Inspection on 15/06/06 for Greenacres Cheshire Home

This inspection was carried out on 15th June 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (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. These are things the inspector asked to be changed, but found they had not done. The inspector also made 29 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenacres Cheshire Home 21/05/09

Greenacres Cheshire Home 28/06/07

Greenacres Cheshire Home 14/11/06

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 Unannounced Inspection 15th and 16th June 2006 11:30 Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 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.V291674.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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.V291674.R01.S.doc Version 5.1 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 Care Home 32 Category(ies) of Physical disability (32) registration, with number of places Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 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 23rd January 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 in the grounds, 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. Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork was unannounced involved two inspectors and took place over two days. The inspectors met at least twelve residents and time was spent observing care practices, interactions and support from staff. A tour of the building was made. Residents care plans and risk assessments were inspected. Staff’s training records were examined, and a number of Health and Safety records were inspected. The inspectors spoke to the acting manager, care supervisor, general manager three RGNs and two care staff. The care coordinator completed and returned a pre-inspection questionnaire prior to the inspection. Information within the questionnaire was used to inform the inspection and this report. What the service does well: What has improved since the last inspection? Only very limited progress had been made on previous requirements. CSCI did not receive an action plan in response to the inspection in January 2006 within the required timescales. It is evident that the management team has gone through a very unsettled time and this has clearly had an impact on the home. Residents and staff spoke of improvements in recent months. This included improvements in general communication and that the temporary manager is approachable and has a presence in the home. The general manager has kept CSCI informed of developments at the home. It is essential for residents that there is clear leadership and sense of direction so that the home meets its aims and objectives. CSCI will monitor progress closely. Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 6 The management of complaints has improved and evidence on the complaint file indicates that formal complaints are dealt with promptly. Resident were positive about the current management team and said that they felt listened to. One resident was very pleased with how a formal complaint had been handled. 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. The provider has requested a meeting with CSCI to discuss the management arrangements and development plans for Greenacres to improve the service afforded to residents. This is welcomed by CSCI and has been arranged for early July 2006. A summary of the main areas impacting on residents is as follows. The shortfalls in the pre-assessment document must be addressed so that resident’s needs are clearly identified prior to admission. 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. There were also several gaps on the daily records where entries had not been made which indicate inconsistencies in the monitoring of residents 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. Residents who can eat independently but require minimum staff support needs improvement as to how staff provides the required support and supervision so that resident’s independence and dignity is promoted but staff are close by should discreet assistance be required. The monitoring and support given to residents during the night is of serious concern. It cannot be over emphasised how complex some residents needs are. An urgent review of the support given to residents at night must be undertaken. Care plans must be specific about the care, support and monitoring that residents require. Staff training is required on peg feeds and continence care so that residents receive the care they require from a staff team with appropriate skill and knowledge. For some residents this may prevent frequent admission to hospital to have medical procedures that trained staff in the home could do. Accident and incident recording and monitoring was poor. Monthly auditing of accidents had not been completed since January 2006. The accident reports seen were often entered into the accident book several days after the incident Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 7 occurred. The Regulations require the provider to notify CSCI of such incidents and of the action taken to minimise the reoccurrence of such events and to safeguard residents. A review of the practice for residents who take medication to day centres and residents admitted for respite care was required so that residents receive the appropriate support with their medication and are protected by the homes procedures. Discussions with some of the qualified nurses regarding their understanding of what is reportable to CSCI via a regulation 37 and the homes adult protection procedure raised the need for further training on these issues. So that they are clear about what is reportable to CSCI and what action to take in the event of a protection matter occurring in the home, so that resident’s well being is promoted and protected. 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 nigh time observations. It is really difficult to ascertain if the staffing levels are sufficient if the recoding and monitoring systems are inadequate. The systems to monitor staff performance and their understanding of their job role and how this translate into residents care are not in place and have the potential to severely impact on residents care. Staff must receive the support training and supervision to do their job. 