Inspection on 03/10/06 for Greenacres

This inspection was carried out on 3rd October 2006.

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

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

Other inspections for this house

Greenacres 26/07/07

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 Unannounced Inspection 10:17 3 October 2006 rd 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.V295257.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.V295257.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 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.V295257.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 07/02/06 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. The design enables residents to access all areas of the home easily. There is car parking to the front and side of the home and a central courtyard provides a garden area for residents to sit in. Bedroom accommodation comprises of 40 single bedrooms and one double bedroom all with en-suite facilities. Communal space within the home consists is a lounge area, a dining room and a smoking area on a main corridor. The home is located in a residential are of the Wavertree district of Liverpool and is within easy access to bus routes, churches, shops and local amenities. Greenacres DS0000025108.V295257.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 a period of one day. The inspector arrived at the home at 10:17 and left at 18.10. The inspector spoke with 14 residents, 2 visitors, 3 relatives, 6 staff, the deputy manager and the manager. The inspector completed the inspection by a site visit to Greenacres, a review took place of many of the records available in Greenacres and CSCI offices. This site visit included the discussions with residents, relatives, visitors, staff and management. The inspector followed an inspection plan written before the start of the inspection to ensure that all areas identified in need of review where covered. All of the Key standards were covered in this inspection, these are detailed in the report. Feedback was given to the manager during and at the end of the inspection. The arrangements for equality and diversity were discussed during the visit and are detailed throughout this report. Particular emphasis was placed on the methods that the home used to determine individual needs, promote independence and support to make informed decisions in line with individual choices. What the service does well: What has improved since the last inspection? Some of the carpets in the home have been replaced and the table clothes in the dinning room have been replaced. Greenacres DS0000025108.V295257.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 DS0000025108.V295257.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 DS0000025108.V295257.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 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Greenacres. Residents do not move into the home until their needs have been assessed. EVIDENCE: A review of resident’s records detailed that that an assessment of residents individual care needs is carried out before they move into home. The assessment covers all the areas needed to help staff make a decision if they can meet the resident’s needs. 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. This can often mean meeting the residents and their families in hospital or in their own homes. One resident and relative spoken with remembered the manager visiting they said the manager was, “very kind and wanted to make sure that we knew everything about the home”. The home makes sure that they have other assessment information such as social services available to help plan each resident’s individual care. Greenacres DS0000025108.V295257.R01.S.doc Version 5.2 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7 8, 9, 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Greenacres. The management of medications and care is in need of improvement to make sure that staff are fully aware of the residents needs and are able to meet them. Residents are dealt with in a dignified manner. EVIDENCE: Four care plans were viewed. The plans look health and personal care needs and those viewed where up to date. The general detail was not specific and did not give detailed instructions to staff as to care for a resident. One resident explained that “agency or new staff very often didn’t understand” her needs. She preferred that more permanent staff dealt with her, as they are more aware. Staff spoken with said that they rarely read the care plans but do tell each other all information about the residents. Three residents spoken with during the site visit discussed their particular health-care requirements these aspects where briefly covered in their care plans. Two residents spoken with said that the staff were “very caring” and always try their best”. Greenacres DS0000025108.V295257.R01.S.doc Version 5.2 Page 10 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. One resident said, “it’s never made obvious you just get helped”. One relative said that the staff were “caring, ready to help and very pleasant”. During a tour of the building it was noted that the medication had been left out in the dining room. Some of this medication had been taken out of its box therefore it was not possible to identify who it belong to. This issue was addressed with the acting manager immediately who ensured the medication was then stored safely. The acting manager agreed to address this issue with the member of staff concerned. Medications were checked, the records for medications where not maintained in a consistent manner. Four medications where audited two of these showed these had accurate records and all medications could be accounted for. The other two medications were inaccurate and could not account for all the medications given. There storage space in the medicines area is insufficient and this has meant that medications to be returned and medications arriving in the home are not always maintained appropriately. The staff undertake a number of healthcare monitoring such as blood pressure and pulse. These are tasks for which the staff have had no training for and would not be in a position to determine any further action for. If these