Inspection on 12/06/07 for Greenauns

This inspection was carried out on 12th 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 there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Greenauns 21/04/08

Greenauns 01/06/06

Greenauns 08/03/06

Greenauns 27/09/05

Greenauns 29/11/04

Greenauns 13/07/04

Greenauns 09/03/04

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

CARE HOMES FOR OLDER PEOPLE Greenauns 81 Fountain Road Edgbaston Birmingham West Midlands B17 8NP Lead Inspector Ann Farrell Key Unannounced Inspection 12th June 2007 08:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenauns Address 81 Fountain Road Edgbaston Birmingham West Midlands B17 8NP 0121 420 3361 F/P 0121 420 3361 greenaunscarehome@yahoo.co.uk 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) Mrs Mary Loftus Mr James Patrick Loftus Mrs Mary Loftus Care Home 8 Category(ies) of Old age, not falling within any other category registration, with number (8) of places Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. The home is registered for 8 service users requiring care and accommodation for reasons of old age. The home may accommodate one named service user who at the time of admission was under 65 years of age. The home may accommodate two named service users who have dementia until such time that their needs are no longer met at the home. No other service users suffering with dementia will be admitted to the home. 1st June 2006 Date of last inspection Brief Description of the Service: Greenauns is a small family run home for eight older people situated in a residential area of Edgbaston. The home is a five- minute walk from the main Hagley Road, from which one can travel into Birmingham by bus in one direction. In the other direction one can travel to Kidderminster and access the M5 motorway. The home is registered to care for older people who are frail and require 24hour care, excluding people in need of care for reasons of dementia, learning disability and other categories. It provides a homely environment with consistent carers who know the residents well. There are two double bedrooms and four single rooms decorated in individual style and with people’s personal belongings evident. All of the bedrooms have an en-suite facility consisting of toilet and wash hand basin. A lounge/dining area is situated on the ground floor that leads on to a small conservatory, which overlooks the garden. The garden is flat, has a patio plus table and chairs where residents can sit when the weather permits. A bathroom is situated on the ground floor that has an assisted bathing facility, but there is limited space. A stair lift gives access to the first floor and grab rails are available in toilets to provide assistance to residents with mobility problems. The home is generally well maintained with off street parking for two cars to the front of the property. Staff have developed some information for prospective residents and their representatives to inform them of the facilities available, but further development is required to ensure it is up to date. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 5 The current charges range from £314 to £346 a week. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The fieldwork inspection was conducted over one day commencing at 8.30am and staff were not aware of the inspection prior to the inspector arriving. A senior member of staff was available for the duration of the inspection. During the fieldwork two members of staff, three residents and two visitors were spoken to. The feedback from residents and relatives was very positive: relatives stated it was a homely environment; they were made welcome when visiting. This was the first statutory key inspection for 2007/2008. Information to inform the inspection included a tour of the building, sampled resident’s files and other documentation in relation to the management of the home. Case tracking was undertaken in respect of three residents, which included discussion with the resident, inspection of their room, any equipment used to meet their needs plus records in respect of care, medication, accidents, finances etc. to determine care from the time of admission. Plus direct and indirect observation was used, as some of the residents were unable to communicate their views verbally. Information was also utilised from the pre inspection questionnaire, which was provided by the home prior to the fieldwork visit. What the service does well: The home continues to provide care to the residents in a homely environment in a family setting. Residents stated that they were happy with the food provided. One resident stated “They give you more than enough; I have put on weight since of have been here”. Residents were happy living in the home and stated, “Staff do very well and I receive help when they need it”. There had been no changes in staff who know the residents well, so providing good continuity of care for the residents. . Visitors stated they could visit at any time to suit themselves so residents can maintain links with family and friends. They stated they were made welcome by staff and were offered a drink plus biscuits. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 7 The feedback from relatives/friends was positive and one stated, “She has thrived since she has been here, she seems to be happy and never had any complaints/concerns. “Staff are very pleasant, you can have a laugh with them. A letter stated, “It is home from home, the staff are quick to get medical attention and provide individualised care and attention”. Good, personalised care plans were available for residents, so ensuring staff have the information required to meet their needs. Health care needs are met with regular visits from health professionals and reviews by the G.P. There was evidence of pressure relieving equipment in place reducing the risk of pressure sores and demonstrating liaison with the district nurse team. The management of medication was of a good standard so ensuring residents receive the medication prescribed. Concerns/complaints are taken seriously and acted upon to address concerns and ensure they are not repeated. What has improved since the last inspection? Staff have worked hard since the last inspection and there have been a number of developments. The proprietors have purchased a new computer, which has assisted in developing some of the records, care plans etc. so ensuring they are more accessible and auditable. There have been improvements in the assessment and care planning system so ensuring resident’s needs are identified and care plans drawn up outlining the action required by staff to meet residents needs. Regular comprehensive reviews are undertaken, so ensuring residents needs are monitored and changes made where necessary. Staff have started undertaking risk assessments in respect of tissue viability, nutrition etc so ensuring any risks are identified and appropriate action taken to reduce risks to residents. Staff have developed the range of equipment for indoor activities to include a range of DVD’s, CD’s and reminiscence material so providing a more stimulation for residents. The procedures for the protection of residents have been reviewed and updated and there is a record of concerns raised demonstrating residents are listened to and an open approach to concerns. Some new items for furniture had been purchased and a carpet replaced so enhancing the environment for residents. A lock has been fitted to one of the bedroom doors so enhancing arrangements for privacy. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 8 Two member of staff are currently undertaking the Registered Managers Award and some training has been undertaken in respect of tissue viability, nutrition and palliative care so providing staff with the knowledge and skills to meet residents needs. The arrangements for the servicing and maintenance of equipment have been undertaken in a timely manner ensuring residents, visitors and staff are protected. Feedback from residents and relatives are sought as part of the quality assurance process, so that staff can review services and make improvements in line with resident’s preferences and expectations. What they could do better: The statement of purpose and service user guide could be enhanced so providing prospective residents and their representatives with comprehensive up to date information about he services and facilities, so enabling them to make an informed choice about moving into the home. Further improvements in the activities outside the home would provide more variety and stimulation for residents. Suitable bathing facilities are required on both floors to enhance privacy and accessibility for residents with mobility problems. Further re-decoration of bedrooms is required to enhance the environment for residents to live. An audit of linen, pillows and mattresses should be undertaken and items replaced where they are worn/torn etc to ensure residents comfort. All staff must undertake updated core training in respect of fire prevention, basic food hygiene, infection control, moving and handling plus first aid to ensure they have the appropriate skills and knowledge to care for residents. Obtaining feedback from other stakeholders in order to further develop services should enhance the quality assurance system. A review of staffing rotas should be undertaken to ensure arrangements so not impact on standards of care and staff health and is not in breach of the working time directive. Please contact the provider for advice of actions taken in response to this Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 9 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. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 10 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 11 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,6 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The information about the services and facilities needs further development to enable prospective residents and their relative’s make an informed decision about moving into the home. The admission process was found to be satisfactory providing confidence to prospective residents and their representatives that the home is able to meet their needs. EVIDENCE: The home admits residents for long term care or respite care only. Senior staff have been developing the service user guide in order to provide prospective residents and their representatives with information about the services and facilities to enable them to make an informed choice about moving into the home. Some work has been undertaken in respect of the statement of purpose, but further work is required to ensue it is comprehensive and up to date. The manager has stated in the pre inspection information provided that Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 12 they plan to develop this document and the welcome pack for residents, which will be in colour and with pictures. The welcome pack (service user guide) will benefit from colour and pictures and consideration should be given to large print or alternative formats to ensure it is suitable for the client group. Contracts of residence were available for residents informing them of the terms and conditions of their stay in the home. The records in respect of one resident who had been admitted some time ago were inspected and found to good range of information about the