Inspection on 16/07/07 for Greenways

This inspection was carried out on 16th July 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Poor. 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

Greenways 13/01/09

Greenways 09/01/08

Greenways 30/05/06

Greenways 05/01/06

Greenways 05/10/05

Greenways 02/02/05

Greenways 27/04/04

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

CARE HOMES FOR OLDER PEOPLE Greenways 720 Preston Road Bamber Bridge Preston Lancashire PR5 6AL Lead Inspector Mrs Marie Cordingley Unannounced Inspection 16th July 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greenways DS0000005926.V338421.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. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenways Address 720 Preston Road Bamber Bridge Preston Lancashire PR5 6AL 01772 339083 01772 334633 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) Ark Care Services Limited Mrs Sandra Clements Care Home 30 Category(ies) of Old age, not falling within any other category registration, with number (30) of places Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 30 service users in the category of OP - Old age, not falling within any other category. 30th May 2006 Date of last inspection Brief Description of the Service: Greenways is a residential care home providing 24-hour personal care and accommodation for 30 older people. The home is owned by Mr and Mrs Ajisebutu, who also own a second home in the South of England. The home is located in a residential area on the outskirts of Bamber Bridge, close to all local amenities and the motorway network. The home is a two-story building. Accommodation is provided in single bedrooms, the majority of which have en-suite facilities, comprising of a wash hand basin and WC. Although the rooms are pleasantly furnished, service users are also able to take personal possessions with them when they come to live at the home. Bedrooms are located on both the ground and first floor. There is a passenger lift. Accessible toilets and bathrooms are located on both floors near to bedrooms and living rooms. There are three dining areas; two of these are a combined lounge with a dining area. A separate conservatory is also available. The home is a no smoking home. The fees at the home range from £310.50 -£360 per week. There are additional charges for hairdressing and newspapers. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection of this home included a site visit which was carried out over the course of ten hours. Throughout the visit we held discussions with residents, staff members and the owner of the home. The registered manager was not present during the visit. A selection of documents such as staff personnel files and residents’ care plans were viewed and we carried out a tour of the building. In addition, a full inspection of the home’s medicine store and systems was undertaken by a specialist pharmacy inspector. As part of this inspection a case tracking exercise was carried out. This involved us looking closely at selected residents’ care from the point of their admission to the home. What the service does well: Greenways is a spacious home with all accommodation offered on a single room basis. The majority of bedrooms have en-suite facilities. The bedrooms that we viewed were pleasantly decorated and contained personal items of the occupant such as ornaments and pictures. At the time of our visit we found all areas of the home to be well maintained and nicely furnished. In addition, the home was clean throughout. When viewing daily care records we found that staff at the home act quickly when residents require medical attention. Daily care records confirmed that in circumstances when a resident is feeling unwell for instance, GP advice is requested straight away. Daily care records also confirmed that residents are regularly supported to access routine health care such as optical or dental treatment. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: In some cases care plans don’t reflect the residents’ current circumstances and don’t provide a full picture of all their care needs. Care plans are not reviewed on a regular basis or after significant events. There is no evidence that residents or their representatives are involved in the development of their care plans. We made requirements in relation to these matters. Some risk assessments that have been developed in relation to residents falling or developing pressure sores contain out of date information and lack clear guidance for staff in how to go about reducing identified risks. In the case of some residents, changes in their circumstances such as deterioration in their mobility have not been taken into account in their risk assessments. We made a requirement in relation to this matter. There is a lack of clarity in relation to individual moving and handling arrangements for some residents. Carers are not clear about which techniques they should be using for certain residents which means there is a risk of them using unsafe techniques. We made an immediate requirement in relation to this matter. Safeguarding adult policies and procedures within the home contain information and guidance which is incorrect and conflicts with the guidelines set out in the Department of Health publication ‘No Secrets’. We found evidence that on several occasions the manager of the home had failed to take proper action to safeguard certain residents despite receiving information to indicate that they might have been at risk. We made an immediate requirement in relation to this matter. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 7 We found some examples where residents had made complaints or raised concerns but the manager of the home had failed to record these properly. The complaints had not been taken seriously and there was no evidence that any investigation had been carried out. We made an immediate requirement in relation to this matter. Medicines are not always administered to residents as prescribed or at the right time in relation to food intake. The paperwork (including records of receipt, administration and disposal) to support this must be improved for this to happen. Receiving medicines at the wrong dose, wrong time or not at all can seriously affect the health and well being of residents. The competence of care staff in handling and recording medicines must be improved to ensure residents receive their medicines correctly. Checks (audits) on medicines must be carried out to show that they are being given to residents as prescribed and to prevent mistakes from happening again. We made requirements in relation to these matters. Residents’ care plans do not contain any information about their preferred pastimes or hobbies. There are no up to date records kept to detail the activities that residents have taken part in. There are no arrangements in place to provide individual residents with the opportunity to take part in enjoyable activities. We made a requirement in relation to this matter. In some examples we found, new staff had been recruited without providing a full employment history. Whilst references had been obtained for each staff member, these were not always from the person’s last employer. We found that some staff had been promoted within the home to senior positions without making a formal application or attending an interview. We made requirements and recommendations in relation to these matters. Through viewing daily communication books and talking to residents and staff we were aware that there had been some concerns about the conduct of some staff members. However, there was no evidence that any of these issues had been addressed with the people concerned. When issues are identified in relation to a staff member’s performance this must be dealt with appropriately. Any such issue should be carefully recorded and investigated. Staff members with performance issues must be advised how they can improve and be closely monitored by a member of the management team. We made a requirement in relation to this matter. There is an inconsistent approach to the recording of accidents with carers recording accidents in various different places, or not at all in some cases. Some accident reports we viewed were illegible and made little sense to the reader. This is an extremely important area and it is necessary to ensure that all accidents are recorded in a consistent manner and written accurately. We made a requirement in relation to this matter. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 8 When viewing records within the home we found that residents had sustained a high number of unexplained injuries. Whilst the injuries had been recorded in general communication, no further action had been taken. Any unexplained injury to a resident must be properly investigated. A record of such an investigation must be made and maintained within the home. We made a requirement in relation to this. The home has a training programme in place which begins with an induction programme for new staff members. When viewing records of the induction we found that the training was inconsistent and varied in content from carer to carer. Currently 6 out of 16 staff members hold a National Vocational Qualification in care at level 2 or above. It is recommended in the National Minimum Standards that at least 50 of staff hold the qualification. The home continue to work towards this target. We made a requirement and some recommendations in relation to these matters. Whilst we were able to confirm that residents are provided with a nutritious diet we found that there was not a great deal of variety in the daily main meals. We also found that not all residents or staff were aware that there was an alternative choice available for the main meal on a daily basis. We made some recommendations in relation to these matters. 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. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 9 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 Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 10 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. Standard 6 is not applicable to this home. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Prior to any new resident moving in, the home obtain enough information to ensure that they can meet the resident’s care needs. EVIDENCE: We case tracked five residents and found that prior to them moving into the home, a senior staff member had carried out a pre-admission assessment. This involves gaining information about the prospective resident’s daily care needs to ensure that these can be met within the home. The information obtained also gives carers a chance to put a plan of care in place from the beginning of the resident’s stay. Where appropriate, a social work assessment had also been obtained and was held on the individual resident’s personal file. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 11 The home has a useful tool in place called ‘residents own account’ which gives the prospective resident the opportunity to express their views about the care they would like to receive. However, in the majority of cases this form had not been completed. It is recommended that this form is used in the future as it provides a good opportunity for people to be involved in their own care planning. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 12 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 & 10 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents’ health and wellbeing is at risk because their changing needs are not always taken into account when planning their care and appropriate measures are not always put in place to safeguard those who are at risk of, for example, falling. Residents are also at risk because they are not always given their medicines correctly. EVIDENCE: There is a care plan in place for every resident. However we found a number of examples where they did not reflect the individual resident’s daily care needs. For example, one resident required regular preventative pressure care but there was no reference to this in his care plan. In another example, a resident had some complex psychiatric needs but his care plan did not reflect this. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 13 In particular, there was very little or no information included in the care plans of those residents who require extra support because of complex behaviours. It is important to have clear guidance in place in these circumstances so that staff can approach challenging situations confidently and consistently. When we discussed care plans with staff, some did not seem to understand the concept of regularly updating or reviewing them. Some carers told us that they worked more off verbal information rather than what was written in residents’ care plans. There was no evidence that residents had been involved in the development of their care plans. Risk assessments are in place but in many cases have not been reviewed for long periods of time or following significant events. For example, one resident had experienced deterioration in his mobility and had started to fall more frequently. Despite this there had been no review of his risk assessment and as such, there was no up to date plan to maintain his safety. When we talked to carers they were not always clear about the individual moving and handling arrangements for certain residents. For example, some carers thought a hoist should be used for one particular resident whilst others thought not. There must be an up to date moving and handling assessment for each resident that includes clear guidelines for staff. Without such guidelines there is a risk that carers will use unsafe techniques. At the time of our visit there were no residents looking after their own medicines. However, suitable written policies and paperwork were in place that would help ensure residents receive any support they might need in this area. The morning medicines round is usually started at 8am and medicines are given to residents after they have had their breakfast. Several currently prescribed medicines are supposed to be given before food however care staff and residents said, and the records confirmed this, that all medicines are given after mealtimes. Giving medicines at the wrong time in relation to food intake can affect the way they work and can increase the chances of side effects. We found that the medication administration records were not always complete. Records of medicines received into the home and given to residents were not always accurate showing staff were not giving and recording medicines the right way. Several examples of medicines not “adding up” correctly were found and this was confirmed with the senior carer who usually dealt with the medicines. These mistakes showed care staff sign the records but sometimes forget to give the medicines, this was noticeable for medicines contained in bottles and boxes. Staff also confirmed that the carer preparing the medicines and signing the records would not always be the carer that gives Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 14 and witnesses the residents take their medicines. This is not good practice as it increases the chances of mistakes. Failing to give medicines correctly can seriously affect the health and well being of residents. We found that handwritten records, notably for residents on respite care, were often incomplete or incorrect which had contributed to some of the mistakes. Past advice from CSCI inspectors had advised two care staff to check and sign these records but this has not been followed. There are no records of medicines returned to the pharmacy for safe disposal since July 2006. The senior carer said she had returned numerous medicines every month since July 2006 but did not make a record because she had been told that it was not necessary. A record must be kept of all medicines leaving the home, this is the law because accurate records are needed to show that medicines are being given to residents correctly and to prevent mishandling and misuse. Excessive amounts of medicines waiting to be disposed of were found in the storeroom, this was due to poor reordering procedures and inefficient stock control. Medicines are generally stored securely, this is important to help prevent mishandling and misuse. We found that medicines prescribed as “when required” or, as a “variable dose” did not have clear written instructions for care staff to follow to ensure they are given correctly. This is particularly important for residents that are suffering with pain or who are agitated and have difficulty communicating. Regular checks (audits) on medicines records and stocks are not carried out. We found a number of mistakes in recording and administering medicines that had not been identified by the manager of the home. Regular checks are important to ensure staff are handling medicines in the right way. The manager said, all staff that handle medicines had attended a “medicines awareness” course. However, no formal assessment of competence is carried out and staff are not regularly supervised to ensure they are and remain competent. This lack of assessment has contributed to poor record keeping and mistakes when giving medicines, which could seriously affect the health and well-being of residents. In discussion residents generally felt that their dignity and privacy was respected by staff at the home. However, a number of carers expressed concerns to us about the approach of certain staff members. The concerns were based on the staff members talking to residents in a disrespectful way. It was also reported to us by a number of staff that one carer had deliberately teased a resident on more than one occasion. These concerns were discussed at length with the owner and deputy manager of the home during the visit who agreed to address them without delay. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 15 Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 16 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): 12, 13, 14 & 15 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents at the home do not have regular opportunity to take part in their preferred hobbies and pastimes. Residents are provided with nutritious meals, however they would benefit from having more choice and variety. EVIDENCE: In discussion with residents and staff we were told that entertainers such as musicians visit the home on a regular basis. However, none of the care plans we viewed contained information about residents’ preferred pastimes and hobbies. The care plans did not provide any information about activities that residents had chosen to take part in within the home. There was a record held within the home for the purpose of recording residents’ activities but this had not been completed since January 2007. To ensure that residents’ individual needs are met in relation to fulfilling and stimulating activities, the area should be addressed in their care plans and regularly reviewed. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 17 In general residents said that they were satisfied with the meals provided at Greenways. When we viewed records of meals served and menus we were able to confirm that residents are provided with a nutritious diet. When viewing weight charts of several residents who had been underweight when they were admitted to the home we noted that they had all experienced a steady gain to a healthy weight shortly after their admission. Records of meals served confirmed that residents were able to choose from a number of different breakfasts and evening meal options. However, there was no evidence that an alternative option was provided for the main meal each day. When we talked to residents and staff the general feeling was that an alternative was not available for the main meal. We spoke to the owner and deputy manager of the home and advised them to ensure that all residents were made aware of the alternative choice available each day for their main meal. We found that menus of main meals were quite repetitive. For instance, in one week, desserts with custard had been served for four days running and there was not a great deal of variety on the main courses. This was discussed at the time of the visit and we recommended reviewing menus to provide more variety. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 18 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 & 18 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Residents are not being protected from abuse, their safety and wellbeing is not safeguarded. Residents’ complaints are not always taken seriously or investigated. EVIDENCE: We identified a number of serious concerns in this area and issued a number of immediate requirements. There is a complaints procedure in place which advises residents how to go about making a complaint and gives an outline of what action will be taken if they do so. However, it is a very basic procedure which provides the necessary instructions but in a fairly abrupt manner. It is recommended that this procedure be rewritten to give a more positive message to people, that the home value their feedback and look on complaints as an important way for them to improve quality. As a result people may feel more comfortable in raising any concerns that they have. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 19 Throughout the inspection we found evidence that a number of residents and staff had made complaints which had not been acted upon by the manager. This was particularly concerning in view of the fact that some of these complaints related to the conduct of staff members within the home. There was a complaints book in the home. However, there were no entries in the record after 2003, despite the fact that daily diary sheets gave details of a number of occasions when complaints had been made by residents. There are specific guidelines that must be followed in the event that an incident of abuse is reported or suspected which are provided by the Department of Health (No Secrets), these are generally referred to as Safeguarding Adult procedures. We found that on several occasions, the manager of the home had failed to adhere to these guidelines resulting in a failure to protect residents’ safety and wellbeing. The home did have written safeguarding adult procedures in place, however they were not in line with the Department of Health guidance and did not list the correct procedures that should be followed. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 20 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 & 26 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home is furnished and maintained to a good standard. EVIDENCE: We carried out a tour of the home and found that all areas were well maintained, nicely furnished and clean. Greenways is a spacious home with several communal areas including a large conservatory for residents to use. All the accommodation at the home is offered on a single room basis and ensuite facilities are provided in most bedrooms. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 21 We viewed a number of residents’ bedrooms and found that they were personalised with their own possessions such as ornaments and pictures and in some cases, furniture. There is a well equipped laundry at the home and infection control procedures are in place to assist staff in reducing the risk of cross infection within the home. Throughout our visit we found the home to be uncomfortably warm. We issued an immediate requirement that the temperature within the home be maintained at a comfortable level at all times. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 22 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 & 30 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Staffing levels are sufficient to meet residents’ care needs. The home’s recruitment procedures are not good enough to ensure that positions are being filled by people with the suitable skills and values. EVIDENCE: We viewed a selection of staff members’ files and found that they all contained evidence that suitable criminal records checks had been carried out. In addition all staff files contained two references. However, these were not always from previous employers. Not all staff files we viewed contained completed application forms or a full employment history. It is important to obtain a full employment history and investigate any gaps in the dates prior to offering a candidate a post. We were concerned to find that a number of internal promotions had taken place within the home without any evidence of a formal process being followed. Several staff members had been promoted to senior carer positions without having attended an interview. We also found that one carer had been given a senior position despite the fact that there had been a number of concerns raised about her conduct and care practices. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 23 A senior care post involves a great deal of responsibility including the monitoring of standards and a degree of role modelling to other staff. Therefore it is extremely important to ensure that a person carrying out such a role has the correct skills, abilities and values to do so. In addition, the home must ensure that when recruiting for new posts they are following their own equal opportunities policy and procedures. The home has a training programme in place which begins with an induction programme for new staff members. When viewing records of the induction we found that the training was inconsistent and varied in content from carer to carer. Induction training needs to be reviewed to ensure that it is line with The Skills for Care standards and as such, covers all the necessary areas. In addition an induction checklist which covers areas of competence should also be introduced. Ongoing training is offered in areas relevant to carers’ roles such as moving and handling and first aid. In addition, carers are provided with the opportunity to complete National Vocation Qualifications in care. Currently 6 out of 16 staff members hold this qualifications at level 2 or above. It is recommended in the National Minimum Standards that at least 50 of staff hold the qualification. The home continue to work towards this target. From viewing staffing rotas and in discussion with residents and carers we were able to determine that staffing levels at the home are sufficient to meet residents’ needs. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 24 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, 32, 33, 35, 36 & 38 Quality in this outcome area is poor. This judgement has been made using available evidence including a visit to this service. Presently the standard of management at this home is poor and there are a lack of systems in place to promote the safety and wellbeing of residents. EVIDENCE: Throughout this inspection we have identified a number of occasions where the registered manager has failed to take appropriate action to safeguard residents. In particular, there has been a serious lack of action in response to concerns or complaints raised by residents and staff. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 25 The managers failure to follow formal safeguarding adult procedures following information that indicated certain residents may be at risk of abuse is particularly concerning. We issued several immediate requirements in relation to these issues. Financial procedures have been implemented for staff to follow when dealing with residents’ monies following a requirement made at the last inspection. However, we made a number of recommendations to improve these procedures and further safeguard people. These recommendations were that reasons for withdrawals from individual residents’ finances should be clearly stated in the record, receipts should be numbered for ease of auditing, transactions should be witnessed by two carers at all times and audits should be carried out by a member of the management team more frequently. Staff supervision is an area that requires a great deal of improvement. Whilst supervision meetings do take place on a regular basis, records of these confirm that they consist largely of a self-assessment completed by the carer without any additional feedback from the supervisor. Whilst a self-assessment is a useful tool to use within supervision, it is also important that any issues relating to the staff member’s conduct are formally raised and recorded. We found that when issues relating to a staff member’s performance had been raised either by staff or residents, there was no evidence that these issues had been addressed. For example, there had been a number of concerns raised about the conduct of one carer, in relation to her care practices and approach to residents. Her supervision file contained no reference to this, nor were any separate meetings carried out with her to discuss the issues. Issues like this must be raised in a formal setting in line with the home’s own disciplinary procedures. The staff member must be made aware of unacceptable behaviour and dealt with appropriately. If a decision is made to retain the staff member they must be given clear performance targets and closely monitored by a member of the management team. The home has a health and safety policy in place, which is supported by a number of procedures such as fire safety and the control of substances hazardous to health. However, we identified some concerns in relation to the moving and handling of residents. There appeared to be some confusion amongst carers about the specific moving and handling arrangements for individual residents. This could lead to carers carrying out unsafe moving and handling techniques. As such an immediate requirement was issued relating to this matter. There is an inconsistent approach to the recording of accidents with carers recording accidents in various different places, or not at all in some cases. Some accident reports were illegible and made little sense to the reader. This Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 26 is an extremely important area and it is necessary to ensure that all accidents are recorded in a consistent manner and written accurately. When viewing records within the home we found that residents had sustained a high number of unexplained injuries. Whilst the injuries had been recorded in general communication, no further action had been taken. Any unexplained injury to a resident must be properly investigated. A record of such an investigation must be made and maintained within the home. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 27 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 2 x x x HEALTH AND PERSONAL CARE Standard No Score 7 1 8 1 9 1 10 1 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 1 17 x 18 1 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 2 29 1 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 1 1 1 x 3 1 1 1 Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 28 yes Are there any outstanding requirements from the last inspection? STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15(1) Requirement Timescale for action 31/07/07 2. OP7 15(2)(b) 3. OP7 15(2)(c) 4. OP9 13(2) A care plan must be in place for every resident which details all their current care needs so that carers know what care they should provide. Residents’ care plans must be 31/07/07 kept under constant review and reflect their changing needs so that they always receive the care they need. Residents and their 30/09/07 representatives must be given the opportunity to be involved in the development of their care plans wherever possible, so they can voice their opinions and maintain control over their lives. (Previous timescale of 31/08/06 not met.) Medicines must be given to 06/08/07 residents as prescribed and at the right time in relation to food intake so that their health and wellbeing is safeguarded. An accurate record must be kept of all medicines received into and leaving the home to help prevent mistakes from DS0000005926.V338421.R01.S.doc 5. OP9 17(1)(a) Schedule 3(i) 06/08/07 Greenways Version 5.2 Page 29 happening that can affect the health and well being of residents. 