Inspection on 14/11/06 for Greenacres Cheshire Home

This inspection was carried out on 14th November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 Cheshire Home 21/05/09

Greenacres Cheshire Home 28/06/07

Greenacres Cheshire Home 15/06/06

Greenacres Cheshire Home 23/01/06

Greenacres Cheshire Home 21/06/05

Greenacres Cheshire Home 25/11/04

Greenacres Cheshire Home 10/06/04

Greenacres Cheshire Home 13/01/04

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

CARE HOME ADULTS 18-65 Greenacres Cheshire Home 39 Vesey Road Sutton Coldfield West Midlands B73 5NR Lead Inspector Donna Ahern Key Unannounced Inspection 14th November 2006 10:05 Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 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 Cheshire Home DS0000024843.V316163.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 Adults 18-65. 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 Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenacres Cheshire Home Address 39 Vesey Road Sutton Coldfield West Midlands B73 5NR 0121 354 7753 0121 354 6065 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.leonard-cheshire.org.uk Leonard Cheshire Stephen Plant (waiting registration with CSCI) Care Home 32 Category(ies) of Physical disability (32) registration, with number of places Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. Residents must be aged under 65 years 15 beds must be nursing 17 beds must be residential care Date of last inspection 15th June 2006 Brief Description of the Service: The home is registered to provide care and accommodation to 32 adults who have a physical disability. A range of specialist equipment is available to support people’s needs. Greenacres is located in a quiet residential area, close to the centre of Sutton Coldfield. There is a range of shopping and leisure facilities nearby, and public transport links to the home by bus and rail are good. There are plans in place to reprovide the service in a new build home so that it meets the needs of its client group. The home has a bar, a large dining area, kitchen and physiotherapy facilities. Residents all have their own bedroom. There is a bungalow linked by a walkway to the main building, which accommodates four residents and is a more domestic style environment. The home has a pleasant courtyard garden. To the front of the home there is a parking area for several cars. The fee level for the home is £584-£1556 per week. The CSCI inspection report is shared with residents in their meetings. Some residents obtain their own copy of the inspection report directly from CSCI. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork visit was unannounced involved two inspectors and took place over one long day lasting eleven hours. This was the homes second key inspection for the inspection year 2006-2007. A unannounced Random inspection took place on 12th September 2006.The reason for this visit was to monitor progress on the previous requirements made at the key inspection on the 16th June 2006 in respect of the care planning and monitoring of residents needs at night. The outcome of this visit is referred to in this report. During the fieldwork the inspectors met at least twelve residents, observed the opportunities and support provided to people, looked at the premises, and read records about care, staffing, and health and safety. Time was spent with the manager, senior nurse, and discussions took place with four staff. The home is required to report incidents, accidents and other events that occur in the home to CSCI. These are called regulation 37 notifications. All information reported via a regulation 37 notifications since the last inspection was analysed prior to the fieldwork visit. A number of surveys and questionnaires were forwarded to the home to be given to residents and relatives for their comments. Eleven were returned to the inspector. Many made positive comments about the home and the permanent staff. However, a number raised concern about the high use of agency staff, staffing levels and security issues in the home. People’s comments are included in the main body of the report. What the service does well: The organisation has plans in place to reprovide the service and is exploring possible ways forward to do this which will meet residents needs best. Greenacres has its own Physiotherapist who provides a full programme of support for people’s mobility needs. This is a valuable and essential service in a home accommodating people with a physical disability. This ensures people manual handling and mobility needs are met. Regular residents meetings talk place so residents can meet to talk about dayto-day issues in the home. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Significant development of the home is required so that the home can evidence that resident’s needs are being met. Care plans and risk assessments required further development. The shortfalls are of concern and have the potential to cause inconsistencies in the care and support given to residents. Monitoring and observations systems must be in place so that staff are able to evidence that they have followed the persons care plan and that residents have received the support and care they require to meet their needs. Risk assessments must be developed so the format used is clear and relevant and details how risks should be managed so that residents well being is promoted and protected. Activities within the home and community must be developed so that all residents have the chance to take part in leisure and social activities that meets their assessed needs. Support provided to the people who live in the “bungalow” linked to the main part of the home must be looked at. The manager must ensure that people are receiving adequate support that meets their assessed needs and allows people where possible to maintain and develop their independence. People must be weighed as in accordance with their care plan. The monitoring of peoples weight is important for the early detection of other health problems or complications. Care plans had not been implemented for specific health care needs such as diabetes and sight loss. A care plan must be implemented so that these specific needs can be planned for and met. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 7 People must receive the right support at meal times, guidelines must be followed and the required equipment must be available at all times so that people can be assisted safely. The home has a lot of vacant care hours. Residents, relatives and staff are all concerned about the impact of a high use of agency staff on the home. The provider must make sure that there is an effective staff team and that there is enough staff on duty day, night and weekends to meet residents needs. The manager must look at security issues and make sure that people feel safe and that residents returning to the home or visitors can gain safe access to Greenacres. Accident and Incident monitoring must be improved to minimise the reoccurrence of such events and to safeguard residents. Other relent organisations such as Social care and Health must be informed of relevant incidents as they are the lead agency on any protection matters. 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 Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The pre assessment process requires some further development so that the manager can evidence that residents needs have been assessed in full prior to admission and the resident is reassured that these will be met. Information about the home must be developed so that it is available in suitable formats for the people who live or may choose to live at Greenacres. EVIDENCE: Greenacres provides care to a diverse range of residents in terms of age, ethnicity and care needs. The home is registered to provide nursing care. At the time of the inspection there was thirty-two residents. Two of the bedrooms are used for respite. Fifteen of the residents were receiving nursing care. Many of the residents have lived at the home for a number of years. The current age range of residents is from people in there thirties through to people in their seventies. Some of the residents have very complex nursing and health needs. The manager was in the process of applying for a variation to the home registration so that they can continue to accommodate residents over the age of 65years. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 10 The previous key inspection highlighted shortfalls in the preassessment document. It identified that the document did not include a section on personal hygiene so this information was omitted from the document. This information is essential to have prior to admission, so that staff can assess and meet resident’s personal care needs and has now been added to the document. The previous report highlighted that the admission policy (dated 24 June 2002) was under review. This document had been revised and now meets the required standard. The Statement of Purpose and The Service User Guide which contain information about the aims of the home, the facilities and what will be provided to residents required updating, so that perspective residents can make an informed choice about living at the home. The provider should explore how information could be made available in different formats suitable for the people who live or may choose to live at the home. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 11 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is adequate. 6, 7, and 9 This judgement has been made using available evidence including a visit to this service. Care plans and risk assessments required further development. The shortfalls are of concern and have the potential to cause inconsistencies in the care and support given to residents. EVIDENCE: Previous inspection reports have raised concerns about the shortfalls in residents care plans and the potential for such shortfalls to cause inconsistencies in the care and support given to residents. A random inspection took place on 12th September 2006. The reason for this visit was to monitor progress on the previous requirements made at the key inspection on the 16th June 2006 in respect of the care planning and monitoring of residents needs at night. The findings of the Random inspection was that many entries in the daily records were not signed and many had no time recorded of when the entry was made. There are no systems in place for the recording of when turns or observations had been done for residents with specific health and medical needs. The nighttime care plans for two residents had not been completed. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 12 Where care plans and risk assessments had been implemented further development was required so that the support given and how and when checks are done are made explicit. It was positive that at the time of this fieldwork visit a manager from another Cheshire home was working alongside staff to develop care plans so they are more comprehensive documents, which should improve care given to residents. Four peoples care plans were looked at. There was evidence of some improvements to the quality of individual care plans. A summary of people’s personal support had been implemented on some of the individual case files looked at. This gave a good overview of peoples general care needs, likes and dislikes. However there are still no systems in place for the recording of when turns or specific observations are done. Discussion took place with the manger regarding possible suggestions for how this could be achieved. It is important that staff are able to evidence that they have followed the persons care plan and they residents have received the support and monitoring they require to meet their needs. There were still a number of daily records that had not been completed properly with the time and signature. This presents problem when monitoring people’s needs and the care given to them. This is a particular problem on the recording of care given by staff during the night if no time is recorded then the care given could have been at any time during a nine-hour period. Daily records must include how decisions have been reached and peoples involvement in the decision making process. This is not clear on care plans looked at. A completed CSCI questionnaire from one resident