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 Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 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.V291674.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the 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. 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-one residents and a new admission took place on the afternoon. 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 will need to apply for a variation to the home registration to accommodate residents over the age of 65years. The pre assessment information for the most recently admitted person was assessed. It included good information on the persons past medical history. It was not very specific about some of the specific care needs including manual handling needs and no reference was made to self-medication. It referred to pain management but there were no details of where the pain was. It included Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 10 details of the resident’s family but there was no reference to their involvement or the possible impact of the admission on close family members. The pre assessment proforma does not include a section on personal hygiene needs so this information was omitted. The shortfalls in the pre assessment document must be addressed so that resident’s needs are clearly identified prior to admission. The previous report highlighted that the admission policy (dated 24 June 2002) was under review. This remained outstanding and must be actioned so that it reflects current practice. The Statement of Purpose was dated 24th June 2002 and required updating so that perspective residents can make an informed choice. The provider should explore how information could be made available in different formats. The afternoon handover session was observed (14.30) this consisted of nursing staff imparting information to the care staff who were working the afternoon /evening shift. There was no mention of the resident who had been admitted earlier in the afternoon (12.30). When questioned at the end of the handover the nursing staff said that the admission was still taking place. It is of concern that staff were not made aware of an admission taking place and of the residents needs. It is unclear when care staff would of received this information. One of the residents who was staying for a weeks respite and had stayed several times before said, “ I enjoy staying at Greenacres. Staff are very good. I am well looked after. The home is clean and safe and I can still go to the day centre every day”. Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 9 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the 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. In January 2006 the manager and the care supervisor stated that a new care plan format referred to as “Individual Service Planning” was in the process of being implemented. Four people were case tracked. This included care plans of residents who have recently moved to Greenacres, a resident with complex health and nursing needs and a resident who had lived at the home for sometime. (See also standards on Personal and Healthcare support) The care plan of a resident who was recently admitted had no identification photograph. Some of the areas highlighted on the “Support/Nursing plan Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 12 assessment” had no outcomes recorded. The moving and handling assessment was very detailed and gave clear and specific information about the person handling needs and included the persons preference about their needs which was evidence of consultation with the resident. The emotional and social section of the care plan was not completed or the goal plan section. Copies of the community care assessment forms completed by placing authorities contained only minimum information. One of the assessed files had no care plan from the placing authority although the person had been living at Greenacres for four months. Senior staff said this information had now been requested. Resident should not be admitted without the required information, which should be used to inform the pre assessment process. It was positive that the care plan of the resident who has lived at the home for a while had been reviewed and transferred onto the new care plan documentation which is more comprehensive. Some of the previous relevant information had been omitted in the process. This is of concern, as the care plan must fully reflect residents care needs including reference to specific strategies to manage difficult situations. When asked a resident said that they were really pleased with the way staff had requested information from them to put on their care plan. They felt that they had been “fully consulted” and that staff had asked them specifically about their cultural and religious needs and had not made assumptions about what these needs are. They had a named key worker who they felt kept their care plan under review. The residents said that they could direct their own care and that “staff were sensitive to their needs”. When assessing the care plan it was not possible to evidence that all this information had been documented. Daily records sampled were poor and to not reflect the residents care plan. A resident went to stay with their family for a week. Their return to the home was not entered until the day after their return. It is unclear how care staff were informed of the persons return to the home. They had been unwell before the period of stay with their family and there were no details of how the person was upon return and of any matters that may of required following up. There were also several gaps on the daily records of the sampled care plans where entries had not been made which indicate inconsistencies in the monitoring of residents 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. The organisation has a format called “risk taking by service users” these had not been implemented on sampled care plans. Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 13 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13, 15, 16, 17 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the 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 and they must keep adequate records in relation to these. 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. 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. Many of the residents have their own computer equipment in their bedroom and said that this is invaluable to them. A resident who recently came to live at Greenacres was in the process of having equipment installed in their room. Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 14 The activity coordinator was off sick residents said that there had been some impact on the planning and organising of activities during her period of sickness. An activity board in the communal lounge had information about forthcoming events including theatre trips. 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 staff the homes own bar. On the night of the inspection a number of residents enjoyed watching the England match on the large screen television and the bar opened early to provide refreshments. Residents seemed to enjoy the very sociable occasion. Some of the residents spoken to said that they have a lot of contact with family and friends and some residents visit their family. 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 also essential. The shortfalls highlighted in outcome standards “individual needs and choices” identified that this area must be developed. Meals are served in the main dining room. Residents said that there are two choices at each mealtime. A resident who is vegetarian said that their catering needs were well provided for. A residents cultural mealtime requirements required some further exploration regarding the supplier and arrangements in place to store food brought into the home by the resident’s family. Residents with medical requirements and specific eating requirements were catered for. Residents were very complimentary about the quality of food served and said the temporary chef was a “really good cook”. Menus were available daily for residents to make choices. The kitchen is industrial in style and layout and staffed by a team of catering staff. Residents said that they could help themselves to drinks and snacks, which were available in the dining room. The support given to residents at meal times was generally satisfactory. Residents came in the dining room at different times and this was well catered for. For residents who can eat independently but require minimum staff support, some improvements could be made to how staff provides support and supervision so that resident’s independence and dignity is promoted but staff are close by should discreet assistance be required. A brief inspection of the catering kitchen identified that suitable and appropriate facilities are available for food storage. Regular temperature test of the fridge and freezer were taking place. The cleaning schedule for the kitchen had not been completed for the last two weeks. This required attention, as it is Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 15 evidence that the staff comply with environmental health regulations. The storage area for dry food stock required some remedial attention so that it is suitable and safe for the storage of food items and does not pose any health risk to residents. Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 16 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to the service. The health and personal care needs of residents are not fully documented on care plans and failed to provide sufficient detail on how best to support residents and were not 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. They had been reviewed annually. Residents made positive comments about the input from the physiotherapist. The physiotherapist stated that care staff would be receiving training in passive exercises in July 2006 so that they can undertake passive exercises with residents. The loler inspection and annual service of hoist equipment was up to date. Due to the large amount of equipment in use it is advised that an inventory of equipment is established to assist with the cross referencing of service details, to specific moving and handling equipment. The monitoring and support given to residents during the night was of serious concern. The “handover sheet” is used to make entries about care given. Most entries for residents care during the night consists of just a tick in a box or Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 17 single entries such as “ no problem” “padded” “rang several times” or “night bags”. None of these comments were signed. It cannot be over emphasised how complex some residents needs are. An urgent review of the support given to residents at night must be undertaken. Care plans must be specific about the care, support and monitoring that residents require. Night time records must be implemented. Care given, observations and monitoring throughout the night must be underpinned by a risk assessment. Many of the people have very complex needs. As previously mentioned the care plans of four residents were assessed. More information is required regarding what continence products are used and what catheter size. There was no mention of observing for signs of infection and what to look for. A resident had recently had their continence needs reviewed by the continence nurse who had implemented a programme however, the care plan had not been updated and there was no entry in the daily records. More detail was required regarding how oral mouth care should be provided so that care staff know what to do. Waterlow scores were being completed every three months. In light of residents complex needs these must be completed monthly. Nutritional risk assessments had been completed as required however, a nutritional care plan had been implemented