Inspection on 28/06/07 for Greenacres Cheshire Home

This inspection was carried out on 28th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. 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 no outstanding requirements from the previous inspection report, but made 2 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 14/11/06

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 Mrs Mandy Beck Key Unannounced Inspection 28th June 2007 09:00 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 DS0000024843.V334031.R02.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. DS0000024843.V334031.R02.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 Care Home 32 Category(ies) of Physical disability (32) registration, with number of places DS0000024843.V334031.R02.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 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. 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. This does not include extra services such as hairdressing, chiropody, toiletries and holidays. These are all available at extra cost to the residents. The CSCI inspection report is shared with residents in their meetings. Some residents obtain their own copy of the inspection report directly from CSCI. DS0000024843.V334031.R02.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home undertaken by three inspectors. We have used a variety of methods to collect information about the home and the service it provides. We spent time during the inspection talking to the manager, staff and residents. We also looked at resident’s files as part of our case tracking process. This enables us to make decisions about whether the home is meeting resident’s needs. Staff files were examined to make sure the home is continuing to recruit people in a way that safeguards the residents and to ensure that all staff are receiving the required training. We have also included in this report comments from residents and relatives who completed our questionnaires. The manager has also supplied us with information about the service they provide in their Pre Inspection questionnaire. All of the above has been used to help us make judgments in this report. All of inspectors would like to thank the manager, staff and residents for their hospitality throughout this inspection. What the service does well: All of the residents we spoke to said that they considered Greenacres to be their home and enjoyed living there. Comments included “it’s a caring service good all round”, “in general the home is excellent more full time staff would be great” and “I find Greenacres to be very caring in every aspect and always willing to attend my needs”. Residents are involved in the recruitment of staff. This will enable the most suitable candidates to be selected to work at the home. Complaints and concerns are all managed well. The manager works with residents and relatives in addressing their concerns and they can feel assured that action will be taken to resolve any issues. Residents said “if I’m not happy I will tell the manager and he will sort things out”. DS0000024843.V334031.R02.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: When we asked residents what improvements the home could make they were all unanimous in their responses. “we need more staff, the permanent staff are good but the agency let them down”, “lots of agency staff means lack of continuity of care is hard to achieve no one seems to check up on them”, “I wish the care staff were better paid for the job of work they do”. DS0000024843.V334031.R02.S.doc Version 5.2 Page 7 One resident said “I keep myself busy with my university work and watching sport on tv, the full time staff are excellent agency not so helpful”. Another said “it is difficult to get support staff to accompany an outside event”. Other improvements the residents wanted were the provision of a new large minibus because the current one is getting old and has no tail lift. This will enable them to go out as a larger group than is currently possible. In addition to this they wanted drivers for the minibus to help them get about. Residents also raised concerns about not being informed of the fees they are expected to pay for their resident. The home does not routinely give residents a statement of terms and conditions upon their admission. This means that residents do not necessarily know the cost of their fees or who is paying for them, they do not know the role and responsibility of the provider and they may be unclear about their rights and obligations as a result. One resident commented “we have been asking for a breakdown of fees they give us excuses”. 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. DS0000024843.V334031.R02.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 DS0000024843.V334031.R02.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 good Prospective residents have the information they will need to make a choice about where to live. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at the home’s statement of purpose. It was pleasing to see that it has been updated and reviewed since the last inspection. It now gives an up to date description of the service’s aims and objectives and its philosophy of care. Residents said that they were kept informed about the home and its progress by the staff and they had had the opportunity to read the inspection reports about the home. As part of our case tracking process we also looked at the contracts for some of the residents. we found that there was room for improvement. For example some residents had not received an updated contract for over three years, others had a letter from a funding authority and no contract. Residents have also commented “for years I’ve been asking for a breakdown of fees but I never get one”. This was discussed with the manager who agreed that contracts needed to be reviewed. He was advised that residents should also receive a statement of terms and conditions of residency, that provide clear DS0000024843.V334031.R02.S.doc Version 5.2 Page 10 guidance on fees, the role and responsibilities of the provider (Leonard Cheshire) and the rights and obligations of the resident. It was pleasing to see that all of the residents files were saw had an in depth assessment that contained enough information to form basis for care planning and risk assessment. Each new resident is given the opportunity to spend time at the home on a trial basis but the manager explained that this can be difficult for the resident at times. The home provides a specialist service and as such places are at a premium, prospective residents visit from all areas of the country. In case we noted that the care manager and another member of staff had visited a prospective resident in Surrey to complete a pre admission assessment. On the first day of admission other residents show all new residents around the home. This helps them to settle in and to get a feel for the home from the people who live there. The manager could further enhance this process by writing to prospective residents confirming that the home is able to meet their needs prior to admission. DS0000024843.V334031.R02.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): 6,7,9 Quality in this outcome area is good. People who use this service expect to be supported in making choices about their lives and they will be supported to take risks to promote their independence. This judgement has been made using available evidence including a visit to this service. EVIDENCE: We looked at three residents files are part of the case tracking process. It was pleasing to find in all of them, each residents needs were clearly documented. All plans contain an over view of the needs assessment and provides summaries of individual needs. A more detailed plan of how the home will meet those specific needs is also available. Residents were spoken to and they were able to confirm that they had been involved in the planning and evaluation of their own care. Where possible residents have signed their care plans to demonstrate their agreement with them. Regular reviews of the care plans were seen to be in all files. DS0000024843.V334031.R02.S.doc Version 5.2 Page 12 Information in all cases from physiotherapist was very detailed and sets out very clear instructions for staff and residents about how their needs can be met. These instructions mirrored what the residents said and also other documentation in respect of mobility and some health needs. Discussions with residents, indicated that they have seen the plans and stated that they have improved recently and are easier to understand. The care staff have improved the risk assessment process, we found that risk assessments were clear and concise and had detailed control measures in place. This means that the home is able to demonstrate how they intend to work with residents to reduce risks and promote their independence. Residents were able to confirm their involvement in decision making. One plan detailed a friendship with ex carer who takes a resident out to Speedway and local shopping centres. The resident stated that there are no limitations and he is able to do what he wants. Residents also discussed their involvement in meetings and being good friends with other residents. DS0000024843.V334031.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,15,16,17 Quality in this outcome area is good People using this service have the opportunity to develop and maintain their relationships and are involved in day time activities of their own choice. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home now has an activity coordinator. A range of activities were taking place during the inspection with pieces of residents artwork and painting displayed throughout the home. one relative said “since the activity lady started the whole room is the place to be, I come down here with my son every day to enjoy the atmosphere”. Residents also said that they are enjoying the opportunity to use the home computer “suite” with residents supporting each other to use it. There is still some work to do with the suite before it is finally finished. Most of the residents are having broadband installed in their own rooms. Several residents have keys to the unit this means they can access it as they wish. DS0000024843.V334031.R02.S.doc Version 5.2 Page 14 The new café area has proved to be very popular and is equipped with drinks machine and vending machine. Residents are given tokens to use in these machines this enables them to have drinks and snacks whenever they want them. One resident was very proud of that he had achieved a Diploma in Sociology the previous year. We were also told inspectors that several residents went out every day to day centres. Residents also said that there were a lot of opportunities to go out to a variety of places. Some of the service users were going to the cinema that evening to see Shrek 3. However only a limited number of residents can go out at any time, this is because the home no longer has enough drivers to take residents out. Residents also said that they really needed another minibus so that more of them could go out as a group, rather than a driver having to take a number of trips to enable residents to go. Other residents said that they were looking forward to a number of concert visits that have been planned. Residents also told us that they have started to raise funds for a minibus and have already raised £200 towards their goal. The home has a “pub” that is opened one to two evenings a week staffed by volunteers that residents