Inspection on 25/04/06 for Greenlands

This inspection was carried out on 25th April 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 19/09/07

Greenlands 05/12/06

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 25th April 2006 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.V289696.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 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 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.V289696.R01.S.doc Version 5.1 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. 7th November 2005 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 shared rooms £315.18, singles £345.04 (LA funded) and shared rooms £325.00, singles £350.00 (privately funded). 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.V289696.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection was unannounced and took place over one day for a period of 9 hours. The inspector took the opportunity to look round the home, view records as well as talk with 5 residents and 5 staff members. Discussion and feedback was also held with the Deputy Manager. The home is registered to provide accommodation for 28 people. At the time of the visit there were 20 people living at the home. Although the inspection was unannounced the completion of a pre-inspection questionnaire was requested, along with feedback surveys from residents and staff. The inspector received surveys from 3 residents. All the key standards were looked at during this inspection visits. What the service does well: What has improved since the last inspection? Several complaints have been made since the last visit. Some of the concerns were about the care of residents as well as the poor relationship and lack of communication between the manager/owners and staff team. Due to the issues a few meetings have been held with the Vulnerable Adults Team. Visits to the home by the inspector and social workers have also taken place to look at what is being done within the home and check that the residents are happy and being cared for properly. Some improvements have been made. The manger/owners have looked at ways to improve relationships within the team. This has included improving and monitoring care plans, developing risk Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 6 assessments, purchase of chair scales so that weights can be monitored, training for staff, better, safer recruitment procedures and work to enhance the environment. Feedback received from staff supported this. Staff spoken with said ‘the team is working better together’ and ‘that morale has improved’. Feedback from residents and families following the review meeting found that the majority were happy living at the home and with the level of care provided. The manager/owners have also out together a ‘development plan’ for the next year. This looks at what other areas they would like to improve on so that Greenlands provides a good service to its residents and staff. What they could do better: 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. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 7 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.V289696.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 and 6 Quality in this judgement area is adequate. This judgement has been made using available evidence including a visit to this service. Information regarding the home, it’s facilities and what the residents should expect have been developed however they are not routinely given out. Without this information individuals are not able to make an informed decision regarding the suitability of the home and if their needs can/are being met. EVIDENCE: Documents are available within the home and detail the facilities and services offered. The inspector took copies of the information so that information could be assessed against the standards. The homes ‘Statement of Purpose’ had last been reviewed and up dated in March 2005 to include the change in Ownership. Whilst the majority of information has been provided, amendment is needed to details where reference has been made to NCSC and that information stated about the activities provided on ‘a daily basis’ are not routinely provided therefore this Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 9 should accurately reflect what the home is currently making available to residents. In relation to a ‘Service User Guide’, this could not be found however two further documents were taken and included a coloured leaflet including photographs of the home and another document called ‘Quality of care for the elderly’. These two documents contained the same information outlining the facilities within the home and the support provided. However neither document provided all information outlined within the standard. A copy of the ‘Service User Guide’ was received following the inspection visit. This included all information in line with the standard. In discussion with the deputy manager it was explored how information had been shared with existing and prospective new residents. It was found that information is not routinely given out and that information would be read through and discussed. A copy of each of the documents are kept next to the office for easy access should this need to be referred to. The manager should review the documents ensuring that information includes all details outlined with the standards and Regulation. Once completed this information should be made available to each of the residents and all prospective referrals made to the home so the individuals are able to make an informed decision about the placement and whether their needs can or are being met. Greenlands does have a contract agreement, ‘Contract of Residence’. This clearly identifies information with regards to room to be occupied, fees payable, and expectation