for one resident although there were no nutrition problems identified. It was positive that a short-term care plan had been implemented for chest pain however there was no mention of how the monitoring of the chest pain would take place. The Peg feed care plan assessed stated “Staff to administer feed regime and water as advised by the dietician”. There were no details on the care plan regarding what feed was prescribed, when and the rate. The tube required rotating daily there was no evidence that this was being done and no recording system for monitoring this. There was nothing on the care plan about positioning while the feed is in place. The peg feed information must be concise in a reflective care plan to ensure that resident’s nutritional needs are met in a safe manner. Staff training is required on peg feeds and continence care so that residents receive the care they require from a staff team with appropriate skill and knowledge. The care coordinator said that discussions had taken place with the community health teams and this training should take place over the next few months. Many of the residents use a wheelchair. The physiotherapist holds the information regarding the service and maintenance of the chairs. Residents Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 18 said that repairs are dealt with promptly. Risk assessments must be implemented for the use of lap belts/ posture belts. Accident and incident recording and monitoring was poor. Monthly auditing of accidents had not been completed since January 2006. The accident reports seen were often entered into the accident book several days after the incident occurred. An accident on 23rd March 2006 was entered on the 12th April 2006. Another dated 30th March was entered on 12th April 2006. Some incident such as an alleged theft and a medication error had not been reported via a regulation 37 to CSCI. The regulations require the provider to notify CSCI of such incidents and of the action taken to minimise the reoccurrence of such events and to safeguard residents. Medication procedures, storage, and recording were assessed. There were concerns about the systems in place for a resident who was admitted for respite. The Medication Record Chart was handwritten and had not been signed by two nurses. The quantity of medication had not been recorded and there were no copies of the prescription. There were no dividers between the records of two residents with the same first name. Which may lead to medication errors if nurses are not vigilant. Prescribed creams that are kept in resident’s rooms must be on the Medication Record sheet. It was not possible to audit non blister pack medication because the outstanding balance from the previous month had not been carried over. A review of ordering and stock control was required to avoid a build up of non blister pack medication. A review of the practice for residents who take medication to day centres was required so that residents are protected by the homes procedures. Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 19 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the service. Residents said they are listened to. Staff training must be provided in adult protection matters and complaints procedure so that residents are supported by an informed staff team who can safeguard 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 one complaint since the last inspection. All the paper work was available on file and indicated that the matter was dealt with appropriately. Residents spoken to said staff on the whole are very friendly and approachable. One resident said that they had a concern and felt it had been dealt with very well. The previous report identified that a number of staff must complete their training on complaints and adult protection training. It was not possible to assess what progress had been made as the training matrix was not provided. This remains as an outstanding requirement. Discussions with some of the nurses regarding their understanding of what is reportable to CSCI via a regulation 37 and the homes adult protection procedure raised the need for further training on these issues so that they are clear about what is reportable to CSCI and what action to take in the event of Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 20 a protection matter occurring in the home. So that resident’s well being is promoted and protected. 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 are the lead agency on all protection matters. Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 21 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 27, 28, 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to the 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. Many parts of the main building has been extended and refurbished over the years. There is a distinct difference in décor between the old and new areas. The organisation plans to reprovide the service in a new build home. The consultation process was in place with residents. It was noted in the report of January 2006 that much work had taken place to improve the internal standards of décor. Painting and decorating had taken place throughout the ground and first floor communal areas, passageways and stairway areas. New carpet had been fitted on the ground floor. Some bedrooms had also been painted and some bedroom carpets and furniture had been replaced. Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 22 Previous report had required the need for a covered walkway between the bungalow and the main building. Residents said that they feel a lot safer and were really pleased that this work had finally been completed. 