Inspection on 19/02/09 for Greenheys (52)

This inspection was carried out on 19th February 2009.

CSCI found this care home to be providing an Adequate service.

The inspector found no outstanding requirements from the previous inspection report, but made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenheys (52) 03/10/07

Greenheys (52) 15/08/06

Greenheys (52) 08/03/06

Greenheys (52) 16/12/05

Greenheys (52) 20/10/04

Greenheys (52) 10/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

Extracts from inspection reports are licensed from CQC, this page was updated on 19/06/2009.

Inspecting for better lives Key inspection report Care homes for adults (18-65 years) Name: Address: Greenheys (52) 52 Greenheys Road Wallasey Wirral CH44 5UP     The quality rating for this care home is:   one star adequate service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Diane Sharrock     Date: 1 9 0 2 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Adults (18-65 years) can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Adults (18-65 years) Page 2 of 40 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.csci.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 40 Information about the care home Name of care home: Address: Greenheys (52) 52 Greenheys Road Wallasey Wirral CH44 5UP 01516388248 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Alternative Futures Limited Name of registered manager (if applicable) Type of registration: Number of places registered: Conditions of registration: Category(ies) : care home 5 Number of places (if applicable): Under 65 Over 65 0 learning disability Additional conditions: 5 The registered person may provide the following category of service only: Care home only: Code PC, to service users of the following gender: Either. Whose primary care needs on admission to the home are within the following categories: Learning disability: Code LD. The maximum number of service users who can be accommodated is: 5. Date of last inspection Brief description of the care home 52 Greenheys Road is registered with the CSCI to provide personal care for 5 adults with a learning disability. Alternative Futures Limited, a registered charity operating in the North West, operates and manages the home, with the premises being owned by Alternative Housing Association. The home is a purpose built detached bungalow with a large garden, close to Central Park in Liscard, Wirral and is within walking distance of local shops. There is car parking at the front of the home. Communal areas comprise a large lounge, with doors to the garden, and folding doors to the adjacent dining room. A domestic style kitchen and separate laundry facilities are provided. The home benefits from having a bathroom with W.C and separate shower room with W.C on the Care Homes for Adults (18-65 years) Page 4 of 40 Brief description of the care home main corridor leading to the bedrooms. There is a separate toilet next to the lounge. There are five single bedrooms each with a wash hand basin. The fees for the home are 1069.86 pounds per week. Items not covered by this fee include chiropody, haircuts, presents, toiletries and confectionary and some activities. A service user guide and a statement of purpose, which describe the services offered at 52 Greenheys Road, are available for everyone. The manager is hoping to publish this very soon and make available and the manager can supply a copy of the most recent inspection report carried out by the commission. Care Homes for Adults (18-65 years) Page 5 of 40 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: one star adequate service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is one star. This means the people who use the service experience adequate quality outcomes. We gathered information for this inspection in a number of different ways. We carried out an unannounced site visit on 19 Th February 2009. This took place over six hours and included reading records, meeting people and looking at the building. We spent time looking at the support the people living at Greenheys receive. (this is called case tracking). This included looking at the support they get with their daily lives, care plans, medication, money, activities and environment. We met the four people who live at Greenheys and two members of staff. We also spoke throughout the Care Homes for Adults (18-65 years) Page 6 of 40 visit to the manager. We reviewed any information we had received about Greenheys following our last key inspection. The manager completed a self assessment form called an (AQAA) which we sent to her before our visit. We used the information in this form and the other information we had to help plan our inspection and write this report. We sent out a collection of surveys to the staff, people who live there and health professionals, however up to writing this report we had received just one survey back from a member of staff. What the care home does well: What has improved since the last inspection? There are several systems in place at Greenheys to check the quality of the service provided. The manager carrys out monthly audits and the area manager carrys out 3 monthly detailed health and safety audits. These visits provide a formal way to check on the health and safety and standards offered at the service. Each person has a person centred plan which gives information to show how their personal care and support would be met. They also included details on how to support each person with specific risks and needs including risk assessments covering, eg, support with medication, road safety and risk of scalding. Staff had developed picture dictionarys for each person to describe words and signs that they use to communicate, eg some people have specific signs they use with staff to ask for various things such as a drink, the bath to go on a bus. This helps people to be supported in choosing what they want to do in their home. The manager has just purchased a large flat screened TV and is waiting for their maintenance team to install it in the lounge. She said they will get new curtains when the new settee arrives at the home and she feels this will make the lounge alot more attractive and comfortable. Care Homes for Adults (18-65 years) Page 8 of 40 What they could do better: An updated copy of the statement of purpose and service user guide must be forwarded to the Commission and