tasks are to be done a specific purpose this should involve individuals qualified to do so. District nurses, GP’s and other medical care is accessed by the staff when needed. Residents records detailed their choice of GP is maintained at that hospital appointments are attended. Greenacres DS0000025108.V295257.R01.S.doc Version 5.2 Page 11 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 14, 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Greenacres. Information in the home about menus, food, activities and daily routines is minimal. Residents are not kept up to date in the options that are available for them. EVIDENCE: An activity organiser is employed in the home for four hours per week and two of these hours are very well spent in making sure that one resident who is very isolated has a good social in put. However this means that the rest of residents have only 2 hours planned activities each work. This tends 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. Three relatives and visitors spoken with said “I am always welcomed”, “the staff make sure that I can visit as needed” and another said, “there are arrangements that help me take my mother out”. A number of residents confirmed they had their own routines with regard to social activities and were free to go about their day as they wished. Several of the residents said that these are changed in accordance with staff’s understanding of their choices and staffing levels. There are three residents who get up early every morning as they are considered to be “at risk” by the Greenacres DS0000025108.V295257.R01.S.doc Version 5.2 Page 12 staff. There is no records within the home that detail what residents choices are or how they would like their daily routine to be and as such it is not possible for the staff to be fully aware of the residents needs. Although staff said they “know” what the residents like, it is not possible for all staff to “know” all the residents personal choices. There are no menus available for the residents to read or a copy of any activities. As such there is no information for residents to help with their daily choices. Residents made mixed comments about the food all agreed that they found it “tasty”, “pleasant” and “enjoyable”. Some residents said that if they did not like the choice available alternatives where available. Other residents where unsure what choices there where. Choices are asked for in the evening and a member of staff goes around and asks the residents. However there were no recorded choices available at lunchtime. The menus do not reflect special diets such as diabetic diets soft diets or what arrangements could be in place for any other diets that may be needed Greenacres DS0000025108.V295257.R01.S.doc Version 5.2 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, 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Greenacres. Residents are aware of how to raise concerns and confidant that they will be addressed. Further information needs to be made available to staff in order that they can fully safe guard the residents. EVIDENCE: The residents spoken with during the site visit said they “have no worries”, “no cause for concern” and “staff are very nice here”. The manager stated that they log all concerns no matter how and a book is available for this. This is good practice, as it makes sure that all concerns can be looked at. A relative said that when a concern had been raised it had been addressed “promptly and satisfactorily” Staff have received training in protecting vulnerable adults. However discussion with the staff detailed that they were not able to determine what would happen if a concern of this nature was raised or of who took responsibility for investigating these concerns. A copy of Social Services policy on dealing with vulnerable adults was not available for staff to review. All of the service users spoken to during the inspection confirmed they were treated with respect and courtesy at all times and had never experienced anything other than kindness from the staff team. Greenacres DS0000025108.V295257.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19, 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Greenacres. Residents can make their bedrooms very personal, however the communal areas of the home or in need updating, making more homely and adapting to meet the needs of all the residents. EVIDENCE: There are two large lounges, a dinning area and a smoking area on a main corridor. The corridors of the home area dark and number of carpets have been replaced but a lot in the carpets in the corridors remain stained. In general Greenacres looks clinical, there are very few pictures available, all bedrooms are painted the same way and large areas of flooring are lino and not homely at all. The doors in the home are identical in appearance and there are very few clear “signposts” that would help residents wit visual or memory impairment to find there way around the home. Some of the residents have made their bedroom space very personal and said “ like my bedroom”, “it’s a comfortable place to be” and “I’ve got all my own things around me”. Greenacres DS0000025108.V295257.R01.S.doc Version 5.2 Page 15 In general the home was clean and tidy and systems were in place to prevent the spread of infection. However the main lounge had an offensive smell. This was commented on by staff, residents and visitors who all detailed that the smell had been there for a significant time. Appropriate laundry facilities are provided. The domestic and laundry staff confirmed they always had sufficient equipment and materials to carry out their work. Greenacres DS0000025108.V295257.R01.S.doc Version 5.2 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, 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to Greenacres. Staff are available in sufficient numbers to meet the care needs of the residents are appropriately checked before they start work in the home. However there are not enough staff to cater for residents social needs and training specific to the residents assessed needs is not readily available. EVIDENCE: Discussions with staff and residents detailed that in there opinion there was sufficient staff available. A duty rota showed that if staff were absent