Inspection on 19/09/07 for Greenlands

This inspection was carried out on 19th September 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Adequate. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Greenlands 05/12/06

Greenlands 25/04/06

Greenlands 07/11/05

Greenlands 10/05/05

Greenlands 24/01/05

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

CARE HOMES FOR OLDER PEOPLE Greenlands 46 Green Lane Bolton Lancashire BL3 2EF Lead Inspector Lucy Burgess Unannounced Inspection 19th September 2007 09:30 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 Greenlands DS0000061961.V344928.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. Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenlands Address 46 Green Lane Bolton Lancashire BL3 2EF 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) 01204 531691 greenlands@btinternet.com Mrs Asma Ali Khan Mrs Shagufta Parveen Rasul Hussain Mrs Shagufta Parveen Rasul Hussain Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The service should employ a suitably qualified and experienced Manager who is registered with the Commission for Social Care Inspection. 19th March 2007 Date of last inspection Brief Description of the Service: Greenlands is a private residential care home registered to provide care for up to 28 older people. Placements made at the home are made from the local authority or through private referral. Fees range from £315.00 to £350.00. This is dependant on single or shared accommodation. The property is detached and set in its own well-maintained gardens. There is also parking to the rear. The Home is situated close to all local amenities and easily accessible for local transport to Bolton. The Home comprises of four single bedrooms and twelve double rooms. They are individually decorated and furnished and include a wash hand basin and a nurse call system. There are no en-suite facilities. The Home offers the choice of two lounges and a separate dining room. The standard of cleanliness is good. There has been an on-going programme of maintenance and re-decoration to enhance the environment. Greenlands provides comfortable accommodation for the residents living there. Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced visit to the home. The inspection was carried out over one day, between the hours of 9.30am to 5.45pm. During the visit time was spent looking at paperwork and the environment as well as observing staff interactions with residents. The inspector also spoke with residents, staff and the manager. As part of the inspection process the manager was asked to complete an Annual Quality Assurance Assessment (AQAA), which was then forwarded to CSCI. Information provided was detailed and looked at both the strengths and weaknesses of the agency and what plans had been made to develop and improve the service further. Feedback surveys were also sent to service users and staff. The inspector received 2 completed surveys from a GP and relative. Comments have been included in the report. The home is registered to provide accommodation for 28 people, however the occupancy level at the time of the inspection was 20. All the key standards were looked at during this inspection visit as well as the action identified during the last visit. What the service does well: Some of the residents living at Greenlands have lived at the home for some time and appear very settled and happy living there. One residents expressed that she ‘liked it here and wouldn’t want to be anywhere else’ and that the staff were ‘kind and looked after her’. Although no feedback surveys were received from residents’ comments were made by a visiting GP and a relative. Comments included; ‘they show kindness and love, they meet the persons needs and inform us of anything they think we need to know and we are always made welcome’, ‘residents are treated with kindness, dignity and consideration as individuals, their families are also catered for’ and ‘there are some excellent junior staff, a couple who are outstanding’. The manager has recently sent questionnaires out to relatives to get some feedback from them about the service provided by the home. The questions looked at the food, activities, communication and the environment etc. Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 6 Some of the comments received included, ‘I am very satisfied with the home and the care given to my mother’, ‘bit tired in places but I am aware of the ongoing refurbishment’ and ‘I think the staff treat my friend really well and try to do as much as they can to make her stay comfortable. She seems quite happy and appreciates her trips out, overall she is well looked after’. What has improved since the last inspection? What they could do better: Assessment documents need to be developed and completed in full when admitting people to the home. This will ensure that the relevant information is gathered and that the home only admits people where they are able to meet their needs. The manager must ensure that where there are changing care needs of residents this should be reflected in the care plans and risk assessment so that information is accurate and up to date so that staff have a plan to follow and residents are kept safe. Another comment received was in relation to accessing treatment. It was stated that ‘some residents have been ill all day but it has been left to the night staff to seek medical attention and wondered why help had not been called for sooner’. Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 7 The process of inducting and training new staff should be consistent so that everyone receives the same information and support in order to carry out their roles and responsibilities properly. The manager is to provide a training matrix showing what courses staff have completed as well as what is still needed. This should include adult protection. The manager must ensure that all quality training is provided by a suitable training provider. Minor improvements are needed when recruiting new staff to ensure that residents are protected. One of the areas the home should explore is annual report based on the feedback from service users and other parties about the quality of service provided and how this will inform future plans. With regards to health and safety, arrangements should be made for hand washing products to be provided within the laundry to prevent cross infections. Water temperature should be recorded to show that staff are monitoring the water when assisting residents with the electric showers. The manager is also asked to forward a copy of the home’s fire risk assessment, as this was not available at inspection. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greenlands DS0000061961.V344928.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 Greenlands DS0000061961.V344928.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. JUDGEMENT – we looked at outcomes for the following standard(s): 3 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The assessment process allows for the needs of prospective residents to be gathered prior to them moving into the home. EVIDENCE: Care files were examined for three residents. One was a new resident, who had recently moved into the home on a permanent basis. Information was examined with regards to assessment information. Documentation had been provided by the local authority, which included an assessment, general risk assessment and service specification. Information was detailed and outlined the emotional, physical and medical needs and the support they required as well as any aids needed. Further details included areas of risk, health screening, finances and mental health and provided a good over view into the needs of residents and whether they could be met by the home. Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 10 The manager had also carried out her own assessment and gathered additional information in relation to the service users needs, however this had been roughly recorded on a piece of paper. The manager is reminded that where individuals are self-funding a detailed assessment should be completed in line with standard 3, ensuring all relevant information is gathered prior to any decisions being made. This should be recorded more formally covering all areas in relation to the persons’ social, emotional and physical well-being. Following placement at the home, an early review is held between the social worker, resident, their family and the home to establish if the placement is suitable and meeting their needs. Evidence of such reviews were seen on file. Standard 6 does not apply to Greenlands as they do not provide intermediate care services. Greenlands DS0000061961.V344928.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. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Individual plans need to reflect the current and changing needs of residents to ensure that resident’s health and well-being is addressed. The management and support offered to residents with regards to medication was found to be safe. EVIDENCE: Care files were examined for three residents. One was a new resident, the second had health concerns and the third was tracked during the last inspection due to changes in behaviour and wandering. Information about residents is held both upstairs near to the manager’s office and downstairs near the dining room. Whilst the files upstairs are accessible to staff it is unclear if they are read as the day-today records are held downstairs. Files looked at were orderly and evidenced that information had been reviewed however some information did not reflect current health changes. Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 12 One resident was being cared for in bed due to deterioration in health. The resident had been in hospital however had returned home and was being supported by the home and district nurse team due to a pressure sore. The risk assessments in moving and handling and pressure care had not been updated to reflect the changing needs. Another resident had a pressure care assessment in place however this had not been completed in full and therefore did not fully reflect their assessed level of need. This person is generally supported in their bedroom as this is were they spend most of their time. Due to the age and needs of the resident the plan in relation to mobility could be expanded to include what equipment is used, support of 2 carers and how support is provided when transferring. This will ensure that all staff are offering support in a consistent way. Another file stated that the resident’s skin was ‘in tact’ however further entries within the diary and pressure care assessment showed that treatment was being provided due to pressure blisters. The moving and handling assessment also differed from the care plan with regards to falls. The care plan stated that the resident did have a history of falling, however the moving and handling assessment was scored zero, therefore did not provided accurate information. The manager must ensure that information is updated when reviewed on a monthly basis or more frequently if needs change and that plans are accessible to staff at all times ensuring the care offered is consistent. A comment was received about staff accessing appropriate treatment for residents. It was stated that ‘some residents have been ill all day but it has been left to the night staff to seek medical attention and wondered why help had not been called for sooner’. The manager should explore this and ensure that prompt action is taken by all staff when on duty to ensure that the health and well-being of residents is maintained. Additional records are also completed and include daily diaries, monthly weight records, professional visits, such as GP’s, social workers, dentist, hearing checks, dentist and district nurse etc. Weight records continue to be monitored and evidence where changes had occurred. Suitable arrangements had been made for those individuals requiring supplements. Records are being maintained with regards to accidents and incidents. Information identified on the AQAA had also been passed on to CSCI and a Regulation 37 notification form completed. The medication system was examined. Medication continues to be supplied by BOOTS pharmacy. A recent audit had been carried out on the 1 August 2007 and no issues were identified. Records continue to be made when items are received and retuned by the home. Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 13 All medication is stored within two secured trolleys in the dining room. On examination of records, information was recorded. However where changes have been made to the sheets or additional medication has been added, arrangements should be made for hand written records to be signed, dated and then countersigned by 2 staff to ensure that the information recorded is correct. Staff were observed administering medication at tea-time. Water was provided with medication and residents were informed of what they were being given. The staff member then observed medication being taken. Residents were also asked if they would like pain relief where this had been prescribed. The inspector also spent some time observing and speaking with residents. From the observations it was noted that staff and residents enjoyed a good rapport and joked with each other. One resident spoken with said, ‘they are great here’, ‘couldn’t want for anything’ and ‘I wouldn’t want to leave, I’m very happy’. Feedback from a relative and GP was also received. Comments included, ‘we are satisfied with the care and attention our mother has from all the staff’, ‘they show kindness and love, they meet the persons needs and inform us of anything they think we need to know and we are always made welcome’, ‘residents are treated with kindness, dignity and consideration as individuals, their families are also catered for’ and ‘there are some excellent junior staff, a couple who are outstanding’. Greenlands DS0000061961.V344928.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. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. A choice of activities and outings are provided offering some choice and stimulation. Suitable arrangement are in place with regards to meals. EVIDENCE: Residents continue to enjoy regular contact with family and friends. Daily records evidence that visits have taken place. As previously identified family members have expressed that they are ‘always made welcome when visiting the home at any time of the day’ and ‘are happy with the care and the day trips they have been taken on’. Records did show that residents had enjoyed outings to Smithills for a show and dinner, another trip was to Knowsley safari park. Two residents had also attended the wedding of a staff member and one resident had recently celebrated her 100th birthday and a party was held. Arrangements were being made for a trip to Rivington as well as plans for an outing for Christmas. The home access Bolton Community Transport for such activities. Other activities are organised by the staff, these include ball games, nail care, foot massage, quizzes, sing a long and discussion groups. Residents also Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 15 enjoy watching the television. One resident said she was quite happy with the television and had a TV magazine to refer to. Some residents have newspapers and magazines delivered to the home. A hairdresser also visits the home as well as an outside entertainer. Records are maintained with regards to what has been offered and who has taken part. One of the residents continues to attend the Asian Elders Centre as well as having a volunteer. This enables her to access the wider community as well as socialising with other people from her own religion and culture. Adequate arrangements are made within the home with regards to providing a Halal diet and festivals are observed. The homes dining room has recently been refurbished with new tables and chairs being purchased. Tables were nicely set with clothes, flowers and cruets. The nutritional needs and weights of residents are recorded. Those residents requiring a special diet are catered for and appropriate support is offered where necessary. Meal times were unhurried. Menus are said to be reviewed and alternative option provided for those who request it. Generally a larger lunch is served with a lighter meal in the evening. Hot and cold drinks are served with meals and throughout the day. It was noted however that the kitchen looked tired and in need of some attention. The cook expressed that cupboard doors were in need or replacing. This has been detailed further within the report under environment. Greenlands DS0000061961.V344928.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. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Systems are in place with regards to complaints and adult protection issues. Relevant training is needed for new members of the team to ensure that they are fully aware of the procedure and that residents are protected. EVIDENCE: An easy to read copy of the homes complaints procedure is displayed within the home and accessible to both residents and staff. This had been amended to include the new contact details for CSCI. The manager was asked if any issues had arisen since the last inspection. The manager explained that they had received only one concern, which the inspector was made aware during the last visit in March 2007. No other concerns or complaints had been received nor have any issues raised with the CSCI. Information in relation to adult protection procedures are also held within the home and available to staff. In relation to Adult Protection training, this has been provided to existing members of the team, however of the files examined there was no evidence to show that new staff had completed the course. This should be arranged. From the feedback surveys received from residents, each acknowledged that they were aware of how to speak to if they had any concerns. Greenlands DS0000061961.V344928.