also be accessible to everyone at the service. This will help keep everyone informed about all aspects of the service and any proposed changes. One staff member stated, There is no clear plan as to what is to happen to one client or timescale involved. As the house is due to be split up, I feel it important that the clients remain in the area which they are familiar with, with colleagues that understand and will deliver their needs.... To make sure each identified person has an appropriate person(advocate) acting on their behalf especially regarding proposed changes to their living accommodation. This will help them be supported in their best interest. Everyone must be included in any proposed changes to their home and evidence must be in place to show any changes are in each persons best interest. The responsible person must provide an update to the commission regarding any future changes to the current registration of Greenheys. One staff survey returned to us gave some comments about current staffing levels and how it effected peoples choices and needs, stating, A balance has to be made as far as male to female staff ratio. This has meant more active clients are missing out on activities in order to be there in case of aggression from other clients. To review the current staffing rotas to look at how females living at the home can have the right ratio of female staff. Staffing levels must be kept under review in order to make sure that staffing levels are appropriate to the needs of the people living at Greenheys. These reviews should include staff and peoples opinions. This will help to show that staffing levels enhance each persons quality of life rather than impinge on their ability to not be able to do what they want due to staffing levels. To support and facilitate everyone at the service to access a variety of age and culturally appropriate activities on a daily/regular basis and make sure staffing levels meet their needs and never restricts their daily living and quality of life. To develop an ongoing activity planner for each person as stated in the services AQAA. To show what plan and actions are taken to provide the right support for an active life. To provide staff with guidance and training on supporting people with activities. We identified various training that needed to be organised and provided for staff to help assist them in being up to date in practices with medication, safeguarding, challenging behaviour and first aid. One staff member provided comments around training stating,IE, Due to upheavals in head office, yearly updated training has not been followed or information such as when I am due to go on the courses has not come back. Medication records and care plans should include details of any changes and circumstances in which medication is to be given as required(PRN). This guidance should be updated and covered in best practice and training necessary for staff to act appropriately. To stop any further practices of staff handwriting over prescription labels which covers the general medical practitioners prescription. Care Homes for Adults (18-65 years) Page 9 of 40 To provide evidence of appropriate and regular investment to the decoration of the building to try and achieve a higher standard of living facilities more suitable to the needs of younger adults. To develop a maintenance, decorating and development plan for everyone at 52 Greenheys so they can be kept informed and included in the developments of their home. To include information as to when they can have their bedrooms redecorated and refurbished. To produce a cyclical maintenance programme accessible to everyone at Greenheys as advised in the Aqaa. To update support plans for those people at risk of poor nutrition and include regular recording of weights and monitoring and include professional opinions IE, the community dietitian in how they should be supported. The manager should keep updated records of employment checks such as (crb) police checks for all staff. These checks help to make sure the people living there are safe and that staff are suitable to support them. The service must be provided with uptodate policies relevant to all areas within Greenheys, including infection control and financial policies and all other policies identified on the services Aqaa which had old review dates. They are necessary to assist with good practice and to give the staff access to the most uptodate guidance for their practice. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.csci.org.uk. You can get printed copies from enquiries@csci.gsi.gov.uk or by telephoning our order line –0870 240 7535. Care Homes for Adults (18-65 years) Page 10 of 40 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 11 of 40 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between the person and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People at the service have not been given enough information regarding changes to the service which has left people unsure of plans for their future at Greenheys. Evidence: The manager has developed a residents guide and a statement of purpose which will be available to everyone when they have been updated and published. The guides include good levels of information on the purpose of the home and the facilities on offer. The manager has advised in her questionnaire filled in prior to this visit that she plans to develop these records however during our visit it was still being developed and only accessible on the services computer. Everyone living at the service had been there for many years so there had been nobody new moving in. We looked at old admission assessments for one person and it showed that they had numerous trial visits before they decided to choose to live at Greenheys Road which is an example of good practice in supporting people to make decisions. Care Homes for Adults (18-65 years) Page 12 of 40 Evidence: The AQAA , (the report provided by the manager before our visit) told us that the service was under reconfiguration to ensure peoples compatibility, which was likely to result in people moving from the service by April 2009 in line with assessment undertaken by a social worker last year. However staff were unsure what the plans were for the future and they had no definite details or dates regarding plans. They did have a proposed visual plan for the building to develop it into 3 flat-lets. However