can go to with their families if they wish. There is also a trolley for toiletries and other items to purchase if residents need them and are unable to go out. Meals and mealtimes generally were satisfactory with many service users commenting on how good the food was. On the day of inspection the kitchen was closed so that repair work could be carried out to the ceiling. Service users had help plan for this closure and had agreed on take away meals for the 3 nights the kitchen was out of action. “I really like egg and chips”, “the café is great we can relax help ourselves and talk to the others”. If residents have been assessed as needing extra help at meal times, for example, the risk of choking is identified, staff have drawn up detailed risk assessments to show how they will manage this and the care plan gives clear guidance to staff so that they are sure they will be helping the resident in a way they prefer. DS0000024843.V334031.R02.S.doc Version 5.2 Page 15 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): 18,19,20 Quality in this outcome area is good People who live in the home have access to health care service both within the home and in the local community. Medication practices have significantly improved offering more protection to the people who live in this home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Residents preferences in respect of the personal hygiene needs are now being recorded into their care plans. Staff have recorded with residents their likes and dislikes for instance the times when they choose to get up and go to bed or when they would like a bath. Each plan is detailed enough to guide staff on how to do this for the resident. Some of the residents we spoke to said “sometimes although the care is planned if the agency nurse comes to help you you do have to tell them what you want”, “the permanent staff are excellent and they know exactly what to do”. “I feel worried at times about who will get me up because they might not know what I want”. This was discussed with the manager who explained that the staffing situation is currently under review and expected to be resolved in the coming months. This should then ensure that residents have the continuity of care they are asking for. DS0000024843.V334031.R02.S.doc Version 5.2 Page 16 At the last inspection concerns were raised about nightime care plans containing too little information to meet residents needs. We found nightime care plans to be descriptive and when we spoke to residents they were able to confirm that they had been consulted about the care needs during the night. They also confirmed the care that had been planned for them takes place but with the odd exception and this is usually when an agency carer is on duty and doesn’t know their needs. Concerns were also raised about the level of care planning for those residents who have swallowing difficulties and the assistance they require. Again we found that care plans had been thoughtfully planned and risk assessments had been completed that demonstrated how the home were going to reduce the risks of choking to those particular residents. In all of the plans we saw we found that every resident has access to health services and other professionals in the community and the home is supporting them to maintain their own health. Residents said that if the doctor comes to see them they are able to see them in the privacy of their own rooms. It was pleasing to find that risk assessments for pressure sore risk development, nutrition, falls and moving and handling were being used. Where an area of risk had been identified, a care plan detailing how that risk was going to be managed had been written. Furthermore we found that any equipment necessary for reducing risks such as pressure relieving mattresses and cushions had also been supplied. This means that staff are now highlighting risks to the residents and taking appropriate action to reduce the likelihood of harm happening to them. Medication practices have improved considerably since the last pharmacist inspectors visit. The manager completes a monthly audit of all medication and as a result is able to stamp out bad practice. Each of the members of staff who administer medicines have been recently reassessed to make sure that they are competent and confident in administering medication. All medicines are now being logged into the home when they are received from the chemist. This enables staff to check if the correct medication has been sent for each resident. A new policy and procedure has been put into operation for the provision of medicines when residents go on social leave and for when they require “homely remedies”, for instance a cough medicine or mild pain relief. We looked at the Medication Administration Record (MAR) for all residents and found that there were generally no gaps in recording, although staff must make sure that they sign when they have administered creams and lotions to residents. Each resident now has an individual profile of the medication so that all staff are aware of their medication regime and of their allergies where appropriate. DS0000024843.V334031.R02.S.doc Version 5.2 Page 17 There were some minor areas that require improvement, for instance staff are now recording the fridge temperatures, this is positive as it means that all medicines requiring cold storage will be keep safely, however staff were only recording the minimum/maximum range and not the actual temperature. When we checked we found that the temperature was 10oC this is higher than is recommended this was bought to the manager’s attention who will address this. Staff should also record the temperature of the treatment room as a matter of good practice to ensure that all medicines are kept at the correct temperatures. DS0000024843.V334031.R02.S.doc Version 5.2 Page 18 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): 22,23 Quality in this outcome area is good People who live in this home can feel confident that their views will be listened to and acted upon. They can feel assured that the staff will protect them from abuse and neglect. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Since the last inspection the home has received 11 complaints, these have included care staff not completing their jobs as expected, the food not being available and the heating not being consistent. The manager has demonstrated that he is able to respond positively to residents and their relatives and works with them so that resolution of any issues can be quickly found. We found that there are clear records of complaints, investigation and outcomes. The manager also completes a monthly audit of complaints in order to identify trends and take appropriate action if needed. Some of the residents and relatives who completed our questionnaires felt that at times the home does fail to address their concerns, they said “complaints are biased in favour of the staff, what may seem trivial to them is important to the residents”, “they promise the moon but nothing gets done I feel like I am talking Chinese at times”. The majority of the residents said “since the new manager has been here, we feel confident to tell him what we feel”, “I know that if I have an issue he will help to sort it out for me”. The home now has all multi agency guidance regarding the Safeguarding of Vulnerable Adults. Staff have received training and there is a good system in DS0000024843.V334031.R02.S.doc Version 5.2 Page 19 place to ensure that those staff who require an update in their knowledge receive further refresher training. The manager has systems in place for the recording and management of Protection of Vulnerable Adults (PoVA) referrals, although none have been made since the last inspection. Residents can have access to their money Monday to Friday, they said that this is a good arrangement and they can see the administrator who gives them the money they need. Each resident has their own personal safe in their bedroom to keep valuables secure. There is no access to their money at weekends because there is no management or administration available to them so some forward planning can be required. This does not cause any concern for residents who said “we know that if we want to go out at the weekend to get all the money on Friday, we forward plan it’s not a problem”. The manager also stated that the home is acting as signatory for residents building society accounts but is taking steps to find them an independent source to ensure that there is no conflict of interest. It was suggested that the manager contact individual residents social workers to discuss this issue and ask them for further advice in how to manage this situation. DS0000024843.V334031.R02.S.doc Version 5.2 Page 20 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, 30 Quality in this outcome area is adequate People who use this service can feel confident that improvements are being made to the environment and that they will have the equipment they require to meet their needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home is spacious and although in part is an old building had been converted and extended to meet the needs of adults with a physical disability. There are a number of lounges around the home enabling residents to choose where they spend their time and if they either want other company or be on their own. There is a large dining room which has the “pub” off it with a bar piano and organ, large widescreen tv for special events. There is also the café which has been recently furnished and residents spoken to said they enjoy taking their friends and families there where they can get a hot drink should when they wish. DS0000024843.V334031.R02.S.doc Version 5.2 Page 21 The home is being refurbished and this is continuing. The Manager agreed that many areas have already been redecorated since he came to the home but due to the size of the home the total refurbishment may take some time. Residents said that all areas of the home and garden are accessible to them, several residents took the opportunity to enjoy the sunny day out in the garden and grounds of the home. On the day of inspection the home was been painted externally and a new kitchen ceiling was being installed. The home has a variety of aids and adaptations such as push buttons at wheelchair height to open doors. Lowered work surfaces in the kitchen that residents use. Overhead ceiling hoists, mobile hoists and pressure relieving mattresses. Doorways are wide and the home is spacious. Furniture is arranged to maximise resident’s access in each room and around the home there by also promoting their independence. The majority of the home is single story although there are some bedrooms upstairs and there is a passenger lift that again can be easily used by residents. There are assisted bathing facilities but several were not in use at the time of the inspection. Residents had also complained prior to the inspection that bathrooms were not always clean. They said “bathrooms are not always cleaned on a daily basis”. We noticed that there was a slight unpleasant odour in some of the bathrooms that should be addressed. Residents also informed us that there are plans to replace the baths that are currently out of service with newer and better models. The manager also confirmed that there are plans for the total refurbishment of the out of action bathrooms. Residents said that they didn’t use the current baths because they didn’t like them and found them uncomfortable. Residents also told us that at times the hot water supply can be