CARE HOMES FOR OLDER PEOPLE
Greenford 260-262 Nelson Road Gillingham Kent ME7 4NA Lead Inspector
Graham Cummings Announced Inspection 7th March 2006 10:00 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 Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for 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. Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION
Name of service Greenford Address 260-262 Nelson Road Gillingham Kent ME7 4NA 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) 01634 580711 Mr Cemal Osman Vacant Care Home 18 Category(ies) of Dementia (18) registration, with number of places Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION
Conditions of registration: Date of last inspection 7th July 2005 Brief Description of the Service: Greenford is home to 17 service users with dementia. The home itself is situated in Gillingham adjacent to Gillingham Park, which can be accessed via the back courtyard. The home has mainly single rooms, two having en-suite facilities, day areas have a homely feel even though it is open plan in design. The main town of Gillingham offers High Street shopping and a mainline railway station. The home itself is on a bus route. There is limited parking to the rear of the home. Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Graham Cummings carried out the Announced Inspection on the 7th March 2006. The inspection consisted of discussions with the acting Manager and another Home Manager from Charing Health Care as well as the cook and one member of the care staff. The Inspector received a completed Pre Inspection Questionnaire and three Relative Comment Cards, the Inspector looked around the home and viewed three staff and three Service User files. The home was welcoming and had a relaxed atmosphere. The home has not had a Registered Manager since September 2005 and is currently being managed by the Deputy. There were nine Requirements from the last inspection in July 2005. Of these a Statement of Purpose has been written but there is still a need for an easy to read Service User Guide. The home does have individual care plans in place and these are used throughout the company however they are quite repetitive in the information they contain. The medication storage has not been addressed and the small trolley is still used. Some of the Health and Safety issues raised have not been addressed and these still need to be completed. The Inspector looked at three staff files and those seen had been updated and complied with the Regulations. New commodes have been purchased for Service Users’ rooms but some of the furniture is in poor repair with the back of a wardrobe not fixed appropriately, wall tiles loose and dirty in the kitchen. The Acting Manager has improved the home in areas of care and positive outcomes for Service Users that she is able to control but has not had any formal supervision. The majority of the work from the last inspection is still to be addressed and needs to be carried out by Charing Health Care. The work has been requested but they had not carried out any work at the time of the inspection. The kitchen has to cater for eighteen Service Users plus staff but has only got an average household four burner stove and oven. The Inspector was informed that when all 4 burners were in use other cooked items had to be left on the side as no other form of equipment to keep the food warm was available. The Kitchen sink is too low and is likely to cause injury and backache for staff when washing up and the fridge is not large enough to cater for eighteen Service Users. The Inspector left the home with concerns that the poor environment was having a detrimental effect on the positive care that the Acting Manager was trying to implement. The company employs one Maintenance person to deal with the nineteen homes owned by them. At the end of the report the Inspector has listed the findings of the Inspection under three Requirements and not individually. The Provider should send an Action Plan to the Inspector of how they are to deal with the Environmental Requirements made. Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 6 What the service does well: What has improved since the last inspection? What they could do better:
The home has not had a Manager since September 2005 and has been run by the acting Manager. The Inspector was concerned by the limited support given to the acting Manager who has received no formal supervision. The issue regarding the safe keeping of medication and the dispensing from the trolley still needs to be addressed. The last report stated that ‘improvements to the environment were seen as a priority’. The Inspector found furniture in some of the bedrooms was in poor and dangerous condition, with the back of a wardrobe hanging away and a nail exposed. One of the toilets had a toilet roll holder and grab rail that were in poor condition and rusty. There were no controls on the hot water outlets in Service Users’ bedrooms. There were no locks on Service Users’ doors and redecoration of at least seven bedrooms is required. There were holes in some walls and some wallpaper was ripped. Of more concern was the fact that when the washing machine was filling with water it stopped the water flow to the kitchen, downstairs bedrooms and
Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 7 bathrooms. The Inspector was viewing a bedroom when the sound of ‘bubbling’ water came from the sink. The Inspector was informed that when the washing machine was filling or emptying this occurred. Since the washing machine is used during the night by wake night staff the Inspector was concerned that the Service Users sleep would be frequently disrupted. The kitchen was in poor condition with tiles coming away from the wall and the sink was a Health and Safety hazard due to its height. The cooker and fridge were of an inadequate size. The Inspector was told that there were frequent occasions when pans of food had to be put on the work surface due to lack of space on the cooker as it was a ‘normal’ 4 ring and there was nowhere to keep it warm. The fridge was of a ‘normal’ family size and often food was inappropriately stored in it in such a way that it did not meet food hygiene standards. 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. Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 8 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 Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,5,6 Prospective Service Users have the information they require to make an informed choice about where to live. Service Users cannot be confident that they have fully completed written contracts on file. Prospective Service Users can be confident that they will be invited to visit the home and that their needs will be properly assessed prior to their placement. EVIDENCE: The Inspector was given an updated Statement of Purpose and informed that an easy to read Service User Guide was being prepared. Service Users have written contracts on file, the acting Manager went through the admissions procedure that she would follow and these met with good practice and included visits to the home with family members included. The home does not cater for intermediate care or rehabilitation of Service Users. Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 10 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,9,10 The Service Users benefit from having their own individual plans of care. Service Users can be confident that their health care needs will be met. Service Users can be confident that they will be treated with respect. EVIDENCE: All of the Service Users have an individual care plan that contained relevant information. However, there was a lot of repetition of information and the document could be streamlined. Service Users’ families are now involved in the process. The Inspector was shown a new care plan that the company are looking implement soon. This was a larger document than was being used and still contained a lot of duplicate information. The Service Users are all registered with a local Doctors, Dentists and Opticians. A Chiropodist the home visits at regular intervals. Staff monitor Service Users weight on a monthly basis and this is recorded. None of the Service Users self medicate although the home does have relevant policies and procedures in place should the occasion ever arise. A pharmacy inspection was carried out in February and the Requirements from this need to be implemented. During the visit the Inspector observed positive interaction with staff asking and offering choices to Service Users.
Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 11 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 13,14,15 Service Users are enabled to maintain contact with their families and relatives. Service Users are helped to exercise choice and control over their lives. Service Users benefit from receiving a nutritious and healthy diet. EVIDENCE: The Inspector was informed that family and friends are able to visit at any reasonable time of day or evening. Service Users are involved in choosing what clothes to wear, the activities they wish to participate in and the menu planning. On the day of inspection lunch consisted of casserole or fish with fresh vegetables. The food is purchased in bulk on a weekly basis and ordered by the home. Service Users receive a wholesome and nutritious diet. The home has recently purchased some new DVD’s of older classic films and have singers coming into the home. Other activities include music and movement, art therapist, colouring and bingo. Future activities include belly dancing. Over the coming weeks an Easter theme is planned. The Acting Manager is hoping that in the summer they can hire a minibus to go on trips out. Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 12 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Service Users can be confident that their complaints will be listened to, though the home needs to ensure that service users’ families and relatives are aware of the home’s complaints procedures. Service Users are protected from abuse by the home’s policies and practices in the area of Adult Protection. EVIDENCE: The Inspector received three comment cards and all of them stated that they did not know about the complaints procedure, the inspector did see a copy of the procedures on display in the entrance hall. The home has received one complaint since the last inspection. The Inspector was shown the records relating to the complaint and the outcome was completed in seven days- well inside the 28 days stated in the homes procedures. There have been no complaints received by C.S.C.I.. Adult Protection training is planned for the near future. The acting Manager talked through the procedure she would follow if an Adult Protection issue arose. Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 13 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19,20,21,23,24,25,26 Service users are put at serious risk because of the many health and safety hazards evidenced during the course of the inspection. Not all of the service users have the benefit of living in safe, homely bedrooms and surroundings because of the poor standards of décor and furnishings provided by the home. EVIDENCE: The Inspector was very concerned about the physical environment of the home and the possible negative effects it may have on the Service Users. The company employs a maintenance person to cover the 19 homes owned by Charing Healthcare. The Inspector was informed that requests for work to be carried out had been sent to the company but the home had not been advised as to when the work would be carried out. The majority of the home was in need of redecoration as wallpaper was ripped and had been left; paint had been scraped off the walls by use of walking aids; water was not available in the kitchen or Service User bedrooms if the washing machine was being used; the sink in a Service Users bedroom was heard to gurgle when the washing
Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 14 machine was emptying and as the machine is in use during the night by wake night staff this could disturb the occupant of the room. The cooking and refrigeration equipment was not adequate to meet the needs of 18 Service Users and meet with Food Hygiene and Health and Safety requirements; the tiles in the kitchen were loose and the grouting was dirty and the sink was too low and also a health hazard. The last inspection report highlighted the need for the dispensing and storage of medication to be improved and for thermostatic valves to be fitted to all sinks. In Service Users’ rooms, there were no locks on bedroom doors and no risk assessments and agreements were seen to be in Service Users files in which Service Users agreed to no lock being fitted. None of these have been addressed. The furniture in some of the bedrooms is in poor repair and in one room the Inspector saw the back of a wardrobe hanging away with a nail exposed. The lounge chairs need refurbishing and the dining tables are old and unstable. In one toilet the holder and grab rails were in poor condition and rusty. The Inspector went into the small basement where the laundry is located. The steps are in need of recarpeting and some of the pipe work is held in place by tape. There is no ventilation to the basement which makes it very warm. Although the acting Manager assured the Inspector that requests had been made for work to be carried out on the environment, they would again approach the Company as a matter of urgency to deal with the poor quality of environment. The Inspector recommended that Environmental Health department are invited to visit and give the acting Manager some advice and guidance regarding the issues around the kitchen and laundry. Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 15 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30 Service Users can be confident that their needs will be met by the numbers and skill mix of staff. Service Users are in safe hands and protected by the home’s recruitment policy and practices. The care offered to service users is enhanced by staff who are trained and competent to do their jobs. EVIDENCE: The acting Manager has been in post since September 2005 and has gone through the majority of staff files to ensure they meet with Schedule 2 of the Care Home Regulations 2001. Staff have been asked to bring in original documentation so as to bring the outstanding files in line with the Regulations. Staff have been advised that disciplinary action may be taken if they fail to comply. A staff supervision program has been drawn up and is in the process of being implemented but is still in the early stages. The acting Manager went through the recruitment process she would use and this included getting a full work history for the last ten years, two references, CRB and POVA 1st and random telephone calls to check references. Notes are kept of interviews. When fully staffed the home employs a Manager, Deputy, four Seniors and seventeen care staff plus domestics and a cook. At night there are two waking night staff on duty with a Senior member of staff on call. Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 16 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,36,38 Service Users live in a home that does not have a Registered Manager. The acting Manager discharges her responsibilities well but does not presently meet the criteria to become the Registered Manager. The home is run in the best interests of the Service users and their financial interests are safeguarded. The health, safety and welfare of the Service Users is compromised by the poor environment. The registered provider is failing in its duty by not providing the Acting Manager with regular supervision. This could compromise the care offered to service users. EVIDENCE: The home has been run by an Acting Manager since September 2005. During discussions with the Inspector she showed a good knowledge of the National
Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 17 Minimum Standards and what constitutes good care practice. She does have an NVQ level 3 and is due to start the Registered Managers award at Canterbury College in the near future. The Acting Manager runs the home in the best interests of the Service Users and involves them in as many aspects of the running of the home as possible. The Acting Manager is the only person with access to the Service Users finances. Individual records of income and expenditure are kept that are signed and dated. The Acting Manager when asked, informed the Inspector that they had received limited support and no supervision from the company. Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 18 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 3 2 3 X 3 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 X 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 1 2 3 X 2 1 1 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 X 3 X 3 2 X 2 Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 19 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 OP19OP25 Regulation 23(1)a 23(2)b d 23(5) Requirement Timescale for action That the Registered person shall having regard to the number and needs of the Service Users ensure that: the premises are suitable for the purpose of achieving the aims and objectives set out in the Statement of Purpose; and that 31/08/06 all parts of the care home are kept clean and reasonably decorated; The Registered person shall undertake appropriate consultation with the authority responsible for Environmental Health for the area in which the care home is situated. Issues to be addressed are: Kitchen, appropriate cooker and fridge to meet needs of Service Users; Laundry stairs need recarpeting; the effect on the kitchen and bedrooms water outlets when the washing machine is filling; toilet roll holder and grab rail are rusty and need replacing; Dining tables are unsteady and dangerous;
DS0000029057.V282388.R01.S.doc Version 5.1 Page 20 Greenford 2. OP31 9(2)(b)(i) 3. OP38 13(4)a c Lounge chairs need repairing or replacement. Bedrooms and communal areas need redecorating; Bedroom furniture needs to be replaced or repaired. A person is not fit to manage a care home unless – he has the qualifications, skills and experience necessary for managing the care home The Registered person shall ensure that – all parts of the home to which Service Users have access are so far as reasonably practical free from hazards to their safety; and unnecessary risks to health or safety of Service Users are identified and so far as possible eliminated. 31/08/06 31/08/06 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. 3. 4. Refer to Standard OP2 OP16 OP30 OP36 Good Practice Recommendations That the Service Users Terms and Conditions include the Purchaser and cost of the service. That Service Users family and friends are given a copy of the complaints procedure or that the copy on display is pointed out to them. The Registered person shall arrange for staff to attend Adult Protection training. That the staff and acting Manager receive regular formal supervision. Greenford DS0000029057.V282388.R01.S.doc Version 5.1 Page 21 Commission for Social Care Inspection Maidstone Local Office The Oast Hermitage Court Hermitage Lane Maidstone ME16 9NT National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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