nobody knew who was going to live in them or were everyone will go. There was no evidence shown regarding the current compatibility and whether the move to other facilities was in the best interest of everyone living there. Staff felt that 2 people would benefit from a move to a single flat-let accommodation but they were unsure about other peoples futures. One staff member returned a survey with comments and included various views such as, There is no clear plan as to what is to happen to one client or timescale involved. As the house is due to be split up, I feel it important that the clients remain in the area which they are familiar with, with colleagues that understand and will deliver their needs.... Recent house minutes show that the proposed moves have been spoken about but no details regarding plans were included in these minutes or staff views regarding the proposed plans. The AQAA did acknowledge that in Wirral they had access to a local advocacy group who can act in the best interests of people. However staff felt that a referral for this service had only recently been applied for and they were still waiting for a response to see if they would agree to act on behalf of one person living at Greenheys. Care Homes for Adults (18-65 years) Page 13 of 40 Individual needs and choices These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Support plans are not always detailed enough to show people how their needs and choices will be met or supported. Evidence: Individual support plans were available for each person, we looked at two of them during our visit. The support plans are reviewed in parts and had been developed following the previous inspection visit . They show regular reviews carried out by staff to try and have updated information describing how they support people living at Greenheys. The plans gave some information to show how their personal care and support would be met. They also included details on how to support each person with specific risks and needs including risk assessments covering, eg, support with medication, road safety, agitation and risk of scalding. Care Homes for Adults (18-65 years) Page 14 of 40 Evidence: Staff had worked hard in developing and producing the use of a picture dictionary to describe words and signs that each person uses to communicate, eg one person has specific signs they use with staff to ask for various things such as a drink, the bath to go on a bus. This helps people to be supported in choosing what they want to do in their home. However there was minimal reference to this picture dictionary and signs used by people in the daily records. A recent care management review arranged by staff was noted to be very detailed and covered all of the support that person had recently received. Staff had worked hard in developing this review which had lots of pictures to describe what the person had achieved and enjoyed. The use of pictures was easy to understand and helped include the person in giving their opinions of the service. This review also showed that one person had been involved in plans for their future and showed planned support and discussion on their proposed move to an individual flat-let, to live more independently. However some plans did not have enough information to show how they would be supported with their choices, especially regarding their future at the service and for who they would like to support them. One persons care management review had good use of pictures of previous activities they had been involved with, but there was no agenda or details of plans for their future. There was no details about who had attended this review or whether they had been included in plans and developments for their future. The AQAA told us that they have a good balance of male and female staff to further address privacy and dignity. However during general discussions we noted that on occasions the service has all male staff on duty which means that at times females at the service have no choice but to have personal care carried out by male staff. This gives them less choice and restricts their privacy and dignity on occasions which is in direct contrast to what the aqaa tells us. One staff survey returned to us gave some comments about current staffing levels and how it effected peoples choices and needs, stating, A balance has to be made as far as male to female staff ratio. This has meant more active clients are missing out on activities in order to be there in case of aggression from other clients. We looked at the records kept of finances managed on behalf of people at the service. The records kept at the home for personal allowances were accurate and well kept. The manager states they have issued each person an individual license agreement. They had not been signed or completed yet. When they are completed they should give clear transparent information about each persons fees and how their benefits and monies are claimed and managed for them. Care Homes for Adults (18-65 years) Page 15 of 40 Care Homes for Adults (18-65 years) Page 16 of 40 Lifestyle These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They can take part in activities that are appropriate to their age and culture and are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Greenheys are usually supported with a lifestyle of their choice. Evidence: We watched staff supporting people in the afternoon getting ready for their lunch. They provided assistance and encouragement in a respectful way. Records of meals served in the service showed that a variety of meals are served in order to offer people as much choice as possible. Staff explained how they support people in choosing what they would like for their meal and they have a lists of what people like and dont like including details for special diets. The dining room was basic in design and bare in decor although clean and tidy. Staff explained that people mostly ate their meals on their own in their own bedrooms and they rarely socialised at mealtimes. Care Homes for Adults (18-65 years) Page 17 of 40 Evidence: People living at Greenheys and the staff have regular meetings to discuss the running of the service. We looked at recent records of these meetings which showed discussions on various things, helping to keep people informed. There was no organised activity during our visit or planned activity programme as referred to in