of placement, termination arrangements and insurances. The manager is reminded that this information should be provided to residents and signed copies held on file. Placement agreements were also seen. The funding authority had provided these. Feedback received from residents through the survey showed that although some were aware that information had been shared they did not have a copy, whilst others were unaware with any documentation being provided. Assessment information was also examined. Information was seen on each of the files examined. Information held for the newest resident comprised of both assessment information from the funding authority and records made by the deputy manager during a visit, which was made prior to the placement being agreed. Information was found to be detailed and considered all areas of the residents emotional, physical and general well-being. Where areas of concern had been identified this had been detailed on a risk assessment document outlining what action would need to be taken to minimise the risk. Information gathered is used to inform the development of a care plan and an early review is set to ensure that needs are being met. Standard 6 does not apply, as Intermediate Care is not provided at the home. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10 Quality in this judgement area is poor. This judgement has been made using available evidence including a visit to this service. Whilst some improvements have been made to care plans and assessments further development is required ensuring that information accurately reflects the needs of residents and how they are to be met. On-going concerns with the management and administration of medication remain. This needs to be addressed ensuring practice is safe and residents are protected. EVIDENCE: The files of three residents were ‘tracked’. These residents were chosen due to serious concerns being raised by the CSCI pharmacy inspector with regards to the management and administration of warfrin, action taken following a resident falling and receiving serious injury and how effective communication is made between staff and an Asian resident. Each of the residents have two files, one that holds ‘current’ information and a second that includes previous plans and assessments, review notes and Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 11 correspondence. Information was orderly and easy to read. All files are held securely. On examination of the files, information included personal details including next of kin and GP as well as other relevant contact numbers. A photograph is also placed at the front of the file. Care plans had been completed, these identified summary information about the specific areas of need, routines and preferences along with any action to be taken. Areas covered included; personal care, diet and weight, mobility, personal safety, mental well-being, medication, communication, social interests and hobbies and family involvement and other social contacts. Although plans had been signed and dated by staff there was no evidence of the residents being invovled. The manager should actively encourage residents to be involved in the development of plans so that information accurately reflects their needs and wishes. Risk assessments had also been completed covering nutrition, pressure care and moving and handling. Both the care plan and risk assessments had been reviewed and updated, where necessary, on a monthly basis by a senior member of staff. The inspector spent time speaking with and observing those residents tracked during the visit. As one of the residents does not have English as a 1st language a member of staff was able to translate the questions and responses given. The resident who has lived at the home for sometime expressed ‘Im very happy living at Greenlands, I want to stay here and I am happy and like the staff. From observations made the resident was relaxed and laughing, interactions with staff were good and humourous. Several of the new staff are Asian therefore the resident is able to converse more easily using her 1st language. Information found on one assessment showed how the resident had been assessed as needing residential care however required support in relation to managing their warfrin medication and diabetes. The care plan outlined that blood sugars would need to be taken daily ensuring this was closely monitored and the relevant medication given, however other than the manager, who is a trainined nurse, no other member of staff had been trained in providing this support. The manager must ensure that relevant staff are suitbably trainied in providing this support ensuring this can be provided safely and effectively so that the needs of the resident are met. Blood tests required in order to establish the level of warfrin required are undertaken by the district nurse. It was noted in the diary that a clinic appointment had been made to review this ensuring the correct level of medication was being provided. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 12 Two issues were raised by the new resident regarding the variety or food and the delivery of a newspaper. This was followed up with the cook and deputy manager. The deputy manager expressed that these issues had been discussed with the resident however due to the health needs of the residnet information was difficult to retain. This was noted during our conversation and through observation. With the third resident recent changes had been noted within the residents health and that the GP had been involved to review medication. From observations made the resident spends alot of time wandering, moving from room to room. Whilst the moving and handling assessment stated that a degree of support/supervision is required due to the number of falls experienced this was not always provided. This needs to be clearly noted within the plan outlining what support is being offered and how staff can ensure the resident is safe from harm. In relation to the medication system issues were identified during the CSCI pharmacy visit on the 14 March 2006. An immediate requirement was made with regards to the safe administration and recording of warfrin medication. The manager has responded to the CSCI with regards to what action was taken to rectify the error however further information has been requested with regards to how the incident occurred. During this visit the co-agulation books for the 3 residents receiving warfrin were seen, information in the books reflected the information recorded on the MAR sheet. Other requirements made by the pharmacist inspector included the development of the medication policy, accurate measuring of drops, adequate stocks regarding painkillers and monitoring of the temperature to the medication cupboard. These too were looked at during the visit, action is still outstanding. Further action was also identified during the visit. This included clarification to hand written entries on the MAR sheets stating none supplied this month. In discussion with the deputy manager and a senior carer there were differences in what this meant. Whilst one thought no medication had been supplied, use exisiting stock another thought this meant that the medication was no longer to be administered. Clarity needs to be sought with the prescribing GP and all staff responsible for the administration of medication made aware so that practice is safe and that residents receive the necessary medication. It was also noted that the times of medication administration had been circled however did not always reflect what was stated on the prescription. For example, residents prescirbed pain relief - 2 tablet up to 4 times per day, records had been circled for breakfast and tea-time administration and therefore administered at those time. Whilst this is a prompt for staff administering the medication it suggests that the prescription is not being followed. The manager must ensure that the accurracy of records are Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 13 maintained and that staff responsible for the administration of medication are clear with regards to any changes which may have occurred. Records are made of all items brought into the home and returned to the supplying pharmacist. New staff had recently undergone the relevant training. With regards to privacy and dignity, residents were appropriately dressed. Several residents appeared to have had their hair cut and a couple of residents were wearing lipstick. From observations staff spoke clearly and politely whilst assisting them. When using the toilet those able to manage unsupported where left to do so or staff waited outside and would knock to see if any assistance was required. Staff spoken with gave good examples of how privacy and dignity is respected especially when providing personal care and again when supporting individuals who share a room. During the observations it was noted that when transferring residents by wheelchairs, footplates were not always in place and whilst supporting a resident at meal time a member of staff stood at the side of the resident. This was not appropriate. Staff should ensure that transfers are safe and when offering direct support with meals that they sit themselves next to the resident so they can support them properly as well as offer some interaction. Review meeting have recently been carried out on 19 placements within the home. All but 2 expressed there satisfaction with the care and support provided. One family did have some issues regarding their relatives safety however were satisified with the action taken by the home to address this. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12 to 15 Quality in this judgement area is adequate. This judgement has been made using available evidence including a visit to this service. More structured arrangements regarding the provision of activities would benefit the residents offering stimulation and variety to each day. Suitable arrangements are in place with regards to meals ensuring the nutritional needs of residents including those with specific dietary needs are catered for. EVIDENCE: Daily routines and the offer of activities need to be improved. Whilst it is recognised that some activities are offered such as ball games, music, sing-along tapes, reminiscence and occasional visiting entertainer, it was found that this is very much dependant on other events which may affect the daily running of the home. It was noted that whilst some residents show interest and will participate others show none or feel some games are unsuitable. As outlined further within the report this area should be explored further perhaps through regular residents meeting so that residents can share their ideas as well as being informed about any plans that have been made. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 15 The deptuy manager explained that a few residents have also been out with the owner to do the weekly shop. Previously (in better weather) the home has also arranged day trips out and meals at Smithles Coaching House. Those who wish to have a newpaper, arrangment are made for these to be delivered. There is a hairdresser who visits weekly and open visiting is availbale for family and friends. Arrangements are made for individuals to observe their cultural and religious beliefs. Local clergy visit the home, muslim festivals are observed and vegetarian/hala meals are provided. One of the residents at the home is Asian and has limited verbal communciation in English. With the employment of new asian staff this has provided more opportunity for the resident to speak in her own language enabling her to express herself fully. Whilst talking with the residents she stated that she was able to make her wishes known to all staff by using key words. A flip chart has also been put in place for staff to refer to which outlines words in English and Urdu. As both of the Proprietors are Asian they too have a good understaning of the cultural and relgious needs of the resident and have ensured that arrangements have been made for festivals to be observed including food items. Arrangements are also in place for the resident to attend a local asian elder centre and regular visits to a befriender. This enables the resident to maintain contact within the asian community as well as developing and maintaining relationships with others away from the home. In relation to meals/diet, the cook was spoken with and meal times observed. Lunch was homemade meat and potato pie and vegetables followed by homemade rice pudding, tea was burgers on a bun with onions and an assortment of cakes, yogurts or fruit. Residents were seen to enjoy both meals, with little food being left over. Those wanting a further helping did so. The cook expressed that adeqaute stocks continue to be provided. Any items required are then purchased by the owner who does the regular weekly shop. The food stocks were seen, with ample food (meat, fish, pies, cakes, tinned goods, dry goods, bread, milk, fruit etc) available. Arrangements were also in place with regards to halal/vegetarian foods. The Food Hygiene Inspection had recently visited the home. Minor action was identified with regard to a broken cupboard door and probe wipes. The inspector was informed that this had been actioned. Some staff, including the cook have recently had training in food hygiene. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16 and 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Recent complaints have identified areas of development within the home, without these improvements there is no assurance that residents are safe and protected. EVIDENCE: Recent complaints are being addressed and progress monitored by CSCI and the Local Authority. The Proprietors have been co-operating and action has been taken by them to address some of the concerns raised. The home continues to be monitored by the Vulnerable Adults Strategy team. A further meeting is being held on the 16 May 2006 to review the progress made and determine what further action, if any is required. Some elements of the complaint have been followed up by the reviewing team as part of the individual reviews. In the main feedback received from family members and residents was positive about the placements at the home. A recent issue disclosed to staff by one of the residents has also been passed to the relevant social worker in line with the Vulnerable Adults Procedure and appropriate action is being taken. CSCI are to be kept informed of outcomes. A previous requirement regarding Adult Protection training has not yet been fully addressed. The manager needs to make arrangement for those staff that have yet to complete the course particularly the newest members of the team. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 17 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Greenlands provides a comfortable homely environment for those that live there. Further redecoration and refurbishment is taking place, this will further enhance the home. EVIDENCE: Greenlands is a large detached home. Accommodation comprises of 2 lounges, a dining room, and a number of bathing/showering and toilet facilities. There are 4 single bedrooms and 12 shared rooms. Additional facilities include a large kitchen, laundry room and office. There is a well maintained garden to the front and side of the property as well as parking for several cars to the rear. The inspector spoke with one of the new residents. The resident said that he had settled well, was quite happy and comfortable in his big room. They have given me a nice room. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 18 The home is situated on a main road and accessible to public transport and all local amenities including a post office, hospital, local shops and a pub. Whilst walking around the home it was seen to be clean and tidy and free from odour. There were adequate arrangements in place with regards to domestic staff and ample stocks held in the garage with regards to cleaning materials. Protective clothing is available and worn by staff when undertaking certain tasks, ie: personal care, cleaning and assisting with meals. Adequate arrangements are in place with regards to domestic staff. The general environment was looked at. Some redecoration had taken place in the dining room, small lounge and 3 of the toilet/bathrooms. This has made the rooms look brighter and cleaner enhancing their appearance. Residents and staff felt the dining room was ‘brighter and more inviting’. The Proprietors have written a development programme for 2006/07 this identifies further refurbishment to the home, which will include re-carpeting of the hall, stairs and landing areas. The owners have also purchased a new heavy-duty washing machine which has a built in sluice facility. It was found that the first floor shower was out of order and had been leaking through to the small lounge. This needs to be repaired so that residents are able to use it when needed and so that no further damage is caused to the lounge. Aids and adaptations are provided throughout the home so that residents are able to move around the home more freely. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 19 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27 to 30 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. With good recruitment practices, sufficient staffing levels and on-going training and development this will ensure residents are cared for safety by competent and reliable staff. EVIDENCE: Due to recent concerns regarding the management of staff, some concerns were noted in relation to maintaining sufficient staffing hours. Due to this rotas had been requested for monitoring purposes. With the recruitment of new staff this has now provided sufficient numbers ensuring the all shifts are covered on a regular basis. The home does not use agency staff, as some of the existing staff are also willing to cover extra shifts therefore offering continuity in care. Through discussion with the deputy manager and on examination of the preinspection information and rotas, three staff were identified who had been employed following the last inspection. These files were looked at by the inspector. Of the new staff identified only 2 files could be found. No rd information was found for the 3 member of staff, although it was noted that shifts had been undertaken as detailed on the rota. The contract for another member of staff had not been dated or signed. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 20 All other information was found on file for the two other members of staff. This included an application form, CV, copies of certificates, references, work permit information and criminal record check. Criminal record checks are in place for all staff. Information not found at the last inspection for several members of staff was looked for during this visit. Documents to confirm the checks had been carried out were seen in each of the files. In the main recruitment procedures had been improved with information being sought prior to new staff commencing employment. Two of the new staff were spoken with in relation to their induction and training provided. Both confirmed that the manager had undertaken an induction programme with them. This involved looking at policies and procedures, health and safety, service user needs etc. Whilst an induction book was seen for one members of staff it had not been signed by the carer to confirm this had been done. No information was found for the second member of staff. The manager must ensure that evidence of all training completed is held within the staff files. In relation to training, several courses had been provided including food hygiene, moving and handling, infection control, 1st aid and fire safety. Some of these training courses, as well as continence care are still needed for existing members of the team. This is an outstanding requirement. The newest staff had completed training as part of their induction in moving and handling, health and safety, food hygiene, fire safety, medication and infection control. Certificates were held on file. Further training is needed in Adult Protection. In relation to NVQ training, this too is being undertaken by some members of the team. The manager is currently completing the Level 4/RMA and the deputy manager is completing the same course but through private study. From the 17 carers (listed on the rota) 7 carers have achieved Level 2/3 whilst a further 3 carers are currently undertaking the training. From observations made and through discussion with both day and evening carers and the cook, it was found that morale within the home had improved. Staff also felt things had settled, that the team was working better together and that generally morale was better. Staff spoken with expressed that they were happier. Some had undertaken recent training and each gave good examples of care practices respecting the dignity and privacy of residents. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 21 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36 and 38 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The development of effective communication and good working relationships will enable the home to achieve its aim in providing a good quality service for the residents. Records need to available at all times providing a transparent service ensuring the interests and safety of residents are addressed. EVIDENCE: The home is managed by one of the Proprietors of Greenlands who is a qualified nurse with experience of caring for older people. She is currently completing the NVQ Level 4/Registered Managers Award. Following the last inspection concerns were noted with regards to the lack of communication between staff and managers and the lack of understanding Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 22 regarding role and responsibilities. This had been causing conflict within the team and was noted within the complaints made. As agreed monthly team meeting have been taking place and minutes recorded although attendance is at times poor. The manager should explore ways of developing this so that relationships can develop further. Staff are now also being supervised on a regular basis by the manager, records are made and evidence seen. This has enabled better communication between the team. Supervision records for a new member of staff who does not have English as a 1st langauage were seen. Discussion had been held with the manager with regards to what support was being offered in developing these skills. Feedback from staff confirmed that improvements have been made. Team members felt the staff were working better together and that morale was also improving. Further development is still needed ensuring communication is effective and that the interests of the residents are fully met. With regards to the development of the home the Proprietors have produced a development programme for 2006/2007. This includes maintaining and retaining staffing levels, staff training, maintaining occupancy levels, investment in the property and fulfilling the requirements of CSCI. This could be explored further with the involvement of residents, relatives and other stakeholders. It is suggested that the recent