resident to enable staff to determine if they can meet their needs. However, the document was not signed and dated to demonstrate when it was undertaken and by whom. The manager stated in the pre admission information that they had improved the process and routinely ask for an assessment from any placing authority now. The inspector did not see any information indicating that they had written to the prospective residents or their representative confirming that they could meet the persons needs so providing them with confidence that their needs could be met before moving in to the home. The senior member of staff stated prospective residents may visit the home prior to moving in and move in on a trial basis. They also consult the residents who are already living in the home about any prospective admissions, as it is a small home and the relaxed family atmosphere is an important element to be maintained. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 13 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Suitable arrangements are in place to meet resident’s health care needs. The care planning system and records were generally of a good standard and demonstrate that staff have a good knowledge of residents and their needs. The management of medication was good ensuring residents receive the medication prescribed by health professionals. . Residents are treated with respect and their privacy is respected. EVIDENCE: Staff draw up a care plan for residents following admission to the home outlining the action required by staff to meet residents needs. The records included risk assessments in respect of tissue viability, nutrition, manual handling etc. in order to determine any risk and implement appropriate action to reduce the risks. However, risk assessments were not consistently completed for all residents. Risk assessments had been completed in respect of other areas when risks had been identified e.g. swallowing and instructions were available. Although the instructions were in the folder they were not with Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 14 the care plan to enable easy access to information. When all assessments and risk assessments are completed the action required by staff to reduce the risk should be brought together in the plan of care to ensure it is easy for staff to use. The care plans were reviewed regularly and the information in both areas was of a good standard. The daily records of residents progress were good giving information about the activities undertaken, mood etc. but there was no evidence that other areas of the care plan had been implemented e.g. personal hygiene, if diet and fluids are taken well etc. It is recommended that these areas be included. On inspection it was noted there were some discrepancies with the tissue viability risk assessment, which could lead to inappropriate action being taken. It is recommended that this be reviewed and further training undertaken where appropriate to ensure all residents needs are met in respect of skin care. It was noted that draw sheets were used on some beds in order to protect them in cases of incontinence. However, these are no longer considered to be good practice in respect of tissue viability and the use of these should stop. Staff also use Kylie sheets and incontinence pads at night for residents with continence problems. It is recommended that the continence adviser be consulted about this practice as it is usually advocated that only one method of protection is used at night. All residents are registered with a local G.P. and records indicated the G.P. had reviewed the residents twice last year. There were also regular visits by the chiropodist and optician, but there was no evidence of visits by a dentist. It was stated that some of the residents had complained about the service provided by some of the visiting health professionals and staff were seeking alternatives. The home had pressure relieving and pressure reduction equipment in use to reduce the risk of any pressure sores developing, some of these having been obtained from the district nurse. Residents have the opportunity to have a flu vaccination in order to reduce the risk of infection, but evidence of written permission was not seen. It is recommended that this be obtained from residents or their representatives. On discussion with relatives they stated, “ She has thrived since she has been here”. Residents weight was being monitored regularly to determine if there were any fluctuations, so that appropriate action could be taken if there was weight loss. Where this was not possible alternative methods of monitoring residents weight were being used and they were stable suggesting resident’s health status was being maintained satisfactorily. One residents walking frame, that is used to aid mobility, was found to have the rubbers on the feet worn and these will need to be renewed to reduce the risk of any accidents occurring. It is recommended that a system of checking rubbers on frames be introduced. The home uses a monitored dosage system of medication, which is stored appropriately. On inspection of the medication it was found to be of a good standard and all audits were accurate. There was no record of any medication Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 15 returned to the pharmacist as it was stated that no medication had been returned. Staff must keep a record of any medication that is returned or destroyed to enable full auditing to be undertaken. On discussion with a member of staff they were not fully aware of the action of medication being administered to residents. All staff who administer medication must have a basic knowledge of the medication they give