Inspection on 10/05/06 for Greengates

This inspection was carried out on 10th May 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Greengates 06/08/09

Greengates 10/12/08

Greengates 29/10/08

Greengates 05/03/08

Greengates 12/10/05

Greengates 20/05/05

Greengates 21/03/05

Greengates 02/08/04

Greengates 29/01/04

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

CARE HOMES FOR OLDER PEOPLE Greengates Greengates Redland Lane Westbury Wilshire BA13 3QA Lead Inspector Roy Gregory Key Inspection 10th May 2006 9:30 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 Greengates DS0000048635.V295333.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. Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greengates Address Greengates Redland Lane Westbury Wilshire BA13 3QA 01373 822727 01373 826320 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) Greengates Care Home Limited Mr Chong Siam Yeoh Care Home 54 Category(ies) of Dementia (51), Mental disorder, excluding registration, with number learning disability or dementia (3), Old age, not of places falling within any other category (51) Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 12th October 2005 Brief Description of the Service: Greengates is situated in a residential area of Westbury. The original property has been extended on several occasions. The home is built round a central patio area, which may be accessed directly from the lounges. The majority of service users rooms are on the ground floor, many looking onto the central courtyard. Seven bedrooms are on three separate first floors. The home is registered to provide care for up to 54 people, of whom three may be aged under 65. Around half of these places are in shared rooms. There were 29 service users in residence at the time of this inspection visit, and so many double rooms were in fact singly occupied. From 10th April 2006, weekly fees ranged between £236.99 and £394.21. Westbury has a main line station, which is about 15 minutes walk from the home, as are the town centre shops. Some parking is available on site and street parking is also available. There is a bus stop at the end of the road. Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The unannounced visit for this key inspection took place on Wednesday and Thursday, 10th and 11th May 2006, for a total of 19 inspector hours. The regulation inspectors, Roy Gregory and Suzanne Collins, were assisted at times by Mr Yeoh, the registered manager, and Mrs Naish, deputy manager. They also had conversations with a number of staff, singly and in groups, including a review of activities provision with the activities co-ordinator. Several residents were spoken with and many care interactions were observed, including service of and assistance with the midday meal. Records consulted included recruitment records in respect of all staff recruited since the previous inspection, and a sample of care plans, medication administration records and pre-admission assessments. All areas of the home were toured, including seeing many individual bedrooms and all bathrooms and toilets. This inspection included review of compliance with requirements from the previous inspection. Subsequent to the visit to the home, survey questionnaires were sent to ten relatives of residents, of which five were returned. The inspector made an unannounced visit to Greengates in February 2006, following concerns about care standards in the home raised by the relative of a resident following the latter’s transfer to hospital. This visit was made by multiagency agreement, through local “Vulnerable Adult Procedures”. The complaints received were not upheld. High standards of personal care were in evidence. Care planning and recording in respect of the resident concerned were of good quality and demonstrated attention to ill-health indicators, with on-going active liaison with GPs and district nurses. No requirements or recommendations were made as a result of that visit. The judgements contained in this report have been made from evidence gathered during the inspection, which included the visit to the service and taking into account the views and experiences of people using the service. What the service does well: Residents spoken to expressed satisfaction with the service, as did relatives through questionnaires returned by post. One relative wrote: “The staff have always provided the necessary level of care and give that little bit extra when my mother is unwell.” Another wrote: “Not only are there sufficient staff but I’ve yet to meet an unfriendly carer. I’ve visited at odd times but the general air is professional and very ‘people friendly’.” These observations highlight particular strengths of the home. Staff showed a shared understanding of the need to base care on sound assessment and planning, and to record how care is given. There was much evidence of close liaison with GPs, district nurses and other health professionals; and of the home’s staff being alert to changes in Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 6 wellbeing and making prompt referrals through their own management chain and on to other agencies as needed. Care plans and residents’ experience of care were not limited to physical needs as the activities co-ordinator had continued to develop provision of occupation. Records, observation and visitors’ perceptions showed activities were offered every afternoon, with almost all residents being involved at various times. These varied from simple walks around the home to groups talking about the seasons or reminiscence. Unsuccessful activities had been supplanted by trying new ideas. Meanwhile, residents could be seen to exercise choices within the everyday routines of the home, which in themselves promote an atmosphere of calm and security, of benefit to the group catered for. Indicators such as hair care and clothing showed residents were assisted to maintain a sense of identity and respect. At staff shift handovers, individual staff gave a brief summary of the care provided to each individual in the group to which they had been assigned, thus ensuring no resident’s wellbeing was overlooked. What has improved since the last inspection? What they could do better: Administration of medicines overall is good, but there was a lack of guidance on how “as needed” medicines were to be used. In one instance, a medication to be used in response to behaviour change had been administered, but with no indication in the resident’s care notes of why this course of