the services aqaa. Staff explained that sometimes activities are depending on the staffing needed for some people living there as some people have 2 people to support them. If some people choose to stay in, this sometimes stops other people being able to go out as they dont have enough staff to give individual support to everybody. During our visit there was no planned activity for 3 people who were up. Staff were unsure whether they were going out later in the day to support one person with swimming. The AQAA stated, that they have developed inhouse events such as weekly chats. We did not see any evidence of staff having weekly documented chats with people. We met everybody who lived at Greenheys and staff advised that they have a diverse mix of people who have very different needs. These differences were very noticeable during our visit were some people sat quietly in their room and others were very mobile and restless. The manager advised that the compatibility of everyone living at the service was a main reason for various plans for the future for some people to move to living conditions more suited to them. The support plans showed very big differences in how each person communicates their needs and choices. Some people are very able in getting involved in the community with support for things such as swimming, gardening, fund raising, doing house work and chores, choosing what meals they would like and they are very able in getting their opinion across in what they want to do each day. Others at the service have to rely on the staff to interpret their needs and requests. Most staff have been at the service along time and have built up a good rapport and ability in getting to know each person and are knowledgeable in how they express their behaviours. Staff had been able to interpret some peoples needs, likes and dislikes and had documented this in their support plans. One person likes regular holidays and likes to go out in the minibus, music therapy, hand games, short walks and get involved in music therapy. However the daily records showed that this person had been out just once in the past 2 weeks and there was very limited references as to what activities they had been supported with each day despite what their support plan said they liked to do. Discussions with staff, and in looking at records, showed that people living at Greenheys do not always receive the support they need to get out and about regularly in their local community. Care Homes for Adults (18-65 years) Page 18 of 40 Evidence: The service shares a communal vehicle with another local house. The records around the management and funding of the communal vehicle wasnt clear. However the managed explained that this service is provided by the company and nobody is charged for transport costs. Care Homes for Adults (18-65 years) Page 19 of 40 Personal and healthcare support These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it in a safe way. If people are approaching the end of their life, the care home will respect their choices and help them to feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The individual needs of people living at Greenheys are identified but they are not always appropritaely monitored so that staff can support them to meet their needs. Evidence: Support plans were available for each person we looked at two of them. Some parts of the plans had been recently updated and revised and gave enough information to show how their personal care and support would be met. Some plans still needed to be updated in parts with more recent review dates so they were sure they were accurate and reflected the persons most up to date needs. Each person has a section on medical needs called, My health action plans. The care records showed they are supported in accessing health care services when needed, especially the doctor and care managers. Each section gave details advising on what they had identified each person needed to help keep them healthy and safe such as, IE support with their medication, road safety, being in the kitchen, at risk of choking, scalding, agitation and poor diet. The records were found to be very brief in parts for some people and gave no advice on what to do if a person eg, does choke and what to Care Homes for Adults (18-65 years) Page 20 of 40 Evidence: do if they continue to lose weight. One plan was discussed with the manager regarding potential problems that they had recorded. In reviewing training records and chatting generally to staff we noticed that staff are not updated and trained in first aid. This means that staff are not being provided with the right training to help them to safely support people with specific needs and potentially putting people at risk. One plan identified poor dietary intake and potential weight loss for one person.There was no record of regular weighing to help monitor a persons health and weight. The manager explained the recent input and guidance from the local dietitian. Following our visit the dietitian has advised they will carry out a review to ensure support plans offer the right support including regular recorded weights and monitoring of food intake to help make sure people are appropriately supported with their nutrition and health. The manager had a date of the next review of these records being due November 09. We discussed this with the manager as it needs to say when it was actually reviewed which would be more accurate. We chatted generally to staff and we met everyone living at the service. Most comments made were quite positive. Some comments included, all staff have been here a long while and know people well We are a good staff team, the staff are a good bunch here General observations showed that staff are respectful towards the people who live there. Staff were aware of the support each person needed and had a good rapport and knowledge base of each person. Each bedroom and area of the home had access to a call system however the manager explained that it isnt in use as no one at the service is able to use it, so it was felt that it wasnt needed. The systems in place for dealing with medication, along with staff training, help to reduce the risk of mistakes occurring that could impact on peoples health. We looked at the storage and procedures of managing medications at the service and they were found to be mostly well maintained and safely managed. However