unreliable. We checked the recording of hot water temperature throughout the home and found that on occasions hot water temperatures were not reaching the required temperatures. Residents also said that they have portable heaters in their bedrooms because the central heating can also be difficult to control. They said “it’s either red hot or freezing cold so we have these plug in radiators to use”. This was discussed with the manager who said that he was aware of these issues and had taken steps to address this. The home has recently had two new Andrews boilers installed in an attempt to rectify the hot water situation but he has agreed to call the engineer to address the central heating issues. Residents invited us into their rooms to have a look around, they were personalised to their tastes and had their own individual stamp on them. Every resident we spoke to said that they all considered Greenacres to be their home and that they were very happy living there. “this is my home and its great to see that since the new manager has been here things are being done, the internet café is my favourite place at the moment”. The internet café and computer room has been adapted for all residents to use, we saw height DS0000024843.V334031.R02.S.doc Version 5.2 Page 22 adjustable tables, large lettered keyboards and PC’s had been adapted for residents use. There was a good supply of gloves and aprons around the home there was also liquid hand gel outside the majority of bedrooms with a request that everyone washes their hands both before they enter the room and when they leave it. We did discuss with the manager the home’s policy that staff do not wear uniforms, Leonard Cheshire policy is that it is residents home and it is not appropriate that staff wear uniform. The manager did confirm that staff use appropriate protective personal equipment but the risk of contamination of their clothes is high and thought must be given as to how the risk of infection could be minimised, such as staff changing their clothes or having separate clothing for work which they change before they leave the home. Residents and relatives raised concerns about the security of the building. They said at times visitors can enter the building and walk around unchallenged. The manager confirmed that there has been a problem with security and they have taken steps to address this. They have now prevented entry to the bungalow from the front of the property. All visitors now enter the building via the main entrance and are required to sign in when they enter. The home is accessed by automated doors, some residents said that it is possible for people to force the doors open and when this happens they don’t shut properly, this makes them feel vulnerable. The manager did say that this situation is under review and residents will be kept informed through their residents meetings. DS0000024843.V334031.R02.S.doc Version 5.2 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, 35 Quality in this outcome area is adequate People using this service are generally satisfied that they receive the care they need to meet their needs but the use of agency staff needs to be reduced to ensure that they receive continuity of care at all times. This judgement has been made using available evidence including a visit to this service. 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). Staff levels have been reviewed since the last inspection. Previously staffing levels at the weekend were reduced by one carer this has now been increased to ensure that there is no reduction of care staff over the weekend. The Manager also said that he was seeking additional funding to have an extra worker employed for the evening to assist residents between 6 and 11pm. DS0000024843.V334031.R02.S.doc Version 5.2 Page 24 The home has relied heavily on agency staff to supplement staffing numbers, which has been an ongoing concern. The manager said that he had been recruiting more staff and the number of agency usage had consistently decreased over the previous few months. Residents consistently said that the permanent staff were very good but they did have concerns about the some of the agency staff. Residents said that staffing levels do concern them particularly during the evening. One resident said “I go to bed at 4.30pm I do this because I know there will be staff to put me in bed and I won’t have to wait”. Another resident said that at time they were frequently unable to find staff to help them. Other comments included “they need more of their own staff”, “you can never find a carer when you want one”, “lots of agency staff continuity of care is hard to achieve and no one seems to check up on the staff”. “its difficult to maintain services when staff are on holiday, its difficult to get support staff to accompany an outside event”. It is felt that once the home has recruited more staff these issues should resolve themselves but in the meantime the manager needs to look at ways of making sure that residents are not kept waiting too long to have their needs attended to. The manager is also reviewing the skill mix of staff and new posts of “Team leader” and “Senior carer” have been developed to ensure that there are senior and well qualified able to supervise carers at all times. This will assist with the supervision of staff as currently formal (written) supervision does not take place as regularly as required. The staff files of 6 staff and 2 volunteers were reviewed and it was found that there had been a considerable improvement in the recruitment and selection of staff to protect vulnerable people. Staff files were complete having an application form, two written references, proof of identity, record of a criminal record and protection of vulnerable adults check, medical history and terms