action had been decided. Thus there is a requirement to incorporate guidance on the use of “as needed” medications within individuals’ care plans. Such guidance must include a requirement that administration is agreed by the senior person on shift, and is fully recorded in care notes, to avoid the risk of inappropriate use of such drugs. There is a recommendation about ensuring that changes to care directions, such as when advised by a district nurse, are swiftly added to care plans, rather than relying on staff handing over such information verbally. Also, a second weight reading needs to be obtained a month after a person’s admission, in order to identify quickly if there has been any significant change requiring attention. To add to the way supervision and care plan reviews have been successfully organised, there could be occasional special themes for key workers to consider for a month in preparation for evaluation of care plans, such as residents’ involvement in activities, mealtime needs or night time care. Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 7 Induction of new staff is based on a format that has grown rather “tired”. There are in any case new national “Core Induction Standards” for care home staff, which will be compulsory from October 2006, and it is a requirement these be incorporated into the home’s induction process. It is recommended that staff be encouraged in the take-up of external training opportunities, such as some publicised in the home at the time of inspection, for which there were as yet few volunteers. It was suggested that a brief six-monthly review of staff annual appraisals could help maintain motivation for identified training needs and wishes. 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. Greengates DS0000048635.V295333.R01.S.doc Version 5.2 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 Greengates DS0000048635.V295333.R01.S.doc Version 5.2 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, 3 & 5 (key standard 6 is not relevant to Greengates) Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. Residents are only admitted to the home on the basis of a professional assessment that demonstrates their needs can be met. Pre-admission visits are facilitated and good information is provided to advocates, although there is scope for improving the nature of information made available to prospective residents themselves. EVIDENCE: Assessments were in place for residents admitted since the previous inspection and these showed appropriate attention to detail. Social worker and/or hospital assessments were used as primary sources of information, together with visits to potential residents by Mr Yeoh where the initial assessment was to be progressed. Written offers of placement included statements that the home could meet the assessed needs. Mr Yeoh said he had been declining a number of referrals, where it was apparent that peoples’ needs were greater than could be provided for by Greengates. Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 10 Pre-admission assessments included initial risk assessments, and linked smoothly into the establishment of individual care plans. Two recently admitted residents understood this process, saying they believed staff knew why they were admitted, and what help they needed. Plans were in a form that could highlight diversity, allowing for a focus on individual care needs. Visits to the home by prospective residents were facilitated where feasible, the inspector being aware of one such arranged at the time of the inspection visit. Relatives of a recently admitted resident indicated via questionnaire that they considered the admission process to have been well handled, with good information provided. Current copies of the home’s statement of purpose and service user guide were provided at the visit. These give adequate and required information in a concise form. Given the resident group catered for, it is perhaps relevant that these documents are aimed more to commissioners and relatives than to users of the service. However, there is scope for developing some easy read and pictorial information to help convey where the home is situated and what it provides. Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 11 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 - 11 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Individual care plans receive regular review and direct care across a spectrum of need, although there may be a time lag in adding newly decided care directions. There is prompt awareness of and response to health needs, including excellent liaison with health professionals and emergency services. Systems and practice in handling medications are mainly good, but use of “as needed” medicines is not sufficiently accountable to ensure it is appropriate and safe. EVIDENCE: Individual care plans showed clearly the primary care and health needs of residents. They were reviewed monthly, and the number of additions and amendments showed this was a meaningful process. When reviewing the care planning and recording for a particular former resident in February 2006, in response to allegations of neglect referred through “Vulnerable Adult” procedures, the inspector was able easily to track staff alertness and responses to indicators of ill health. The allegations were not upheld. In a returned questionnaire for this inspection, a relative wrote: “The staff have always Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 12 provided the necessary level of care and give that little bit extra when my mother is unwell.” Notifications by home staff to the Commission show regular use of community health provision, including out of hours and emergency services, and compliance with directions given. In January 2006 the home notified the Health Protection Agency (HPA), as required, of an apparent outbreak of respiratory infection, resulting in the home being temporarily closed to visitors and new admissions. HPA nurses were very complimentary of the home’s swift notification, their care of residents, and co-operation with all measures asked of them. In the event there was no pattern to the various conditions investigated. The format for care plans allowed for a “whole person” approach. For one resident, there was very good analysis of their social, cultural and emotional needs. By contrast, for another whose recorded background to being admitted appeared traumatic, the care plans for such needs were underdeveloped. Mrs Naish showed that she arranged