to residents and the common side effects in case of any problems occurring in relation to the medication. There was screening available in shared bedrooms and all bedrooms had ensuite facilities consisting of a toilet and wash hand basin. One bedroom had a lock provided to the door to enable it to be locked if the resident wished so enhancing privacy. It was stated the current residents in the home did not want a lock to their door. It is recommended that any new residents be consulted regarding their wishes for a lock to the door and this be recorded in their records. Staff were seen to spend time with residents, interact well and treat them with respect. The feedback from residents indicated that the staff listen to them and are always available to help them when they require. One resident stated “ a nice young lady helps me with a bath”. Residents were observed to be nicely presented and dressed appropriately for the season, their gender and culture. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 16 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is a homely atmosphere with no restrictions. There have been improvements in respect of activities within the home providing residents with more stimulation. Visitors can visit at a time that suits them and are made welcome. So residents are able to maintain contact with family and friends. The menus indicated a variety of nutritious meals. EVIDENCE: There was no evidence of any restrictions and residents were free to come and go as they wish and assistance was provided where required. Visiting is flexible enabling relatives and friends to visit at a time that suits them so residents can maintain contact with family and friends. On discussion with visitors they confirmed they could visit at any time and always received a drink and biscuit. They stated, “Staff are very pleasant you can always have a laugh and joke with them”. “ It’s a family atmosphere and you mix with all the residents when you visit. They stated there was always staff available and they could use the conservatory if they wished to speak in private. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 17 Residents are able to bring personal items of furnishings etc into the home providing a home from home atmosphere. There was evidence that one resident went out to the shops with a member of staff. Other residents sat in the lounge watching television, films, chatting to the staff and having their nails manicured. There were a range of games, DVD’s, videos and CD’s available to play. Some of the residents really enjoyed the quiz programmes on the television and staff sat watching the programmes with them, so providing a family atmosphere. Since the last inspection some action has been taken in respect of reminiscence work and there is a reminiscence corner in the lounge with a range of books etc., enabling staff to discuss areas of interest from the past with residents. Records indicated that special days just as Christmas, birthdays, Halloween, St Patrick’s Day and the Eurovision are celebrated in house. The information provided by the home indicated that they hoped to improve exercise sessions for residents and provide more outings that are less functional and more fun. Staff have commenced meetings with residents in order to gain feedback about their preferences and choices enabling residents to have some control over their lives. Records were available to demonstrate this The staff retain a record of food taken by residents and they undertake reviews in respect of meals on a regular basis. Lunch was observed and staff gave residents a choice of meal and drinks. Assistance was provided where required and appropriate to residents needs to enable independence to be maintained where appropriate. On discussion with residents they stated they enjoyed the meals. One resident stated “ You get more than enough to eat; I have put on weight since I have been here”. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 18 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Quality in this outcome area is good This judgement has been made using available evidence including a visit to this service. The residents were safeguarded by the policies and procedures in the home. EVIDENCE: The Commission had not received any complaints about the home. Staff in the home had recorded ten concerns that had been raised and had taken action to address them. On discussion with residents they stated they had no complaints and they were aware of whom to speak to in the event of a complaint. Visitors stated they had never had any complaints or concerns. There was a suitable complaints policy in place at the home. Two members of staff who are undertaking the Registers Managers Award had completed training in respect of safeguarding residents and were aware of the action to take in the event of any allegation. They were going to pass the training on to other members of staff. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 19 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25,26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The physical layout of the home was suitable for the current residents needs as they have adequate mobility to move around the home. There were some adaptations in the home to assist in meeting residents’ needs. EVIDENCE: Greenaums is a detached three-storey building with off road parking for two cars to the front of the property in a quiet residential area. A CCTV camera is in place for the external perimeter of the home and also the landing area for added security reasons. Care must be taken to ensure this does not infringe resident’s privacy. Accommodation is provided for eight residents over the ground and first floor. The second floor is used as a private flat for staff who sleep in on night duty. The home was fairly well maintained warm, odour free with a homely atmosphere providing a home from home environment. Cleanliness was of an Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 20 adequate standard, but more attention was required to areas of deep cleaning e.g. behind beds to reduce the risk of infection. Communal accommodation consists of a lounge/dining room and conservatory, which was homely and domestic in character. An electric fire was in the lounge with a fire surround, but the surround was not adequately secured and this will need to be addressed to reduce the risk of accidents. There is one assisted bathing facility on the ground floor and no bathing facility on the first floor. The bathroom on the ground floor was small and although it had a chair lift it was only suitable for individuals with a fairly good degree of mobility. Information provided by the manager indicated that they hope to provide a new shower room on the ground and first floor to enhance bathing facilities. Corridors are narrow with grab rails to assist residents with mobility problems. Access to the first floor is by a stair lift, which has one step at the top of the stairs that needs to be negotiated by residents; therefore residents need to have a degree of mobility to assess the first floor. The home has four single bedrooms and two double bedrooms all with en-suite toilet and wash hand basin. All bedrooms have a call bell system to enable assistance to be summoned when required and double rooms have curtains between beds to provide privacy. However, some of the en-suite areas were rather small and did not have a call bell and this will need to be addressed to enable assistance to be summoned if required. Some bedrooms did not have lockable facilities for the storage of valuables or medication etc. It is recommended that all residents be consulted about having this facility. All new residents are consulted about a lockable facility before moving into the home and records retained. Some of the linen was found to be worn/damaged and some pillows were thin/lumpy. A mattress was found to have bottomed out and was not suitable for use. All linen, pillows and mattresses must be reviewed and replaced where necessary to ensure residents comfort. It was also noted that residents clothing was on the floor of the wardrobe. This practice should be reviewed and suitable systems put in place to ensure appropriate respect and care of residents clothing and adequate furnishings are provided to accommodate all residents belongings. Since the last inspection a lock has been fitted to one of the bedroom doors to enhance privacy. During the inspection a range of new furniture was delivered, which will enhance the environment for residents. Whilst touring the home it was noted that washbowls in resident’s rooms were stored on the floor. Although wall mounted soap dispensers were in evidence they were not always in use and small bottles of liquid soap were on wash hand basins. It is recommended that one system should be used giving priority to the wall mounted variety for safety reasons. Also washbowls should be stored off the floor for infection control purposes. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 21 Bedrooms are individually and naturally ventilated and windows are provided with restrainers for safety and security reasons. Radiators and the temperature of water from hot water taps were controlled to reduce the risk of scalding. There is a domestic style kitchen and laundry, which was adequate. It was noted that the foot operated waste bin the in the kitchen was broken, the fridge required more thorough cleaning plus food items and sauces had not been dated when opened to ensure they were used within appropriate timescales. All these areas need to be addressed to ensure adequate hygiene standards in the kitchen. There is a pleasant garden to the rear of the property with patio, table and chairs for use when the weather permits. There is a summerhouse and gated area to the bottom of the garden where items for removal were stored. However, the bolt on the gate was broken and the fence was unsteady. It was stated that residents do not use the garden unsupervised and this was recorded in the risk assessments. However, it is recommended that the gate and fencing be repaired. The information provided provided by the managers indicated that they hope to purchase some new garden furniture and to renew the paving so that it is even, so reducing the risk of any trips/falls when out walking. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 22 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. There was a consistent staff group who had been working in the home for a number of years and were well aware of residents needs. Some staff had undertaken training, but this needs to be extended to all staff to ensure they have the skills and knowledge to care for residents living in the home. EVIDENCE: The duty rota indicated there was two staff on each shift during the day and one staff awake overnight plus a sleep in member of staff and the staff team consisted of the four family members and a friend. All the staff undertook a multi-task role including care, cooking, cleaning and laundry. Although this provides an adequate number of staff on each shift it was noted that some of the staff were working a night duty followed by a day duty. This may have an impact on staff’s health and safety plus resident care during the day. The working time directive states there must be a break of eleven hours following a night shift. It is recommended that this is closely monitored, the