and conditions of employment the only missing information was a photograph of the member of staff. The Manager has also undertaken a review of files of staff who were employed before he was the manager and is ensuring that all of these files also contained the required information. Records of checks of trained nurse pin numbers are kept separately. There was no record that one nurse pin number had been rechecked when was due for renewal. The manager was confident that it had been updated as re-registration is paid for by the home which is excellent and the manager immediately confirmed by using the NMC web site that it had been updated. Residents also told us that they are involved in the recruitment and selection process for new staff this is very positive. This will also ensure that residents are getting the staff they feel will have the skills to look after them. DS0000024843.V334031.R02.S.doc Version 5.2 Page 25 All new staff have induction training with evidence of that within staff files. It was also pleasing to see that all staff have there own “personal Development folder” that details all training that they have received. The number of care staff who have completed an National Vocational Qualification (NVQ level 2) was supplied by the manager prior to the inspection. Of the current 33 care staff 10 have achieved this. There needs to be an improvement in this number so that the home can reach a minimum target of at least 50 of its care staff having obtained an NVQ. DS0000024843.V334031.R02.S.doc Version 5.2 Page 26 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 Quality in this outcome area is good People who live here can expect to be consulted about the running of this home. They can also expect that their health, safety and welfare will be protected. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The manager of the home has been employed at Greenacres since September last year. During this time he has taken significant steps to improve the service provision for the residents and is currently going through the registration process with the CSCI to become the registered manager for Greenacres. Residents said that they felt confident that things would continue to improve. “we have seen many improvements since he came”, “i find that he is approachable and helps to sort any issues I have”. DS0000024843.V334031.R02.S.doc Version 5.2 Page 27 The home continues to work on its quality assurance system. They are now completing regular monthly audits that include health and safety, medication and care planning. The manager also informed us that the home has been selected to pilot an individual service plan research project which will focus on person centred care planning. All staff will be given a two day training opportunity to learn about what person centred planning is and then to learn how to put it into practice for the benefit of the residents. Residents have been consulted about the running of the home when they completed a questionnaire about their views in early January. The results of this survey have been collated and an action plan drawn up to show how the home intends to meet the issues that have arisen as a result. Regular residents meetings are now being held and this gives them the opportunity to discuss any issues they may have. The home continues to ensure the health and safety of its residents by making sure that all safety checks are up to date, that staff receive the required mandatory training and ensuring that all accidents and incidents are recorded. One resident in the home is also part of the health and safety committee this further endorses the residents involvement in the running of the home. DS0000024843.V334031.R02.S.doc Version 5.2 Page 28 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 3 2 3 3 X 4 3 5 2 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 2 25 X 26 X 27 X 28 X 29 2 30 2 STAFFING Standard No Score 31 X 32 2 33 1 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 X LIFESTYLES Standard No Score 11 X 12 3 13 3 14 2 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 2 X 2 X X 3 x DS0000024843.V334031.R02.S.doc Version 5.2 Page 29 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard YA20 Regulation 13(2) Requirement Residents medication that requires cold storage must be kept at the recommended temperature. The irregular hot water supply and central heating must be addressed so that residents are able to access enough hot water and have sufficient heating for their needs. Timescale for action 01/08/07 2 YA24 23 (2) (j) (p) 01/08/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard YA3 YA5 Good Practice Recommendations Residents receive a conformation letter off the home stating that they are able to meet their needs. Resident’s contracts are reviewed so that they can be clear of the fees they are required to pay, the role and responsibility of the provider and their rights and obligations whilst living at the home. Staff must keep records of the treatment room temperature so that residents can be sure medicines are being stored as recommended. DS0000024843.V334031.R02.S.doc Version 5.2 Page 30 3 YA20 4 5 YA24 YA33 The home must produce a refurbishment/redecoration plan so that residents can see what improvements are going to be made to the home and when. Plans for the recruitment of staff must continue so that residents can feel confident they will receive the continuity of care they are asking for. DS0000024843.V334031.R02.S.doc Version 5.2 Page 31 Commission for Social Care Inspection Birmingham Local Office 1st Floor, Ladywood House 45-46 Stephenson Street Birmingham West Midlands 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 - 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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