resident/relative meetings are held on a more regular basis so that feedback and ideas can be sought. In the main money held on behalf of residnets is only personal allowances as families or an idnetified representative take responsibility. A bank account has been set up solely for residents money. Money received/spent is recorded and receipt held/given. Statements would be made available for inspection if necessary to ensure that records held reflect the balance. As this is managed by one of the owners this information was not available for inspection, therefore will be looked at further during the next visit. The home has developed a policy outlining how residents money is to be managed. This needs to be developed to include more information in relation to staff receiving gifts and arrangements with regards to wills. Information was also examined with regards to safety checks carried out in home. Up to date certificates were seen for the gas, electric, PAT testing, emergency lighting, call bells, fire appliances and passenger lift. Agreements were also in place for the removal of clinical waste and trade waste. A food hygiene inspection was also held in April 2006, action identified was said to have been addressed. Further records are made by the cooks for food temperatures and fridge and freezer temperature. Cleaning charts for the kitchen are also completed. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 23 In house checks are also carried out and recorded in relation to fire safety, sounding the alarm, means of escape, emergency lighting. Information was not seen with regards to fire drills or the monitoring of water temperatures. This needs to be provided and available for inspection. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 24 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 2 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 2 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 2 3 X 3 Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 25 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. 2. Standard OP1 OP1 Regulation 4 4/5 Requirement That the Statement of Purpose is amended as detailed within the report. That copies of the Statement of Purpose and Service User Guide are made available to service users or their representatives. That plans fully reflect the current needs of the service users and are signed to evidence that they have been agreed by the service users or appropriate representative (previous timescale of 31/1/06 not met) That service users are monitored in relation to falls and action taken to address any/all concerns. (previous timescale of 31/1/06 not met) That relevant training is undertaken so that staff are able to offer support to residents with diabetes as identified within the report. The registered person must ensure that revised medication policies are implemented (previous timescale 31/10/06 not met) DS0000061961.V289696.R01.S.doc Timescale for action 30/06/06 30/06/06 3. OP7 15 30/06/06 4. OP8 12 30/06/06 5. OP8 18 05/06/06 6. OP9 13/18 18/05/06 Greenlands Version 5.1 Page 26 7. OP9 13 8. OP9 13 9. OP18 13 10. OP18 18 11. 12. OP19 OP29 23 19 13. 14. 15. OP30 OP30 OP31 18 18 12 16. OP35 17 17. 18. OP38 OP38 23 23 The registered person must ensure that all medication records are complete, clear, accurate and up-to-date. (previous timescale of 28 February 2006 not met) The registered manager must ensure that staff are fully informed of changes to medication prescribed for residents. That the financial policy is developed to include information on staff receiving gifts and arrangements for wills That arrangements are made for all staff to complete training in relation to adult abuse (previous timescale of 31 August 2005) That repairs are made to the broken shower. That all staff personnel files are available for inspection and all information as required under schedule 2 is in place prior to commencing employment That information is signed by the new staff to evidence completion of the induction programme. That training is provided in infection control, continence care and care of the dying. That communication between management and staff continues to improve ensuring continuity of care. That financial records held in relation to service users are signed for following each transaction. That records made in relation to water temperature checks are made available for inspection. That periodic fire drills are carried out in line with the homes procedure and records made. DS0000061961.V289696.R01.S.doc 18/05/06 05/06/06 30/06/06 31/07/06 30/06/06 31/05/06 31/05/06 31/07/06 31/07/06 31/05/06 31/07/06 31/07/06 Greenlands Version 5.1 Page 27 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. 4. 5. 6. 7. OP9 OP30 OP33 Refer to Standard OP2 OP8 OP12 Good Practice Recommendations The manager should ensure that where necessary a signed copy of the home contracts is held on residents file. That footplates are in place when transferring residents by wheelchairs to prevent injury. That service users are consulted with in relation to activities within the home. Handwritten MAR entries should be signed, checked and countersigned. The temperature of the medication storage should be monitored daily, action must be taken if the temperature is consistently too high. That consideration is given to providing specific training in relation to the needs of the service users i.e. Dementia. That consultation is made with other parties and feedback included within the homes development programme. Greenlands DS0000061961.V289696.R01.S.doc Version 5.1 Page 28 Commission for Social Care Inspection Bolton, Bury, Rochdale and Wigan Office Turton Suite Paragon Business Park Chorley New Road Horwich, Bolton BL6 6HG National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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