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 en-suite facilities. Bedrooms seen were personalised. The care supervisor said that many of the bathrooms are not used. Residents with bathroom en-suite use their own facilities and the adapted shower rooms are most popular with residents. A sliding door into a toilet was very difficult to close and required attention. Many of the doors have touch pads so that residents can open and close doors independently. The timing on the door closure into the bungalow required attention so that it was safe for residents. One resident’s door required attention so they can safely enter and leave their room. Residents raised the need to look at ventilation in the dining room. The new cover way to the bungalow has enclosed some of the windows. They said in the hot weather it is extremely uncomfortable and suggested that fans cold be installed. Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 23 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35, 36 The quality of this outcome area is poor. This judgement has been made using available evidence including a visit to the service. Residents are not protected by the homes recruitment procedures and practice. 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). It was a previous requirement to review night time staffing levels. The care supervisor said that a review had taken place and the outcome was that the levels remained the same but a review of responsibilities had brought about a change in the medication duties of nurses at night reducing the time that is spent giving out medication allowing for more time to be spent supporting residents. CSCI 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 night time observations. It is really difficult to ascertain if the staffing levels are sufficient if the recoding and monitoring systems are inadequate. Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 24 An up to date staff-training matrix is required so that a full assessment of training achieved since the previous inspection can be made. Staff’s supervision records were assessed and were very poor. One RGN (Registered general nurse) last received supervision in September 2003. Training and induction issues were raised with no evidence that these had been followed through. Another nurse had received supervision in May of this year prior to this supervision had taken place on the 9th March 2005 and June 2004. Supervision records of care staff also indicated significant shortfalls; four of the care staff records looked at had not received supervision this year with records indicating that their last supervisions took place in November and October of 2005. It is evident that staff at all levels have not received the support and supervision to do their job. Residents made very positive comments about staff saying that most are “helpful” “caring” and “Kind”. They said that some agency staff are okay but some aren’t very good. Residents said that they didn’t like it when there was agency staff on duty at night. A staff meeting was held in May 2006 the care supervisor said the minutes were being typed up, prior to this, staff meeting minutes indicate that meetings took place infrequently. A meeting with nursing staff took place in April 2006 prior to this a meeting had taken place in April 2005. The last care staff meeting took place in September 2004 and for night staff the minutes on file indicated that this took place in November 2004. Staff meetings are important for ensuring good communication systems are in place and for disseminating information to the staff team. It is imperative that regular staff meetings are established. Four staff files were assessed. The personal file checklist had not been completed on one file. On another file a previous employer had been “unable to give a reference” there was no evidence that the reasons had been explored. A “discussion record” on a staff members file potentially highlighting poor practice however there was no evidence of how this matter had been addressed by the management team or through the staff supervision process. There was evidence on file that a staff member did not follow the sickness procedure and there was no evidence of how this was followed up through the homes procedures. The terms and conditions of employment required clarification for the nurse employed that is not RGN registered. Some clarification was required regarding one persons home office permit. Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 25 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 39, 42 The quality of this outcome area is poor. This judgement has been made using available evidence including a visit to the service. A number of key areas of service delivery required development so that residents can benefit from a well run home. EVIDENCE: The registered manager resigned from his position in May 2006. A registered manager from another Leonard Cheshire home was supporting the care supervisor on a part time basis (Since May 2006) to oversee the management of the home. The General Manager was also providing support. This report clearly 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. Staff were not able to demonstrate that they are fully aware of the procedures to follow to safeguard residents. The management of accidents and incidents is of concern and not in line with required practice. Risk assessments for residents must be implemented and kept under review. The systems in place for ensuring that Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 26 information is disseminated to staff were not adequate and have the potential to impact on the care of residents. Action plans to CSCI reports have not been received within the required timescale. The risk assessment for the environment was in place however there is no evidence that this document is kept under review when any incidents occur. After a security incident there was no evidence that the document was reviewed. The flat roof accessed off the first floor must be incorporated into the risk assessment for the environment and any risks to residents must be identified and addressed. Residents said that improvements had been noted in recent months. “The new manager walks the home” “the new manager has got the staff moving”. Staff said the managers are “very approachable” and staff sickness and lateness is now being addressed. One of the residents said “I am really pleased that you are doing an inspection and that they didn’t know you were coming unannounced