monthly meetings with each care worker, specifically to review the care plans of those residents to whom they were designated “key worker”. Staff in turn appreciated this support to their key worker roles. There was effective use of a message book to draw the attention of all staff to amendments in care plans. Senior carers were keenly aware of the importance of making such amendments quickly in response to changes recorded in daily records, whereas it remained the case that some matters, for example a district nurse’s guidance on creaming a person’s pressure areas, were not carried over into care plans soon enough. This created a risk of reliance on presence at shift handover as a means of being made aware of such information, such that a resident might not receive the care directed. It was seen, however, that in the case of a resident with a current pressure wound (which they already had at admission), precise care instructions had been placed prominently in the resident’s room, something complimented by the person’s relative as showing very good practice. There was evidence of training of all care staff by the diabetic nurse, who has approved competency of individual staff to undertake blood sugar monitoring. District nurses’ notes showed a high level of liaison, both ways, between them and home staff, particularly with regard to pressure area care. The home has adopted a policy of examining all new residents for incidence of pressure damage very soon after admission, in order to refer for nurse attention at once if necessary. Baseline weights were recorded for all newly admitted residents, leading to a plan for further weighing at individually assessed intervals. It was suggested that in all cases there should be a second weight reading after one month’s residence, to identify any obvious early trend that could then be addressed if necessary for the resident’s wellbeing. Storage and accounting for medications, including controlled drugs, were good. It appeared the home had a sound working relationship with the supplying Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 13 pharmacy, backed by Mrs Naish’s personal attention to the re-ordering of medications. It was good practice that under each resident’s photo in the medicines administration documentation was a summary of the reasons for the use of each of their medicines. There was evidence that Mrs Naish was proactive in seeking GP reviews of medication. Care plans contained guidance on use of prescribed topical creams, but not of “as needed” (“p.r.n.”) medicines. Two uses of a p.r.n. drug, to address a behaviour issue, were correctly recorded in the medicines administration record, but not referred to in the individual’s care notes, which would have alerted all staff at the time to the use and demonstrated the circumstances in which use of the medication was considered indicated. It is a requirement to add care plan guidance on use of all p.r.n. medications, to include recording that such use has been agreed by the senior person on duty, as a safeguard for residents. In respect of two recent deaths in the home, records and discussions with staff showed that family members had been afforded considerable support and assistance, including in one instance accommodation having been made available to a relative who had travelled from Scotland. There was excellent guidance to staff on what to do in the event of a death in the home. Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 14 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): 12 - 15 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The home has developed regular activities provision that links with residents’ individual interests and capabilities, including provision for religious observance. Within the broad structuring of daily care, residents are able to exercise many choices. Community contacts are encouraged. Meals are of good quality. EVIDENCE: One member of the care staff has an overseas qualification in occupational therapy and has a co-ordinator role for activities in the home. Her records showed that there was regular provision of group and one-to-one activities, much on a simple level such as walks around the home or talks about the seasons, some more structured such as floor skittles and reminiscence. It was possible to ascertain that most residents were benefiting from this aspect of care. An earlier concentration on craft activities had been much reduced, having proved beyond or unpopular with many residents. The co-ordinator was pleased with the involvement of her colleagues in supporting an activities and occupation approach to care, and was keen to access more dementia-specific training and resources for herself. The inspector suggested making a link with another service where such expertise might be available to share, and the Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 15 manager of that service has since confirmed contact has been made and assistance offered. Mrs Naish helped sustain regular religious services in the home, for those that wish to attend. Monthly residents’ meetings were recorded and, whilst yielding little information from residents, appeared from minutes and staff feedback to fulfil a valuable function. Relatives indicated in questionnaires that they were mostly aware of the provision of activities in the home. The inspector noted that many residents made choices during the day about where to sit, or whether to return at any time to their rooms. After meals, some chose to linger in the dining room. Teas and coffees were served in the mornings and afternoons, wherever individual residents chose to be located. A person was employed to serve morning drinks and to spend time chatting individually with residents. Meals served were of good quality fresh ingredients, seen delivered daily from local suppliers. Individuals were given as much assistance with eating and drinking as necessary. The inspector joined three residents at table for a lunch and experienced a pleasant social occasion. There was a choice of main course and of sweet, written on a board and communicated verbally. It was necessary to comment on the need to keep the door closed to the adjoining sitting room, whilst the latter was being vacuum cleaned, owing to the noise level, otherwise the dining rooms were a conducive environment for eating. Residents spoken to were satisfied with the quality of meals. One chose to take some meals in their own room. Some residents spoke about ongoing contact with family and friends. They could receive visitors in any part of the home. The nature of family support for individuals was recorded in care plans. Staff meeting minutes showed that Mr Yeoh had recently asked care staff to identify those residents who had not had family contact for a year, so that those families could be invited to see care plans if they wished. Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 16 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 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There is appropriate provision for receipt of complaints. Staff and management act to preserve residents’ rights and independence. Allegations are treated seriously, with full co-operation shown towards multi-agency enquiries. EVIDENCE: No complaints had been received in the home since the previous inspection. A clear complaints policy and procedure is set out in the statement of purpose. The relative of a recently admitted resident indicated they had been made aware of the complaints procedure, and some other questionnaire respondents were also aware of it. Where there have been investigations carried out within multi-agency Vulnerable Adults procedures, Greengates management and staff have been fully co-operative and made all records available. As yet, the home had not received copies of the revised “No Secrets” booklet that guides staff on the operation of the vulnerable adults procedures. There was a readily accessible list of advocates for each service user. There was evidence of a refusal to pass confidential information to a stepfamily, in the absence of clear instructions that to do so would be appropriate. One resident had been assisted to receive a visit from a representative of the Court of Protection in order to give reassurance on their financial security. Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 17 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, 24 & 26 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. The environment provides for comfort, choice and security, and is wellmaintained. Use of various communal spaces is encouraged, providing for choice and variety. Bedrooms are individualised and comfortable. There are high standards of hygiene. EVIDENCE: The home has begun use of a self-employed handyman, who was in the home during the inspection visit. It could be seen that defects noted by any member of staff were swiftly communicated and attended to. A number of residents’ rooms were seen and were bright, airy and individual. A recently admitted resident was seen in his room and was pleased with its aspect and with the furniture provided. An issue with his room was noise from one of the tumble driers in the nearby laundry room, which Mr Yeoh undertook to rectify. Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 18 Whilst many residents had evident favourite sitting places, it was seen that most enjoyed changes during the day. The main sitting and dining rooms give onto an enclosed courtyard by way of lockable patio doors, and good weather during the inspection led to staff encouraging most residents outside during the afternoons, to sit on outdoor chairs. Standards of cleaning around the home were high everywhere, including all toilets and the sluice room. Some toilet brushes were found resting in liquid in containers, needing to be replaced by suspension holders to reduce risk of conditions conducive to bacteria build-up. A domestic worker said that covering her area of responsibility was just possible within the allotted time, but she felt well supported and resourced. The message book showed that one resident’s room was being closely monitored and regularly attended to, in response to a particular current difficulty. The laundry room had been equipped with a new industrial machine in addition to an existing range of appliances. The laundry worker demonstrated a thorough understanding of infection control principles. The laundry was in use all day, every day, but not during evenings and nights. Good practice was observed in the handling of laundry, from source to return. It was confirmed that sponges used for personal washing were washed at 60ºC, and frequently replaced. Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 19 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 – 30 Quality in this outcome area is adequate. This judgement has been made using available evidence, including a visit to this service. Staffing is good in quality and number. There is evidence of ongoing training in-house whilst there is scope for increasing staff experience of external training. Recruitment practice is good, but induction needs to be brought in line with national expectations. EVIDENCE: Staff rotas worked and planned showed there were always a minimum of five care staff on duty between 7:00 a.m. and 10:15 p.m. Sometimes this was achieved by individuals working double shifts, with an hour’s break in the middle of the day. Mr Yeoh said such a working pattern was voluntary and he ensured no-one worked more than 48 hours in a week, much as some offered to do so. All recruitment since previous inspection had been from abroad. This meant that all recruited carers had qualifications equivalent to at least NVQ level 3 in caring or healthcare fields. Three other staff were currently registered for NVQ training, although one told inspectors that assessor availability was problematic. Mr Yeoh was not aware of changes introduced by “Skills for Care” in the expectations of induction programmes for new staff. These introduce common core standards that will have to be complied with by October 2006. The home’s induction process will benefit in any case from an overhaul, because it presents as dated and results in written tests by staff that suggest a degree of learning Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 20 by rote. Thereafter, staff benefit from a number of regular in-house training opportunities that ensure they remain up to date on matters such as moving and handling and first aid. Some free outside training opportunities were displayed in the office, requiring a minimum number of six staff to volunteer for them; take-up was minimal, and Mr Yeoh agreed greater encouragement to attend was indicated. Recruitment practice was found to be safe, in accord with statutory requirements. It was possible to track each stage of establishing that hired workers were safe to employ before they commenced duties, including the self-employed maintenance person. Ancillary staff rostering showed at least two cleaning staff were available every day, including weekends, and there were additional arrangements for specific attention to kitchen cleaning and the operation of the laundry. Residents spoken to said there were always staff at hand. A relative wrote: “Not only are there sufficient staff but I’ve yet to meet an unfriendly carer. I’ve visited at odd times but the general air is professional and very ‘people friendly’.” Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 21 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, 32, 33, 35, 36 & 38 Quality in this outcome area is good. This judgement has been made using available evidence, including a visit to this service. There is effective delegation and participation between management and the care staff team. The organisation of staff supervision is appropriate to meeting residents’ needs through care planning review. External reviews of residents’ wellbeing are used to inform care planning and provision on an individual level. The inspection process is used as a quality monitor, with prompt response to requirements and suggestions. Health & safety of residents and staff are well provided for. EVIDENCE: As owner-manager, Mr Yeoh continued to be in the home daily. He maintained a good working knowledge of the resident group and issues in the home, and carried out assessments of all prospective residents. Residents knew Mr Yeoh well, speaking of lots of contact. Mrs Naish had established an effective deputy Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 22 manager role, with delegated primary responsibility for supervision of care staff, allied to monthly oversight of all care plans and of the home’s medication procedures. Additionally, a senior carer headed each shift. At midday shift handovers, each member of care staff gave an account of the wellbeing of the residents for whom they had had primary carer responsibility during the morning. These handover sessions were also used by management as a channel for communication and reminders, additional to planned and recorded staff meetings and one-to-one sessions. These processes combined to promote staff experience of teamwork and individual value. Actual supervision of individual staff comprised of monthly meetings between individual care staff and Mrs Naish, which concentrated on the key worker role, especially to foster good care plan reviews. Staff spoken to did not identify this process as “supervision”, yet the outcome was that management had a good picture of individual staff strengths and weaknesses, and staff had a strong appreciation of, and application to, their key worker responsibilities. There was in addition an annual appraisal cycle, which had just been completed for all staff, and it was suggested appraisals receive brief six-monthly reviews, to ensure training or other targets do not get “lost”. A further enhancement of supervision would be to ask care staff as individuals or on a group basis to give specific consideration each month to different areas of practice as they affect their respective key residents, for more in-depth evaluation of the effectiveness of their care plans, for example looking at activity involvement or night time care needs. Systematic quality assurance remained underdeveloped, although Mr Yeoh has shown a consistent response to issues identified for improvement through the inspection process. Individual care manager reviews represent a source of feedback that is continuously available and overwhelmingly positive. It was suggested that a six-monthly collation of satisfactions and concerns expressed through this process would give a useful picture of how residents or their advocates experience the care given, to aid forward planning. This would be in addition to existing good practice whereby at an individual level, care management reviews could be seen to influence care planning. Provision for health and safety in the home continued to be of a high order. There remained a low incidence of falls among the resident group, suggesting that supervision of basic safety must be a regular part of care giving. Those residents assisted to spend time outside received a high staff ratio and their exposure to the sun was monitored. The use of upstairs bedrooms for residents had been greatly curtailed. The home has a policy of non-involvement in service users’ personal finances, and of not holding valuables in safekeeping, and so safeguarding of residents’ financial interests is seen as a matter for their respective advocates. The latter are billed directly for expenses such as hairdressing and chiropody. Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 23 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 X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 3 18 3 4 3 X X X 3 X 2 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 3 3 3 X 3 3 X 3 Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 24 Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP9 Regulation 15 (2)(b,c) Requirement Where a service user is prescribed “p.r.n.” medicine, their care plan must include guidance on how such medicine is to be used and recorded. All toilet cleaning brushes must be of suspended design. Staff induction must be based on the Core Induction Standards published by Skills For Care. Timescale for action 30/06/06 2. 3. OP26 OP30 15 (2)(b,c) 18 (c)(i)19 (5)(b) 30/06/06 30/09/06 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. Refer to Standard OP1 OP7 OP8 Good Practice Recommendations Consider developing easy-read and pictorial information for prospective residents. Ensure at handovers that any new care directions have been incorporated into care plans. Always record a second weight reading a month after an DS0000048635.V295333.R01.S.doc Version 5.2 Page 25 Greengates 4. 5. 6. 7. OP30 OP35 OP36 OP36 OP7 individual’s admission Encourage staff to participate in externally available training. Collate outcomes from care manager and CPA reviews to provide an oversight of where business objectives are met or could be developed. Give individual staff the opportunity to review their annual appraisal briefly mid-year. Consider occasional special themes to focus key workers’ evaluation of care plans. Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Chippenham Area Office Avonbridge House Bath Road Chippenham SN15 2BB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greengates DS0000048635.V295333.R01.S.doc Version 5.2 Page 27 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!