said, “I feel that some decisions are overridden by people that assume they know what is best for me rather than respecting my wishes”. A care plan looked at gave good detail regarding decisions that were made on a resident’s behalf about not going out because of safety issues. However, no reference was made to the resident’s involvement in this process. It is essential that residents are involved in the planning of care that affects their life and quality of life. Some of the residents spoken to said they are asked about how care should be given and felt that generally there is a core team of staff who are “good” “hardworking and kind” although many residents raised concern about the number of staff changes and the negative impact of a high use of agency staff who don’t know them or their needs. Risk assessments seen where not adequate. They did not evidence that residents are supported to take appropriate risks and that risk taking is an essential feature of supporting people to achieve their optimum levels of independence. Risk assessments in place for residents were “general workplace risk assessments” which do not fully assess the risk to the resident. A format Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 13 called “risk taking by service users” had been implemented but again these were not adequate, as they had been implemented inappropriately for care needs that highlight risks that need to be managed. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 14 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16 and 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Some residents live very independent lifestyles and engage in a range of leisure activities. The home must improve opportunities for residents who require staff support to access leisure activities. EVIDENCE: Residents have the opportunity to attend day centres and colleges. Some of the residents live very independent lives and stated that they make their own arrangements for social activities. One resident had attended a local university and had just completed a degree. The home has the facilities of a craft room, which some residents said they enjoy using. One resident is an artist and they have their own room for use as an art studio. A computer facility is located off the craft room for resident use. This is not fully operational yet and needs to be completed so residents can enjoy the full benefits of this facility. Residents said they have talked in the residents meeting about how the facility can be Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 15 developed so that it is fully accessible to everyone and to provide computertraining opportunities for residents. The activity coordinator had been off sick for a protracted period and a staff member was covering the position on a temporary basis. Residents made very positive comments and said the staff member is very helpful and will help to arrange trips out. Some residents said that they would like more activities to be arranged. These comments were also made in completed CSCI questionnaires returned to the inspectors. Residents said that staff help support and arrange transport if they want to go out on any activities such as trips to the cinema. There home has volunteer workers who help with transport and assist with the running of the homes own bar. Residents said sometime there are no drivers available which limits the opportunities available. Residents with complex health and nursing needs require significant staff support to engage in leisure and social activities. Some residents are totally reliant on staff to interpret what they want to do. Therefore good care panning systems are essential and should specify what the person likes to do and how this can be facilitated. The monitoring and residents response to activities is essential and should be detailed within peoples care plans to help assist with future planning. The manager stated that the activity coordinators post had now been advertised and interviews were planned for the week after the inspection. The manager acknowledged that this was an area that required development so that a choice of activities is available for the diversity of people who live at Greenacres. Residents spoken to said that they have a lot of contact with family and friends and some residents visit their family on a regular basis. They said family and friends can visit the home and are made welcome by staff. Some of the residents in the bungalow, which is accessed via a covered walkway from the main building, raised some issues about how this part of the home fits in with the rest of Greenacres. A resident said that they feel they do not get the same service as the main building for things such as hot drinks and laundry service. The manager needs to explore how people are supported in the bungalow and see if it is keeping with their care plan and expectations. It is important that residents are enabled to be as independent as possible wherever they live within the home but this must be within a risk assessment framework and in accordance with people’s individual needs. Meals are served in the main dining room. Residents said that there are two choices at each mealtime. Peoples cultural needs and dietary requirements can be catered for. A resident’s preference is to have their main meal brought into Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 16 the home by their family. This must be recorded in their care plan and arrangements in place so that the resident’s food is stored and served at appropriate temperatures and no health risks are posed. Residents with medical requirements and specific eating requirements are catered for. Residents said that they could help themselves to drinks and snacks, which were available in the dining room. The kitchen and food storage areas were not inspected during this visit. The evening mealtime was observed. The support given to a resident with their meal was of concern. Appropriate eating aids were not available. The details of the concerns are contained within the personal and healthcare section of the report. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 17 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 18,19 and 20 Quality in this outcome area is Poor. This judgement has been made using available evidence including a visit to this service. Residents health care needs are not well planned for or met. Residents moving and handling needs are well managed and kept under review. EVIDENCE: Greenacres has its own Physiotherapist who undertakes moving and handling assessments. Sampled moving and handling risk assessments were found to be comprehensive and gave details of size and type of sling and type of hoist so that residents moving and handling needs are well met. Manual Handling risk assessments seen had been kept under review. Residents made positive comments about the input from the physiotherapist. One resident had just been equipped with a new wheelchair they said, “The chair will improve my independence as I will be able to move around more easily”. The Physiotherapy service can be accessed on a flexible basis with morning and afternoon sessions available. The Physiotherapist also provides a service to people who are being cared for in bed and will provide passive movements in Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 18 their room to promote and maintain movement, improve circulation and minimise the risk of chest infections. Residents are also supported to undertake wheelchair licence test for the safe use of their wheelchairs in the local community. The physiotherapist will support individuals in preparing for and undertaking the test that enables the person to be more independent. She also works closely with the wheelchair assessment team at Oak Tree Lane so that people have repairs done, alterations made or replacement wheelchairs chairs provided as required to meet their needs and changing needs. The inspection and annual service of hoist equipment was up to date so that it is safe for residents use. The recent service had identified that work to the Aqua Nova specialist bath was required. The physiotherapist has devised an inventory of equipment to assist with the cross referencing of service details, to specific moving and handling equipment. The previous Key inspection required a full review of the support given to people during the night to take place so that care needs were clearly documented and carried out by care staff. At the random inspection there still remained concerns and the provider was required to ensure that care given, observations and monitoring throughout the night must be documented and underpinned by a risk assessment. Some improvements have been made and nightime care needs were on care plans looked at. However these must specify how checks are to be done. A nightime care plan stated, “Staff to monitor through the night and report any changes” It did not specify how staff should do this. The care plan was not dated which presents problems when reviewing and monitoring changes in people needs. Care plans for catheter care were in place and a chart was in place to monitor any changes. A different size catheter was used on one occasion and no explanation was given. The reason for this should have been documented. It was advised that a referral was made to reassess one person’s continence needs with the continence advisor so that some of the problems experienced and documented on the persons file could be better managed. It was of significant concern that an entry in the daily records stated that “bowel treatment not given today due to staff shortages and a poorly resident”. The entry was made more than two hours before the end of the shift. This matter was brought to the attention of the manager to investigate and ensure that in future residents basic and essential care needs are met. A resident wrote in the questionnaires sent to the home by the inspector that generally the care is good from permanent staff but have had to wait a very long time on some occasions for assistance with their personal care needs. It was positive that short-term care plans had been implemented for shortterm health problems such as wound care and infections. The care plans seen had good detail on them so staff could ensure residents health needs are met. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 19 The monitoring of peoples weight had not been undertaken as specified on peoples care plan. All four care plans looked at required that monthly weight checks take place. Records seen indicated that people were being weighed about every eight weeks. People must be weighed as in accordance with their care plan. The monitoring of peoples weight is important for the early detection of other health problems or complications. Waterlow assessments assess the risk of residents developing pressure ulcers. Care plans seen required that monthly assessments are completed but were only been done every eight weeks. These must be kept under review as stated on the care plans so that the risk of developing pressure ulcers is appropriately managed. A person uses a wheelchair for occasional use. This must be added to the persons care plan and a risk assessment implemented so they receive the right support and staff follow safe practice. Care plans had not been implemented for specific health care needs such as diabetes and sight loss. A care plan must be implemented so that these specific needs can be planned for and met. The evening meal was observed. The staff member supporting a resident did not follow the guidelines and risk assessment in place on the persons care plan. Specific cutlery was not available for the staff member to use to assist the resident. The staff member used their fingers to assist and put the food in the resident’s mouth. The person is at high risk of choking and requires very specific support and close observation. An immediate requirement was made to urgently review the situation and to ensure staff follow the guidelines and that the right equipment is made available. Speech and Language Therapy must reassess the resident. It was also raised that staff training should be provided in dysphasia so that staff has the right knowledge and skills to safely support residents. Some entries on peoples care plans raised concern about medication practice. Night staff had administered some medication but it was not signed for. Another persons medication was given to a resident who had ran out of their own medication. These specific concerns were brought to the attention of the manager to investigate. The inspectors did not inspect the medication procedures in full but decide to make a referral to the CSCI pharmacist inspector so that a full audit of the homes systems and procedures could be completed. The manager welcomed this support and advice and demonstrated a commitment to establishing good medication practice. The outcome of the pharmacist visit will be reported in the next key inspection report. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 20 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 22 and 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Complaint procedures are in place and indicate that people are listened to. The adult protection policy must be developed so that the organisations procedures protect residents from abuse. EVIDENCE: The complaint policy and procedure were available. There is a leaflet called “have you say” which explains how to make a suggestion or complaint The provider had received three complaints since the last inspection. One was regarding failure to follow medication procedures. Two were about staff care practice whilst working at night. All the paper work was available on file and indicated that the concerns were dealt with appropriately through the homes procedures. A concern raised by a resident was appropriately referred to Social Care and Health under the Adult Protection procedures. It was referred back to the home to investigate under their own procedures and was still ongoing. The Protection of Vulnerable Adults from Abuse policy was assessed (dated 17th August 2001) and required review so that it embraces the Birmingham Multi Agency Guidelines. It must make it explicit that Social Care and Health Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 21 are the lead agency on all protection matters. This is outstanding requirement from the previous Key inspection. Staff have completed training on Adult Protection and Complaints and Whistle blowing so they have a grater understanding of their responsibilities to support residents with any concerns they may have. The training matrix seen indicated that fresher training on Adult Protection is provided every two years so staff are kept up to date with current practice and legislation. When the accident book was looked at there was a number of accident and incidents that should have been reported via a regulation 37 form. This is when the Home should notify CSCI in writing of significant events or accidents. The manager agreed to discuss and confirm with the staff team what is reportable. Clarification was also given regarding what incidents must be reported to Social Care and Health no investigations should take place until the matter has been formally discussed with them as they are the lead agency on all protection matters. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 22 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s):24 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There are plans in place to reprovide this service so that it better meets resident’s needs. Progress had been made on maintenance matters so that the home is safe and comfortable for residents. EVIDENCE: Greenacres is a large home and it has a bungalow sited adjacent to the main home which is now accessed by a covered walkway. Many parts of the main building have been extended and refurbished over the years. There is a distinct difference in décor between the old and new areas of the home. The organisation plans to reprovide the service. One site proposed for development has been rejected and further work is taking place to decide on a suitable way forward to reprovide the service in the best way possible for residents. Consultation meetings have taken place with residents and relatives so they are kept informed of future plans. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 23 There is a good range of communal space including a choice of lounges, a large dining room, bar area, television and video lounge, computer and activities room. One of the lounges has now become the designated smoking area. Residents said that there is good space in the home for manoeuvring their wheelchairs. A lift provides access to the first floor. All residents have a single bedroom some have ensuite facilities. Bedrooms seen were personalised. Two bedrooms were in the process of being painted and decorated so they are more comfortable for residents. It was discussed with the manager and agreed that a maintenance and refurbishment plan would be forwarded to CSCI confirming what work will take place to ensure that the physical standards of the home are kept to an acceptable standard for residents comfort whilst waiting on the reprovision plans to be confirmed. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 24 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s):32,33, 34 and 35 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. An effective staff team does not support residents. Staff are not adequately supervised and supported to do their job. EVIDENCE: Staffing levels are 9 carers in the morning (07.30-14.15) and 6 carers in the afternoon /evening (14.15-21.00). There are two qualified nurses on each shift. At night the staffing consists of three carers (21.00-07.30) and a night nurse (20.45-07.45). Staffing levels are reduced by one carer on each shift at the weekend. This must be reviewed, as people still require the same support and assistance at weekends. The previous inspection report required that the support residents receive during the night requires further exploration and this must be done in conjunction with the implementation of night time monitoring and recording and evidence of nightime observations. It is really difficult to ascertain if the staffing levels are sufficient if the recoding and monitoring systems are inadequate. Recording and monitoring systems have yet to be implemented so Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 25 the need to review nightime staffing levels remains an