rota be reviewed and regular checks made in respect of staff health. The home has not recruited any staff recently for a number of years. However, a senior member of staff, who is undertaking the Registered Managers Award, has drawn up a recruitment policy for future employment of any staff and an application form and health declaration needs to be developed to ensure a robust procedure. Records and criminal record checks had been Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 23 undertaken for current staff. Staff records must include the date of commencement and hours worked. . Records of staff training indicated that two staff had undertaken NVQ 2/3 in care and were currently undertaking the Registers Managers award. They had also undertaken training in respect of nutrition, manual handling and food hygiene in 2006. However, other training in respect of fire prevention, health and safety first aid etc had been undertaken in 1996 and is now out of date. There were no records of training for other staff currently working in the home. All staff must undertaken updated core training in respect of fire prevention, manual handling, infection control, basic food hygiene and there must be a least one first aider on each shift to ensure staff have the appropriate skills and knowledge to meet residents needs. No new staff have been employed by the home for many years and therefore there were no records of induction training. However, the inspector was shown a copy of the induction training that would be used if a new member of staff commenced employment. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 24 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38,Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The day-to-day needs of the residents were being met and the management of health and safety was of a good standard. EVIDENCE: The manager was not available for the inspection and it was stated that their son was to take over the management when the Registered Managers Award is completed, which should be within the next few months. The staff in the home have received feedback from relatives in the form of letters, which were positive. One stated, “It is home from home, the staff are quick to get medical attention and provide individualised care and attention”. There were records of feedback from residents and some audits had been undertaken with a plan of developments for the year ahead forming part of the Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 25 quality assurance process. It is recommended that this be developed further to include feedback from other stakeholders e.g. visiting professionals etc. There was no formal supervision for the staff however the individuals had daily contact with each other. The inspector was informed that the home did not manage any monies on behalf of the residents. Since the time of the last inspection the proprietors have purchased a computer, which has aided in the development of some of the records and documents. They also have access to information from the Commission’s website, which they use to inform them of changes and requirements etc. The health and safety of residents, staff and visitors are well protected by servicing and testing of equipment and fittings. All fire safety tests and routine tests of electrical, gas and lifting equipment had been undertaken and were satisfactory. It was noted that the following areas need to be addressed to ensure robust safety procedures: • In house testing of fire points should indicate which point is tested so ensuring they are all tested in rotation. • Risk assessments need to be undertaken in respect of cleaning materials. • Staff knowledge of the procedure to follow in the event of a fire was not adequate to ensure the safety of residents in the event of a fire. This will need to be addressed through training. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 STAFFING Standard No 27 28 29 30 Score 2 3 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 9 10 11 2 3 2 X 3 2 3 2 3 2 3 X 3 2 2 2 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X N/A x X 2 Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP7 Regulation 13(4) 17(2) Requirement The tissue viability, manual handling and nutritional risk assessment should be completed for all residents in the home and reviewed on a regular basis. This ensures risks are identified and appropriate action can be taken to reduce the risks. Timescale 14/7/06 not met A review of the tissue viability assessment must be undertaken and provide a clear audit trail of findings and action required. Training should be provided in this area where required. Systems must be in place for all returned or destroyed medication to be recorded to enable auditing to be undertaken. All staff who administer medication should be aware of the reasons for administration and common side effects of medication to ensure the safety of residents. Accredited training should be provided where necessary to Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 28 Timescale for action 30/07/07 2. OP8 12(1)(a) 18(1) 30/08/07 3 OP9 13(2) 30/07/07 4 OP19 13(3) 5 6 OP20 OP21 13(4) 23(2)(n) 7 OP22 23(2)(j) (n) 8. OP24 16(2)© 9 OP24 16(2)© 10 OP30 16(2)(j) 17(2) 11 OP30 13(5) 17(2) ensure staff have the appropriate knowledge. Appropriate standards of hygiene must be maintained in the kitchen to include: • The fridge is kept clean at all times. • All food items and sauces are dated when opened and used within specified time limits. • A foot operated bin is available and in working order. Ensure that the fire surround in the lounge is secured to reduce the risk of any accidents. Suitable assisted bathing facilities must be provided