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. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. On-going redecoration and refurbishment has improved the appearance of the home providing a pleasant living environment for the residents. EVIDENCE: Successful application was made by the homes owners to the Local Authority for grant money to assist in making improvements to the home. Since the last inspection visit in March 2007 work has been carried out in a number of communal areas. This has included none slip flooring fitted to the lounges and dining room and new carpeting to the hall, stairs and landing. Whilst it is acknowledged that non-slip flooring may be more practical for some areas of the home, this does not reflect a homely appearance in the lounges. The manager explained that carpeting was to be purchased offering more comfort and warmth to residents. Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 18 New dining furniture has also been purchased and lounge chairs, which are more in keeping with the improvements made. Issues with the central heating system on the 2nd floor have now been resolved with the installation of a separate system being installed for that floor. Further aids have been purchased to assist residents when using the toilet facilities, these include frames and raised seats. Outside of the home the mature gardens continue to be maintained. The home is currently having a new canopy built across the front door offering visitors shelter. Residents spoke with commented that ‘a lot of work has been done, the home is looking nice’, and ‘very comfortable, very smart’. A staff member said that the owners has ‘worked hard to do things around the home’. On-going issues have occurred with regards to the passenger lift, which has impacted on residents being able to access their rooms. This was disgusted with the manager who explained that damage had been caused to the machinery due to pigeons being in the roof. The manager said that repairs have now been carried out the roof and to the lift, which has hopefully now resolved the matter. A wasp nest was also found in one of the bedrooms. Pest control were called and sprayed the areas. The manager stated that the officer was due to return to remove the nest. Through discussion with the cook, she expressed that the kitchen was also in need of some attention and that new cupboard doors where needed. Bedrooms also looked tired compared to the work that has taken place within the communal living areas. The manager explained that work would be carried out in each of the rooms over the next year or so. The manager is asked to forward a copy of the homes redecoration/refurbishment plan to the CSCI identifying work is required and the proposed timescales for action. The home has a number of toilets and bathrooms available on each of the floors, therefore easily accessible to residents. Bathrooms had previously been refurbished. Electric showers have been fitted in two of the rooms. The manager was asked how the temperature was checked when supporting residents with showers. The manager explained that thermostatic valves were fitted to the sinks and that staff would check the setting of the shower and the water temperature before a resident would use the shower. In relation to hygiene, the home was found to be warm, clean and tidy. The home employs domestic staff that take responsibility for the majority of domestic tasks however some areas are undertaken by the care staff. The laundry area has been reorganised. Whilst there is a sink available the inspector did not see soap or paper towels for hand-washing. Detergents were Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 19 also on the work surface however the door does not have a lock. The manager is asked to make suitable arrangements to ensure that staff carrying out the laundry wash their hands thoroughly to prevent cross infection and that the room is secure so that residents are not at risk. The inspector was advised that the infection control officer is soon to visit the home again to ensure that suitable arrangements are in place with regards to cross infection following an outbreak of diarrhoea and vomiting. Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29 and 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. To ensure that residents are protected and supported safely the manager must ensure that staff have been appropriately recruited and trained. EVIDENCE: At present the home is supporting 20 residents. Staffing throughout the day continues to be 3 carers (which may include the manager), a cook and a domestic. Evenings are also covered by 3 carers with 2 wake-in staff throughout the night. On some days a fourth member of staff will be rota’d to work throughout the day affording time to be spent on activities, supporting with bathing etc. The team comprises of a manager, 4 senior carers, 16 carers, 2 domestics and 2 cooks. Since the last visit a number of new staff have been employed by the home in the role of carers and domestic help. The personnel files were examined for the six new staff. Information included an application form including health declaration, written references, copies of identification, photograph, POVA check and CRB. Minor shortfalls were found with regards to 2 files only having 1 written reference. A reference on one file was found to be poor and had not been signed, the manager should explore this with the referee and evidence on file the outcome of their discussion. Another file did not provide a detailed employment history with dates missing and gaps not explored. Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 21 Several of the new staff were from overseas. One file held correspondence from the home office with regards to work permits, another file however held a visa stating ‘work must be authorised’. There was no further information to demonstrate that this had been done. It was noted that the owners have been invited to a care home providers meeting, which is to be attended by members of the Immigration Department. It was advised that the managers attend so that relevant information and guidance can be sought when employing people from other countries. Good practice was noted in that where gaps in employment histories had been noted additional information had been sought and recorded. As previously identified the manager is asked to develop a system of formally recording the information so the records and clear and ensure that residents are being protected. Of the files examined information provided in relation to training only consisted of an induction and moving and handling training. Further training has been identified over the next few months through the Bolton Health and Social Care Partnership, covering medication, food hygiene and safe wheelchair handling, however in the main these are for existing staff. The manager must ensure that all staff receive the necessary mandatory training relevant to their role to ensure that practice is safe. The manager is asked to provide the CSCI with a skills audit identifying what training has been completed by staff and future course planned along with dates. The inspector was advised that the home has purchased a number of training DVD’s covering areas such as death and dying, adult protection etc. Whilst it is recognised that these will benefit the team they should not be used in place of good quality formal training carried out by competent training providers. Further training has been offered with regards to NVQ with some funding being made available for Level 2 and 3. Of the 20 carers working at the home at present 7 staff have achieved level 2/3 and a further 4 staff are currently completing their training. Two staff are currently completing social care courses at Bolton and 1 carer has at least 7 years nursing experience in India. The manager has also completed her NVQ level 4 and Registered Managers Award. In relation to induction, copies of the TOPSS booklets are being completed by the new staff with the manager on commencing their employment. The manager may wish to replace these booklets with documents now provided by Skills for Care. On examination booklets were in the main signed by both the staff member and the manager, however the duration of the induction varied. Whilst some staff worked through the book over a number of weeks, 1 book had been completed over just 1 day. The manager must ensure that an effective and concise induction process is followed by all new staff ensuring Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 22 they have the information and guidance required to support residents safely and carry out the duties appropriately. Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. With the development of an effective quality monitoring systems this will enable the home to achieve its aim in providing a good quality service for the residents. Adequate arrangements continue to be in place to safeguard service user finances as well as ensure the safety of residents and staff. EVIDENCE: The manager of the home is also one of the proprietors of Greenlands. She is a qualified nurse and has experience of caring for older people. The manager gained her NVQ Level 4/Registered Managers Award early in the years. Copies of her certificates are to be forwarded to CSCI. Some of the feedback received was around leadership and accessing medical care. It was felt that at times there was not always someone on duty who Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 24 could make the decision necessary. The manager should ensure that suitable arrangements are in place at all times and that staff are clear about their responsibilities in meeting the needs of residents. The owners are members of the National Care Association (NCA) and attend the local Provider meetings (BARCH) where information and guidance is shared between care home providers within the Bolton area. Information provided on the AQAA stated that the home had not completed the National Minimum Data set however during the visit notification had been received from Skills for Care evidencing that this had been completed and registered with them. Both the manager and co-owner work within the home on a day-to-day basis, supporting both residents and staff. Due to this monthly moniroing visits and reports are not carried out. Each undertake period training relevant to the home and have clear identified areas of responsibiltiy. As part of the quality monitoring the manager carries out periodic supervision with staff and records are held on individual files. These were seen by the inspector in files examined. Staff meetings and appraisals are also carried out. The manager has recently sent questionnaires out to relatives to seek feedback from them about the service provided by the home. Questions explore food, activities, communication and environment etc. Some of the comments received included, ‘I am very satisfied with the home and the care given to my mother’, ‘bit tired in places but I am aware of the on-going refurbishment’ and ‘I think the staff treat my