not all staff had received up to date training in the administration of medication to help them in safely supporting people. The use of occasional administration of medications was discussed with the manager as one record was unclear as the medication did not have an appropriate prescription label and staff had handwritten over the original prescribed lable. The manager was able to show a hospital letter from the Doctor advising of a change in the administration of this medication but staff had not passed this information to the right Care Homes for Adults (18-65 years) Page 21 of 40 Evidence: people to help get a safe and appropriate prescription label with the doctors instructions. This is an unsafe practice that should be stopped as it could potentially lead to mistakes being made and medication being given inappropriately effecting the management of peoples health. Support plans did not always give enough advice and guidance on how each person should be assisted with any type of medication that should be given only when they needed it . One persons behaviour plan has advice given around the use of medication. Staff talked to us about their experiences of challenging behaviour and felt that up to date training was not always in place. They felt that if appropriate training and specific guidance was in place they would be clear in the use of distraction techniques to reduce the risks of giving medication. Staff had good insight to the needs of people at the service and felt that in their opinion the use of distraction techniques had helped reduce incidents in challenging behaviour and the use of (PRN) medication. This type of medication is different to those prescribed to be given regularly at the same time each day. This information needs to be accurate and up to date to help keep people healthy and supported in the right way with their health. The manager had already applied to their head office for training called,space training, which is a new training programme that covers behavioural techniques to help staff support people with challenging behaviours. The manager doenot have a date for starting this training yet. We discussed some brief guidance seen in support plans indicating that as a last resort staff may have to restrain people living at the service. It was noted there was no training or guidance to support this advise in the support plan. This potentially puts both staff and people at the service at risk and must be reviewed by the company as a matter of priority. The company had a statement in the services file for challenging behaviour which stated, physical intervention involves the application of the minimum force needed to prevent injury. It goes onto advise that the person centred plans should be specific with the methods used and the circumstances and also they should be recorded. Although staff acknowledged there had been no recent incidents of challenging behaviour, the support plans still identified a need for senior management to support people at Greenheys with providing the right type of training and support plan as a matter of priority. Senior management must consider whether it is still appropriate to have such a statement within Greenheys. Care Homes for Adults (18-65 years) Page 22 of 40 Care Homes for Adults (18-65 years) Page 23 of 40 Concerns, complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them, know how to complain. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Adequate systems are in place within the service for dealing with any concerns or complaints that arise which aim to protect people. Evidence: Information about how to raise a concern or complaint is made available to the people living at 52 Greenheys in a pictorial format with the use of smiley faces. This is good practice as it helps to increase the opportunities for people using the service to have a better understanding of the ways in which they can raise comments and concerns. We looked at the services complaints records and noted there had been no complaints submitted to the commission following our previous visit. In the past the service had submitted(alerts) which are reports about specific incidents which showed what actions they were taking to keep people safe including sending alerts to Wirral Social Services. Staff felt the increased staffing levels to help support some people had helped to reduce the number of incidents. We looked at a sample of staff training records which described various training that they had attended including, safeguarding and abuse awareness. However in looking at these training records it was noted that some staff had not received an update to this training for some time. Some records said that some staff last received this training in September and October 2006. There was no other evidence of how staff are Care Homes for Adults (18-65 years) Page 24 of 40 Evidence: updated in this area during their employment or how they keep up to date with this topic which is necessary to help staff be kept up to date in safeguarding people they support. Staff explained there had been problems with a backlog of identified training due to upheavals at head office. This had impacted on the service with staff not being provided with regular training when required. Care Homes for Adults (18-65 years) Page 25 of 40 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, comfortable, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. People have enough privacy when using toilets and bathrooms. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People live in adequate environment. Evidence: Greenheys is a detached bungalow in a residential setting.The service is situated close to shops, pubs and other community facilities including public transport and a local park. Shared space consists of a domestic style kitchen small dining room and lounge with small conservatory. Everyone has a single bedroom and there are no stairs with facilities all being on ground level. The manager has just purchased a large flat screened TV and is waiting for their maintenance team to install it in the lounge. She said they will get new curtains when the new settee arrives at the home and she feels this will make the lounge alot more attractive and comfortable. We saw a sample of bedrooms, some were personalised were people had brought in personal items to make it more individualised. However some rooms needed some maintenance and showed areas in need of redecoration and updating, eg one bedroom had alot of scrapes and wear and tear and marks to the walls and sink area. Staff described various behaviours regarding why some parts of the building wear bare. This Care Homes for Adults (18-65 years) Page 26 of 40 Evidence: showed a need for further investment to be continually provided to help provide a good standard of living facilities. We were shown around the home and looked at a sample of areas. The manager did not have any planned maintenance and decorating programme for the service. Generally the home is decorated to an adequate standard. There are areas of wear and tear and some furnishings are worn and some areas like corridors, kitchen, lounge toilets and bathrooms are basic and bare in decor. Staff felt they had smooth floor coverings as it helped in keeping the home clean and tidy. Support staff are responsible for the cleaning at the service as there are no separate ancillary staff. Some areas had a build up of cleaning jobs that were needed as there was a build up of dirt and dust in the laundry and the kitchen units needed in depth cleaning. The aqaa said the developments for the future of the homes environment would include, maintaining standards and monitor, but it doesnt say how they plan to monitor the standards at the service. The aqaa stated the service had a cyclical maintenance programme. This was not evident in walking around the home and talking to staff. We did not see a cyclical programme or any type of plan telling people what developments/maintenance or refurbishment was to be carried out in their home. The service did not have a maintenance and renewal programme which has resulted in an environment which is basic in facility and does not always look homely or offer a younger persons design or comfort in some areas. We looked at a sample of maintenance certificates which showed up to date checks as listed in the homes pre inspection questionnaire including the fire extinguishers and gas supply. This helped show what actions were taken to keep the service safe. Care Homes for Adults (18-65 years) Page 27 of 40 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent, qualified staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The people living at Greenheys are adequately supported by staff however sometimes a lack of staffing can impact on peoples lifestyles and choices in activities. Evidence: Records showed that before anyone is appointed to work at Greenheys a series of checks are carried out. These include obtaining written references and checking with the criminal records bureau (CRB). These checks help to make sure the people living there are safe and that staff are suitable to support them.We looked at 2 staff files and most checks were in place but one file did not have evidence of a (CRB) police check. The manager has contacted us following our visit and has agreed to update this persons CRB as a matter of priority. Observation of staff and discussions with them indicate that the staff know the needs of people living at the services and know their likes and dislikes. It was evident they had a good understanding of how to support people and how to make sure their needs are met. Staff explained they mainly have long standing members of staff and rarely have new staff which showed the stability of the current staff team. We looked at staff training records which showed what training had been provided. Care Homes for Adults (18-65 years) Page 28 of 40 Evidence: Staff had received various training while employed by the service. However some staff had not received refresher training for necessary subjects such as, first aid, safeguarding, medications, challenging behaviour, autism, updated induction, food hygiene, and learning disabilities. Staff felt there had been changes with staffing at head office which had effected the usual organisation of training within the service. One staff survey gave some opinions about recent access to training saying, Due to upheavals in head office, yearly updated training has not been followed or information such as when I am due to go on the courses has not come back. Staff need updated training to help keep them up to date in their practices and help to appropriately support people. Staff were positive about working at 52 Greenheys and discussed how they support people with their individual needs. They were able to talk about various support especially in difficult situations regarding challenging behaviours. We met both the staff and people living at the service during our visit and found that they had a good rapport with each other. The AQAA stated that staff induction is provided for all new staff and includes reference to issues of equality and diversity. This was not in evidence at Greenheys and reflective of the staff experiences. New staff have not had an induction to working at the service and they did not receive a planned approach in getting to know people before providing personal support. One staff member had to work on the bank as a member of the staff team and they used this time to help get to know people at the service. There was no evidence of continued training and induction to alot of necessary subjects necessary to support people. One previous induction sheet dated 10/06 covered alot of main topics all in the one day which would indicate they had not been given the right support and training to help develop skills and practices in various topics covered that day. Some staff felt happy with the training they had received and felt very supported in developing their skills to meet the needs of the poeple living there. Some staff gave suggestions to improve the training such as,updated practices in eg,challenging behaviour The manager has supplied various information regarding previous and current training for staff in obtaining a care qualification(NVQ). This helps to exceed the basic guideline for at least 50 of staff to have a care qualification. (NVQ). The NVQ co ordinator was visiting the service during our visit and was providing support for one staff in the process of completing their care qualification., This helps to make sure staff are aware of current good practice in the area of care and how to support people safely and well. Care Homes for Adults (18-65 years) Page 29 of 40 Evidence: Staff explained various staffing issues that they felt effected the service and impinged on peoples choices to go out and do regular activities. They have 2 staff daily and the manager to support 4 people but they explained that 2 people need 2 staff to always support them. This meant they didnt always have enough time to individually support some people, especially in going out. Staffing levels should be appropriately reviewed to provide enough staff to support people with their care and support plans. Care Homes for Adults (18-65 years) Page 30 of 40 Conduct and management of the home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately, with an open approach that makes them feel valued and respected. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The service is adequately managed for the benefit of the people living there and the staff. Evidence: The manager has been at the home for approximately 12 years and offers a great stability and rapport to the staff and people living there. During our visit the manager displayed a good awareness of the support needs and choices of the people living at the service. The manager meets with people on a regular basis and the minutes of these meetings shows good communication keeping everyone up to date and included with things at the service. We looked at a sample of minutes which showed varied agendas including things such as, training, daily records, staffing, environment, bank accounts, person centred plans and furniture. The home is visited on a regular basis by a representative of the organisation. These Care Homes for Adults (18-65 years) Page 31 of 40 Evidence: visits form part of the quality assurance process and form an opinion on the standard of care and support provided. These visits are also a requirement of the care home regulations and a report has to be produced to show evidence of quality checks. We did not see any evidence of these reports during our visit, however following this visit the manager contacted csci 3/3/09 stating she had the last 12 months records they had been held at head office. The monthly reports need to have evidence of checks and auditing of other areas aside from health and safety such as checks on medications, finances, support plans, staffing, and proposed plans for the future. We did look at 3 monthly health and safety audits carried out by staff at head office. They showed detailed checks on health and safety within the service making sure the service was safely managed. The manager carries out her own detailed monthly checks on various areas within the service including the, environment, windows, kitchen, vehicle, clinical waste, coshh, training, medication and accidents. We looked at the previous months audits for 2008 however none were seen for 09. This was due to a new form only just being published and accessible to staff. If the audits are done regularly they will help in providing detailed evidence of checks at the service to show standards are always maintained to provide the right service for people living there. Records and certificates showed that regular checks are carried out on the building. This includes checking electrical installation, fire alarms and equipment and the gas supply. These checks help to make sure that the environment is well managed and is a safe place to live and work in. The AQAA identifies various reviews needed for some policies which were noted to be quite old. The policies for managing finances stated in the aqaa that, all financial policies to be reissued in next financial year following training. This had still not been done during our visit. The manager and staff need all policies and procedures to be up to date to make sure that they are given the right guidance to help in their day to day work and practice. The manager explained that they do an annual resident/relatives survey each year but she didnt have any results to show us or any evidence of previous years survey results. She felt the results were positive and she was just waiting from head office to analyse them. She said there was a query from relatives regarding the management of the transport provided by the company. The manager explained that the company organise a carers forum but no one currently goes to it from Greenheys but in the past they have had relatives attend. The company have stated they are arranging a new Employee partnership forum to Care Homes for Adults (18-65 years) Page 32 of 40 Evidence: enable staff to be consulted on and engaged in decisions that effect them. The manager showed a recent company publication available to everyone dated Jan 09 called, staying in touch, which is a newsletter the first of many to start being published. This was a good example form the company as to how they have started to help keep everyone updated with developments in the company. The manager said they are due to have their next investors in people assessment in November 2009. Care Homes for Adults (18-65 years) Page 33 of 40 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Adults (18-65 years) Page 34 of 40 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 1 6 An updated copy of the statement of purpose and service user guide must be forwarded to the Commission and also be accessible to everyone at the home. This will help keep everyone informed about all aspects of the service and any proposed changes. 12/06/2009 2 20 13 All staff must be provided with up to date training in the administration of medication. To stop any further practices of staff handwriting over prescription labels which covers the general medical practitioners prescription. This will make sure they are competent and able to safely administer medications in line with current and updated policies and procedures 13/05/2009 Care Homes for Adults (18-65 years) Page 35 of 40 3 32 13 All staff must be provided with updated safeguarding training as a matter of priority. So they are provided with the most uptodate information to help them in safeguarding the people they support. 15/05/2009 4 32 13 All staff must be provided with the most up to date training and practice covering behavioural techniques and challenging behaviours. This will help to make sure staff have the right skills and training to deal with risks identified in peoples support plans to help keep them safe.This will help give clear, safe guidance to staff to support people with challenging behaviours. 