inspections are good”. Residents said they have been told about the development plans for the home. They said they do have residents meeting which are chaired by one of the residents. One of the residents said that they had been involved in the recruitment of staff process and had interviewed some staff and had really enjoyed the opportunity. Residents said they do get to hear about the inspection report and what has been said. Significant development of the home is required so that the home can evidence that resident’s needs are being met. It is positive that on the whole residents and staff felt that there had been some positive developments in recent months. It is acknowledge that some of the shortfalls will take some time to achieve the required standard. The provider has requested a meeting with CSCI to discuss the management arrangements and development plans for Greenacres this is welcomed by CSCI and has been arranged for early July 2006. Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 27 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 CHOICE OF HOME Standard No Score 1 2 2 2 3 2 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 3 26 X 27 X 28 X 29 X 30 X STAFFING Standard No Score 31 X 32 3 33 2 34 1 35 2 36 1 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 X 12 3 13 2 14 X 15 3 16 3 17 2 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 1 1 2 X 1 X 2 X X 2 X Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 28 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 2 3 4 Standard YA1 YA2 YA2 YA3 Regulation 4 (1)(c) Sch1 14(1) 14(1) C S Act 2000 Requirement The Statement of Purpose required review. The pre assessment documentation required further development. The admission policy required review. The manager will need to apply for a variation to the home’s registration to accommodate residents over the age of 65years. Care plans required further development. Previous requirement 31/01/06. Daily records were poor. These must reflect the persons care plan and how choices have been made and must be completed concurrently. Risk assessments required further development. “Risk taking by residents” assessments need to be implemented. Previous requirement 31/03/06. The Registered Person must be able to evidence how they consult with all residents regarding activities and can DS0000024843.V291674.R01.S.doc Timescale for action 31/08/06 31/08/06 31/08/06 31/07/06 5 6 YA6 YA7 12 (1)(a) 15 12(1)(a,b) 15 31/08/06 18/06/06 7 YA9 13(4)(a,b,c) 31/08/06 8 YA13 16(m,n) 31/08/06 Greenacres Cheshire Home Version 5.1 Page 29 monitor the programme of activities arranged by or on their behalf. Some progress made further developments required. A review is required of how support is given to residents who require some support and supervision at meal times. The cleaning schedule for the kitchen must be completed. Risk assessments must be implemented for the use of lap belts/ posture belts. Night time care records required implementing. The records must be signed dated and reflect the residents care plan. Personal care needs and how they must be met must be documented on the care plan and kept under review. Resident’s night time support needs must be documented on the care plan. Accident and incident recording and monitoring was poor and required attention. Care plans must be developed so that resident’s specific health care needs are clearly documented and kept under review. 9 YA17 12(1)(a,b) 31/07/06 10 11 12 YA17 YA18 YA18 16(j) 13(4)(a,b,c) 12(1)(a,b) 17/06/06 31/07/06 23/06/06 13 YA18 12(1)(a,b) 31/07/06 14 15 16 YA18 YA19 YA19 12(1)(a,b) 12(1)(a,b) 12(1)(a,b) 31/07/06 23/06/06 31/08/06 17 18 YA20 YA20 13(2) 13(2) 19 YA23 13(6) Acute care plans must be further developed. The outstanding balance of 30/06/06 medication from the previous month must be carried over. A robust system for the 30/06/06 handling of medication must be implemented and adhered to for residents receiving respite care. The Adult protection policy 31/07/06 required review and must embrace the Multi Agency DS0000024843.V291674.R01.S.doc Version 5.1 Page 30 Greenacres Cheshire Home Guidelines. Staff must have an understanding of their responsibility to report notifiable incidents to CSCI. The ventilation in the dining room required review. The timing on the door closure into the bungalow required attention so that it was safe for residents. One resident’s door required attention so they can safely enter and leave their room. A review of the homes staffing levels is required. Regular staff meetings must be implemented. Staff files must have all the required information as stated in schedule 2. An up to date staff-training matrix is required so that a full assessment of training achieved since the previous inspection can be made. Staff must have regular, recorded supervision meetings at least six per year with their manager. A registered manager must be appointed. There must be an annual development plan for the home based on a systematic cycle of planning, action review. The Registered Person must keep the risk assessment for the environment under review. 20 21 YA24 YA24 23(2)(p) 23(2)(b) 31/07/06 19/06/06 22 23 24 YA33 YA33 YA34 18(1)(a) 18(1)(c) 7 9 19 Sch 2 18(1)(c) 31/08/06 31/08/06 31/08/06 25 YA35 31/07/06 26 YA36 18(2) 31/08/06 27 28 YA37 YA39 8(1)(a,b) 24(1) 30/09/06 31/08/06 29 YA42 23(4) 31/07/06 Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 31 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 YA22 Good Practice Recommendations The Registered person should consider introducing a grumbles book to record the comments of residents of the small complaints where they do not want to go down the formal route. It was advised that a log of regulation 37 reported incidents are kept. To review the time that the main meal is served. 2. 3. YA37 YA17 Greenacres Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 32 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 Cheshire Home DS0000024843.V291674.R01.S.doc Version 5.1 Page 33 - 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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