on all floors where residents live to enhance privacy. Ensure a call bell is accessible to all areas used by residents e.g. en-suite facilities etc. to enable residents to summon assistance if required An audit of all linen, pillows and mattresses must be undertaken and items place that are worn/damaged to ensure residents comfort when in bed. Review all wardrobes in bedrooms and ensure they are adequate to accommodate residents clothing etc. All staff must undertake training in respect of basic food hygiene and records must be retained in the home to ensure staff have the appropriate knowledge and practice to maintain adequate hygiene standards in the kitchen and when handling food. Timescale 30/6/06 not met. All staff must undertake updated training in respect of moving and handling residents, systems must be in place to ensure good DS0000016770.V342765.R01.S.doc 30/06/07 30/06/07 30/12/07 30/12/07 30/08/07 30/08/07 30/09/07 30/07/07 Greenauns Version 5.2 Page 29 12 OP30 13(3) 17(2) 13 OP30 13(4) 17(2) 14 OP30 23(4) 17(2) practice at all times to ensure residents safety and records must be kept in the home. Timescale 1/8/06 not met. All staff must undertake training in respect of infection control, systems must be in place to reduce the risk of cross infection and records must be kept in the home. Timescale 30/6/06 not met. Staff must undertake training in respect of first aid and there must be one first aider on each shift to ensure residents receive appropriate treatment in the event of an accident. Timescale 30/6/06 not met. All staff must undertake updated training in respect of fire prevention and fire drills at least twice a year and be able to demonstrate the action to take in the event of a fire to ensure residents safety in the event of a fire. Timescale 30/6/06 not met. 30/10/07 30/09/07 30/07/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP1 Good Practice Recommendations The statement of purpose must include all the information required in Schedule 2 of the Care Homes Regulations including the needs of residents that can be met in the home. The manager should confirm in writing if they are able to meet prospective residents needs before moving into the home to provide them with confidence that their needs will be met upon moving into the home. DS0000016770.V342765.R01.S.doc Version 5.2 Page 30 2 OP3 Greenauns 3 4 OP3 OP7 5 6 7 8 9 10 11 12 13 14 OP7 OP8 OP8 OP8 OP8 OP9 OP10 OP19 OP19 OP24 15 OP26 16 17 18 19 OP26 OP27 OP29 OP29 All pre-admission documents should be signed and dated by the staff undertaking the assessment to indicate the date it was completed and by whom. All action required by staff to meet residents needs should be compiled in one area of the care plan and they should be signed and dated to ensure the information is easy to access by all staff. All daily records should indicate all aspects of care provided to residents to demonstrate care plans have been implemented and resident’s needs met. All residents should be given the opportunity to see a dentist on a regular basis and records retained in the home. The use of draw sheets on beds should cease in line with good practice to prevent risk of pressure sores. The continence adviser should be consulted about he use of Kyle sheet and incontinence pads to manage continence at night to ensure good practise guidelines are followed. Undertake a review of walking frames and ensure any worn rubbers are replaced to reduce the risk of accidents. Written consent should be obtained for all residents who have a flu vaccination to demonstrate their informed consent. Residents should be consulted about their wishes in respect of locks to bedrooms doors to enhance privacy. A review must be undertaken in respect of the garden gate and fencing in the garden to ensure it is safe and fit for purpose. Ensure the use of the CCTV camera does not impact on resident’s privacy. All residents should be consulted about their wishes in respect of having lockable facilities. All new residents should be consulted during the pre admission process about a lockable facility and provided where requested. The systems for the management of deep cleaning must be reviewed and action taken to ensure it is implemented on a regular basis to ensure adequate hygiene is maintained in the home. Washbowls must not be stored in the floor and the hand washing systems reviewed to ensure the risk of infection is reduced and safety maintained. A review of the staffing rotas is undertaken with a view to reducing the times members of staff work a night shift followed by a day shift. Ensure the recruitment process includes the development of an application form and health declaration. All staff records should include the date employment DS0000016770.V342765.R01.S.doc Version 5.2 Page 31 Greenauns 20 OP33 21 22 OP38 OP38 commenced, the hours worked and proof of identity. The quality assurance process should be developed to include feedback from other stakeholders e.g. visiting professionals to enable a greater range of feedback in order to develop standards. The record of fire point testing should indicate which point is tested to ensure they are all tested on a regular basis. Risk assessments must be undertaken in respect of the cleaning chemicals used in the home to reduce any risks to staff and residents. Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 32 Commission for Social Care Inspection West Midlands Regional Office 1st Floor Ladywood House 45-56 Stephenson Street Birmingham B2 4UZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenauns DS0000016770.V342765.R01.S.doc Version 5.2 Page 33 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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