines at the correct temperatures. Items other than controlled drugs need to be removed from the controlled drugs cupboard. Staff need to check that the instructions written down are accurate and are identical to that written on the medication box. Staff need to become familiar with the side effects of medications, patient information leaflets are provided with all medications are a useful source of information. Where medication records say “as per prescriber’s instructions” and does not specify precisely the dose to be given including external preparations and thick and easy. These instructions must be checked with the relevant professionals to obtain full and clear instructions. Menus should reflect all choices including special diets these should be accessible by the residents and in formats suitable to their needs. Where the home decides to monitor Residents Body Mass Index (BMI) a determination of the residents height is needed as it is not possible to determine a BMI on weight only. Consideration should be made to make the building less institutional and review the use of lino flooring. The diverse needs of the residents should be taken into account in decorating the communal areas. The needs of residents who cannot easily identify their own bedroom or a bathroom needs to influence the decoration in the home. A review of the needs of the residents needs to be done and staff made available to support those needs at all times including staff leave and sickness. All policies and procedures in the home need to be reviewed up dated and made available to staff as part of their training. Staff meetings and residents meetings need to be available with minutes kept and distributed. Comments from these need to be used to influence the running of the home. Residents need to be supported to complete their questionnaires as independently as possibly DS0000025108.V346767.R01.S.doc Version 5.2 Page 30 2. OP9 3. OP15 4. OP19 5. OP27 6. OP33 Greenacres a wider range of opinions needs to be sought and a plan as to how the home intends to improve the quality of its service developed. Greenacres DS0000025108.V346767.R01.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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