outstanding requirement. The Random inspection raised concern about an agency staff member undertaking an eighteen-hour shift. Which included a late shift and waking night shift. This was in breach of Health and Safety at work regulations and the manager was required to review this practice. CSCI was informed that such practice has now ceased. There are over 200 care hours vacant. Rotas seen indicated a high level of agency staff being used to maintain staffing levels. On some shifts the balance of agency outweighs permanent staff. Residents and staff spoken with raised their concern about the staffing levels. A resident said “I don’t like not knowing who is going to help get me up in the morning” another said “ We are not introduced to the agency staff then a stranger walks in your room its not right”. A resident wrote in one of the CSCI questionnaires sent to the home by the inspector “Agency carers are useless they do not know what to do”. Positive comments were received about the permanent staff including “Staff are very diligent” “Very willing” “ My relative is well cared for”. Staff spoken with said, “Over 50 of the staff are agency” another said “On one weekend there was only two permanent staff the rest were agency”. The manager said that vacant posts were in the process of being appointed to. He said he recognises the importance of having an effective team in place to meet resident’s needs. The staff-training matrix seen indicated that progress had been made in providing required training so staff have the required knowledge and skills to meet residents needs. It was positive that staff had received training in the specific needs of resident including disability and equality, moving and handling and tissue viability. Catheter care and continence training is scheduled for the end of November and will provide staff with specific knowledge to do their job. The need for staff training in dysphasia was raised earlier in the report so that staff have the knowledge and skills to safely support residents at mealtimes. The staff supervision scheduled was looked at. This is when staff receives one to one support to discuss their work and to identify any training and development needs. Some improvement had been made to the frequency of supervision although it indicated that some staff had not received supervision since August 2006. The manager sent supporting information following the fieldwork visit indicating that regular supervision sessions for all staff had been implemented. Previous inspection reports raised concern about the frequency of staff meetings. The manager said that he was in the process of establishing staff meetings schedule for the next twelve months and was committed to the importance of these. It is imperative that regular staff meetings are Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 26 established. Staff meetings are important for ensuring good communication systems are in place and for disseminating information to the staff team. The manager was looking at reviewing the handover system at the change of each shift so that good communication takes place and residents receive continuity in their care. Three staff files were assessed. One person’s file had a gap in their employment history. The provider must explore all gaps in potential employees work history to ensure that robust recruitment procedures are in place to protect residents. The manager said that a number of personnel issues are being addressed so that staff follow the organisations procedures. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 27 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s):37, 39, 42 and 43 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. A number of key areas of service delivery required development so that residents can benefit from a well run home. A manager is now in post so residents can benefit from a competent and accountable manager. EVIDENCE: The manager had recently been appointed and said he had received a thorough induction to the organisation. He had only been based in the home for four weeks. He has extensive knowledge and experience and is Nurse trained. He was in the process of applying to CSCI to be the registered manager. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 28 This report identifies significant shortfalls in the quality of service. Resident’s rights and interest are not fully safeguarded by the homes practice and procedures. Policies and procedures are not fully implemented. The management of accidents and incidents is of concern and not in line with required practice. The manager demonstrated that he had a clear understanding of the shortfalls in the service provided at Greenacres and the negative impact this was having on the residents and staff team. He indicated that he had a clear sense of direction regarding how the service should be developed to meet resident’s needs. It is acknowledge that some of the shortfalls will take some time to achieve the required standard. Some of the general health and safety records were looked at. Fire records were up to date. The emergency evacuation plan dated August 2005 required review. The general workplace risk assessment had been reviewed. The routine check of gas pipe work identified some work to be done confirmation that this has been done is required. (Following the fieldwork visit the manager confirmed that this work had been completed). As previously mentioned the accident and incident procedure must be reviewed. Staff must be clear of their responsibilities to report incidents so that resident’s safety and well-being is protected. There still seems to be problems with security in the building as raised in previous reports. Comments were made to the inspectors about general security but also about people getting access into the home in the evening. Visitors have had to wait for long periods to get in. This has also been a problem for residents trying to get access if returning back to the home in the evening. A relative raised concern in one of the completed CSCI questionnaires and said “Security is appalling I fear for my relatives safety”. The security and access arrangements in the home must be reviewed so that residents feel safe and appropriate systems are in place for people visiting the home. Residents said that regular residents meetings do take place and they are able to discuss what is happening at the home and activities and future plans. A residents said “we do discuss CSCI inspections and what has been said about the home and what must improve” another said “The new manager attended the meeting to introduce himself the operations manager has also attended which we think is good”. A resident said that they had been involved in the interview process for the new manager. The home is audited by its own organisation every three years and there is a self-assessment audit tool, which the manager said he was in the process of familiarizing himself with. Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 29 The operations manager undertakes monthly regulation 26 visits to monitor the service and reports of these visits including action points were in the home and are sent to CSCI. SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 30 CHOICE OF HOME Standard No Score 1 2 2 2 3 X 4 X 5 X INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 2 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 X 30 2 STAFFING Standard No Score 31 X 32 3 33 1 34 2 35 3 36 3 CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 2 X 2 X LIFESTYLES Standard No Score 11 2 12 2 13 2 14 X 15 3 16 3 17 1 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 1 X 3 X 3 2 X 2 3 Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 31 Yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 2 Standard YA1 YA6 Regulation 4 (1)(c) Sch1 12 (1)(a) 15 (1) (2) Requirement The Statement of Purpose and Service User Guide required review. Care plans required further development. There must be systems in place to evidence that residents have received the support they require. Some progress made further improvements required. Daily records must reflect care given. They must be signed and the time recorded of entry. Daily records must reflect how decisions have been made. Risk assessments required further development so the risk residents face are clear and well managed. A review of how people are supported in the bungalow is required. A range of activities should be available to residents. The Registered Person must be able to evidence how they consult with all residents regarding activities and can monitor the programme of DS0000024843.V316163.R01.S.doc Timescale for action 31/12/06 31/01/07 3 4 5 YA6 YA7 YA9 15 (1) (2) 12 (1)(a) 15 13(4)(a, b, c) 12 (1) b 16 (m, n) 16(m, n) 30/11/06 30/11/06 31/12/06 6 7 8 YA11 YA12 YA13 31/12/06 31/12/06 31/12/06 Greenacres Cheshire Home Version 5.2 Page 32 9 YA17 15 (1) (2) 13 (4) 10 YA17 23 (2) n activities arranged by or on their behalf. Resident’s preference re meals and arrangements in place must be documented on their care plan. A risk assessment is required for meals brought into the care home. Appropriate eating aids must be available for residents. 30/11/06 16/11/06 11 YA18 12(1)(a, b) 12 13 YA18 YA18 15 (1) (2) 12 (1) a, b (Immediate action taken by provider following the fieldwork visit). Personal care needs and how 31/12/06 they must be met must be documented on the care plan and kept under review. Resident’s preference about 30/11/06 how they are moved must be on their care plan. Staff must follow the guidelines 16/11/06 in place about how residents are supported to eat their meal. (Immediate action taken by provider following the fieldwork visit). Resident’s nightime support 31/12/06 needs must be documented on the care plan. How staff are to monitor residents must be specified. 14 YA18 12(1)(a, b) 15 16 YA19 YA19 12 (1) a, b 12(1)(a, b) Further development required. People must be weighed as in accordance with their care plan. Care plans must be developed so that resident’s specific health care needs are clearly documented and kept under review such as diabetes and sight loss. DS0000024843.V316163.R01.S.doc 30/11/06 31/12/06 Greenacres Cheshire Home Version 5.2 Page 33 17 18 19 YA19 YA19 YA20 12 (1) a, b 12(1)(a, b) 13(2) Waterlow assessments must be 30/11/06 kept under review as stated on residents care plans. Accident and incident recording 30/11/06 and monitoring was poor and required attention. The outstanding balance of 30/11/06 medication from the previous month must be carried over. Not assessed requirement carried over. A robust system for the 30/11/06 handling of medication must be implemented and adhered to for residents receiving respite care. Not assessed requirement carried over. The Adult Protection Policy required review and must embrace the Multi Agency Guidelines. Staff must have an understanding of their responsibility to report notifiable incidents to CSCI. A maintenance and refurbishment plan must be forward to CSCI confirming what work will take place to ensure that the physical standards of the home are kept to a acceptable standard for residents A review of the homes staffing levels is required including weekends and nightime. Regular staff meetings must be implemented. Vacant post must be appointed to. Any gaps in staff work history must be explored in full to safeguard residents and ensure robust recruitment systems are DS0000024843.V316163.R01.S.doc 20 YA20 13(2) 21 YA23 13(6) 30/11/06 22 YA24 23 (2) (b) 31/12/06 23 24 25 26 YA33 YA33 YA33 YA34 18(1)(a) 18(1)(c) 18 (1) a 7,9,19 Sch 2 31/12/06 16/12/06 31/01/07 30/11/06 Greenacres Cheshire Home Version 5.2 Page 34 in place. 27 28 29 YA40 17 92) schedule 4 12 13 (4) 13 (4) Accident and incident procedure required review. The emergency evacuation plan required updating. Security and access to the home must be reviewed. 31/12/06 31/12/06 31/12/06 YA42 YA42 No. Refer to Standard Good Practice Recommendations Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 35 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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. Extracts may not be used or reproduced without the express permission of CSCI Greenacres Cheshire Home DS0000024843.V316163.R01.S.doc Version 5.2 Page 36 - 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. 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