13/05/2009 5 32 13 To provide all staff with first aid training and necessary skills to support people at risk of choking. This will help to make sure staff have the right skills and training to deal with risks identified in peoples support plans to help keep them safe. 13/05/2009 6 33 18 Staffing levels must be kept under review in order to make sure that staffing levels are appropriate to the needs of the people living at Greenheys. These reviews 12/06/2009 Care Homes for Adults (18-65 years) Page 36 of 40 should include staff and peoples opinions. This will help to show that staffing levels enhance each persons quality of life rather than impinge on their ability to not be able to do what they want due to staffing levels 7 36 19 The manager should keep updated records of employment checks such as (crb) police checks for all staff. These checks help to make sure the people living there are safe and that staff are suitable to support them. 12/06/2009 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 3 To make sure each identified person has an appropriate person(advocate) acting on their behalf especially regarding proposed changes to their living accommodation. This will help them be supported in their best interest. To review the current staffing rotas to look at how females living at the home can have the right ratio of female staff to help promote their privacy and dignity with personal care. For all person centred plans to have accurate reviews dates of when they have been carried out, and as a minium to have 6 monthly recorded reviews. This will help to manage and plan when reviews are needed and help to show up to date information for people at the service Everyone must be included in any proposed changes to their home and evidence must be in place to show any changes are in each persons best interest. The Responsible person must provide an update to the commission Page 37 of 40 2 6 3 7 4 7 Care Homes for Adults (18-65 years) regarding any future changes to the current registration of greenheys. 5 12 To support and facilitate everyone at the service to access a variety of age and culturally appropriate activities on a daily/regular basis and make sure staffing levels meet their needs and never restricts their daily living and quality of life. To develop an ongoing activity planner for each person as stated in the services AQAA to show what plan and actions are taken to provide the right support for an active life. To provide staff with guidance and training on supporting people with activities. To update support plans for those people at risk of poor nutrition and include regular recording of weights and monitoring and include professional opinions IE, the community dietitian in how they should be supported. The person centred plans should be specific with any methods used in managing challenging behaviour. Any future incident must be recorded on the company incident forms and reported to the commision explaining what actions are taken to safeguard people. These support plans must reflect the most up to date guidance covered in best practice training. Medication records and care plans should include details of any changes and circumstances in which medication is to be given as required(PRN). This guidance should be updated and covered in best practice and training necessary for staff to act appropriately. To provide evidence of appropriate and regular investment to the decoration of the building to try and achieve a higher standard of living facilities more suitable to the needs of younger adults. To develop a maintenance, decorating and development plan for everyone at 52 Greenheys so they can be kept informed and included in the developments of their home. To include information as to when they can have their bedrooms redecorated and refurbished. To produce a cyclical maintenance programme accessible to everyone at Greenheys as advised in the Aqaa. To have updated individual training for each member of staff so they can be supported with the right training to help them with their job roles in supporting people with specific needs. A commitment from the company must be in place to provide all necessary training as detailed in staff training development plans.They should be provided with timescales for refresher courses such as safeguarding, medication, autism, health and safety, food hygiene and epilepsy. New staff should receive structured induction training and foundation training covering 6 months to help Page 38 of 40 6 19 7 19 8 20 9 24 10 35 Care Homes for Adults (18-65 years) assist them in developing their role to appropriately support people living at 52 Greenheys. To provide evidence of at least 5 days paid training per person each year 11 39 To carry out monthly visits to check the standards of support at the service. To include the opinions of people at Greenheys while carrying out monthly checks, so that their views can be considered regarding the service especially regarding development plans for the future, staffing levels and support, training, access to activities, the environment and standards within the service. The services AQAA must be updated and relevant to the service, all areas identified in this report that are in contrast to the statements made in the Aqaa must be reviewed and rectified so that this document offers a true and accurate account of the services and standards provided at Greenheys. The company had a statement in the services file for challenging behaviour which stated, physical intervention involves the application of the minimum force needed to prevent injury. This must be revised by senior management and advice given to staff regarding whether this should stay in the service file. An up to date policy on best practice in managing challenging behaviour must be in place a a matter of priority. The service must be provided with uptodate policies relevant to all areas within the Greenheys, including infection control and financial policies and all other policies identified on the services Aqaa with old review dates. They are necessary to assist with good practice and to give the staff access to the most uptodate guidance for their practice. 12 40 13 40 14 40 Care Homes for Adults (18-65 years) Page 39 of 40 Helpline: 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 We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. 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