or sick they were replaced and where possible additional staff were made available for support for residents attending healthcare appointments. Two residents did said that they would like more activities available, staff said that they thought residents needed more activities but didn’t have the time. All staff files viewed showed that staff had received the appropriate checks before they started working in the home, this included Police Checks and references and that inductions into the home had been done for all staff. Staff training was on going and mandatory training was maintained but to date this included moving and handling, first aid and fire training as examples. However training specific to the needs of residents is not in place such as dementia care and diabetes. Greenacres DS0000025108.V295257.R01.S.doc Version 5.2 Page 17 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to Greenacres. The resident’s finances are well handled. The manager is aware of health and safety and promotes this amongst the staff and residents. There are no arrangements to determine the resident’s views and increase the quality in the home and risk assessments that maintain safety need to be updated or developed. EVIDENCE: The manager is registered with CSCI and residents, relatives and staff spoke highly of her. Comments included “is very approachable and kind” and 2 a very good manager” were made. The home manages the funds of only two residents. Their money is retained in a non-interest baring account, this is arrangement should be agreed with 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. Greenacres DS0000025108.V295257.R01.S.doc Version 5.2 Page 18 There is no evidence that a formal quality assurance scheme is in place that uses resident’s opinions to promote development. Residents and relatives say that meetings have not been held and there are no minutes available. There are no questionnaires available that illicit residents point of view. Monthly provider visit reports that reviews residents views where not available and copies had not been forwarded to CSCI. The homes certificates for gas, electricity and other maintenance areas where up to date. Maintenance records that checked fire alarms as examples where also up to date. Risk assessments for the home such as environment, fire risks and individual residents where either out of date or not available. This included items such as arrangements for the smoking area and risk assessments for residents who smoked as examples. Greenacres DS0000025108.V295257.R01.S.doc Version 5.2 Page 19 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 x HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 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 3 17 X 18 2 2 X X X X X X 2 STAFFING Standard No Score 27 3 28 3 29 3 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.V295257.R01.S.doc Version 5.2 Page 20 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 13 (2) Requirement The registered person must ensure service users medication is stored safely at all times. All medications must be given as prescribed. (Part of this is outstanding from the report of 01/12/05) The registered person must ensure all residents’ choices are determined and are used to influence the routines of the home including, menus, activities daily routines. (Part of this is outstanding from the report of 01/12/05) Timescale for action 03/12/06 2. OP15 16 (2) (m) 03/12/06 3. OP16 13 (6), 22 (2) 03/12/06 The registered person must ensure all staff is aware of the various agencies they can contact if they wish to make a complaint and how complaints including POVA will be dealt with. (Part of this is outstanding from the report of 01/12/05) The registered person must 03/12/06 ensure the carpets that are badly stained in the corridor areas and DS0000025108.V295257.R01.S.doc Version 5.2 Page 21 4. OP19 23 (2) (a) (b) (d) Greenacres 5. OP26 16 (2) (k) dayroom are replaced or effectively cleaned sufficiently to remove the evident staining. (Outstanding from the report of 01/12/05). The registered person must address the offensive smells in the home particularly those in the dayroom. (Outstanding from the report of 01/12/05) 03/12/06 6. OP30 18 (1) (a) 7. OP33 8. OP38 The registered person must make sure that staff receives training to meet the residents assessed needs. Staff must not undertake tasks for which they have not received training. 24 (1) (a) The registered person must (b) (2) (3) review the arrangements for developing quality and put into place a quality assurance system that asks and acts on the resident’s point of view. 13 (4) (a) Risk assessments for the (b) (c) building, individual activities and individual residents must be put into place and updated where necessary. 03/02/07 03/02/07 03/01/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP7 Good Practice Recommendations Care plans should be sufficiently detailed to make sure that staff are able to provide consistent care, support and meet their social needs. Staff should be encouraged to access residents care plans on a regular basis. Audits should be done on a regular basis on areas of the home of importance such as medications, care plans, environment and staff training records. DS0000025108.V295257.R01.S.doc Version 5.2 Page 22 2. OP9 Greenacres 3. 4. OP15 OP12 5. OP19 Menus should reflect all choices including special diets these should be accessible by the residents and in formats suitable to their needs. Information on activities should be available for all residents and arrangements in place to increase the activities for residents less able to join in the two hours organised activities available Consideration should be made to make the building less institutional and review the usage of lino flooring. The diverse needs of the residents should be taken into account in decorating the communal areas. Greenacres DS0000025108.V295257.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Knowsley Local Office 2nd Floor, South Wing Burlington House Crosby Road North Liverpool L22 0LG 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 DS0000025108.V295257.R01.S.doc Version 5.2 Page 24 - 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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