friend really well and try to do as much as they can to make her stay comfortable. She seems quite happy and appreciates her trips out, overall she is well looked after’. The Manager is again advised to explore this area and consider seeking feedback from other people who are known to them, for example, Social Workers, GP’s, and District Nurses etc. Information gathered can also be used to inform home’s annual improvement plan and evidence that the views of residents and other stakeholders are listened too. Copies of the information should be made available to relevant parties including CSCI. Records were not checked on this occasion with regards to resident’s finances. The manager explained that personal money is only held for 3 residents with the remaining being managed by family, solicitor or local authority appointee. Records and receipts are held to evidence all transactions. With regards to health and safety, checks had been carried out be external professional in relation to hoists, passenger lift, fire equipment, gas, emergency lighting and call bells, small appliances and electric. Checks are also made in relation to fire safety and a recent risk assessment and training Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 25 has been completed by an external provider. The manager is asked to forward a copy of the risk assessment to CSCI as this was not available for inspection. Records were seen for water temperatures. As identified early in the report electric showers have been fitted in two of the bathrooms. Records should be completed by staff when assisting residents with a shower to show the temperature reading ensuring residents are not placed at harm. Discussion was also held with the manager with regards to the recent outbreak of diarrhoea and vomiting in the home. The manager is now aware of her responsibility in reporting such outbreaks to both CSCI and Infection Control, as this had initially not reported but passed on due to residents having to attend hospital. Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 26 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 3 X X 2 Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? YES STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 OP8 Regulation 12(1) 15(2) Requirement Detailed plans and assessments reflecting the current and changing needs of residents should be in place and easily accessible to staff at all times to ensure that clear monitoring takes place and the health needs of the resident are met. Timescale for action 30/10/07 2. OP8 12(1)(b) Where residents appear unwell 30/10/07 and need medical attention is needed appropriate action should be taken by staff to ensure their health and well-being is not affected. Arrangements should be made for all new staff to receive training in adult protection to ensure that they are aware of the procedure to follow and residents are protected. The registered person must ensure that staff files include all relevant information in line with the Regulation to ensure residents are protected. DS0000061961.V344928.R01.S.doc 3. OP18 18(1) 30/12/07 4. OP29 19 30/12/07 Greenlands Version 5.2 Page 28 5. OP30 18(1) The registered person must ensure that a training skills audit is undertaken to ensure that all the staff team have received the necessary training relevant to their roles and responsibilities, including domestic and catering staff. A copy must be sent to CSCI. To ensure that the home is run smoothly and in the best interest of residents, the registered manager/providers must ensure that there are clear leadership and direction within the home. Arrangements should be made for recording and monitoring water temperatures when using the electric showers to demonstrated that residents are being cared for safely. 30/10/07 6. OP31 12 30/10/07 7. OP38 23 30/10/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP3 Good Practice Recommendations When service users, particularly those who are self funding, are referred to the home, the manager must ensure that a formal detailed assessment is completed ensuring all relevant information is gathered so that an informed decision can be made about their needs can be met. Residents or where appropriate their relative/representative should be involved in the development of their care plan and then asked to sign to evidence that they agree with the information recorded. 2. OP7 Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 29 3. OP19 A copy of the home’s refurbishment plan is to forwarded to CSCI identifying further work to be carried out within the home along with timescales for completion. Where additional information has been gathered from applicants the manager should develop a system of formally recording the information so the records and clear and ensure that residents are being protected. The manager must ensure that the process of inducting new staff to the home is consistent ensuring staff receive the same level of information and support when commencing their roles. The manager should forward to CSCI copies of her certificates for the NVQ level 4 and Registered Managers Award training, which has recently been completed. The Registered Person should consult with other parties and feedback included within the homes development programme. A copy should be provided to interested parties and the CSCI. The manager should forward a copy of the home’s fire risk assessment to CSCI, as this was not available at inspection. 4. OP27 5. OP30 6. OP31 7. OP33 8. OP38 Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection Manchester Local office 11th Floor West Point 501 Chester Road Manchester M16 9HU National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenlands DS0000061961.V344928.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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