6. OP9 24(1) Regular recorded audits must be carried out to ensure residents receive their medicines as prescribed. All care staff that handle medicines should be assessed as competent and if necessary receive further training to help ensure residents receive their medicines correctly. It must be ensured that staff treat residents with respect and dignity at all times. Risk assessments must contain all relevant information and be regularly reviewed to ensure that any risk to residents are identified and where possible eliminated or reduced. Residents’ individual preferences in relation to activities and pastimes must be recorded so that suitable, fulfilling and enjoyable activities can be provided. Any complaint made must be appropriately recorded and fully investigated to help safeguard residents and promote their rights. It must be ensured that in the event that an incident of abuse is suspected or reported, immediate action is taken to safeguard residents from any further harm. The safeguarding adult policy and procedures must be reviewed and brought into line with the Department of Health Guidance ‘No Secrets’ to help DS0000005926.V338421.R01.S.doc 06/08/07 7. OP9 18(1)(a) 06/08/07 8. 9. OP10 OP8 12(4)(a) 13(4) (c) 16/07/07 06/08/07 10. OP12 16 (2) (n) 30/09/07 11. OP16 22 (3) 16/07/07 12. OP18 13 (6) 16/07/07 13. OP18 13(6) 31/08/07 Greenways Version 5.2 Page 30 protect residents from abuse. 14. OP18 13(6) The home’s policy on safeguarding adults must be extended to include guidance for staff on the action they must take should they become aware of any allegations or suspicions of abuse. (Previous timescale of 31/08/06 not met) Procedures must be implemented to ensure that staff members are not recruited or promoted unless they have the correct knowledge, skills and values for the post. A standard induction programme must be developed for all new staff which is in line with The Skills for Care Standards. Staff must be appropriately supervised to help ensure that residents receive a good quality service and are protected from harm. Records must be kept within the home of any complaint made, subsequent action and the outcome. Accurate records, which are properly completed, must be maintained of any accident affecting a resident. Any unexplained injury found on a resident must be thoroughly investigated. A record of such investigations must be maintained. There must be clear moving and handling procedures in place for every resident. All staff must be aware of these procedures. The home must be maintained at a comfortable temperature at all times. DS0000005926.V338421.R01.S.doc 31/08/07 15. OP29 19(5)(b) 31/08/07 16. OP30 18(1)(c ) (i) 18(2) 30/09/07 17. OP36 31/07/07 18. OP37 17 (2) 31/07/07 19. OP38 17 (1) (a) 31/07/07 20. OP38 12 (1) (a) 16/07/07 21. OP38 13 (5) 16/07/07 22. OP19 23(2)(p) 16/07/07 Greenways Version 5.2 Page 31 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 OP9 Good Practice Recommendations Medicines prescribed as when required or, as a variable dose should have clear written instructions for care staff to follow to ensure they are administered correctly. Patient information leaflets should be used for all medicines kept in the home to ensure medicines are administered correctly. All handwritten medicines records should be an exact copy of the pharmacists dispensing label, which should be double-checked and countersigned, this should help prevent mistakes. Further review of the medicines handling policies is strongly recommended to ensure all best practice is accurately reflected. All prescriptions should be checked by care staff before the pharmacist dispenses them to help improve stock control and to ensure medicines have been correctly ordered. 2. 3. 4. 5. 6. OP3 OP12 OP15 OP15 OP16 The ‘residents own account’ tool in place at the home should always be used when carrying out pre-admission assessments. Consideration should be given to recruiting an activities organiser. Menus should be reviewed to provide more variety of meals. A system should be introduced to ensure that all residents are aware of the alternative main meal choice each day. The complaints policy and procedure should be rewritten with a view to encouraging residents and/or their representatives to report any concerns they may have about the home. All staff should receive training in managing complaints. DS0000005926.V338421.R01.S.doc Version 5.2 Page 32 7. OP16 Greenways 8. 9. 10. 11. 12. 13. 14. 15. OP28 OP29 OP29 OP29 OP29 OP30 OP30 OP33 A minimum of 50 of carers should hold National Vocational Qualifications in level 2 or above. The equal opportunity policy within the home should be reviewed. A full employment history should be obtained for every candidate. Where any gaps exist these should be investigated. A record of interview in respect of each candidate should be maintained. Wherever possible, references should be obtained from a candidate’s last employer. The home should develop a training matrix to enable training needs to be monitored more easily. An induction checklist which includes assessment of competence should be completed for very staff member. The views of families and involved health and social care professionals should be sought in quality assurance processes. The home’s policies and procedures should be reviewed to ensure that they are in line with current legislation and good practice. Meetings for residents should be held on a regular basis. Self monitoring systems which include the home’s management reviewing performance in areas such as complaints management and staff training should be introduced. An annual development plan should be introduced. Records of residents’ monies should contain more detail, i.e., the reason for withdrawals. All transactions made on behalf of residents should be witnessed by two staff members. Receipts obtained when carrying out transactions for residents should be numbered for ease of audit. Regular audits should be carried out of all records relating to residents’ finances. 16. OP33 17 18 OP33 OP33 19 20 OP33 OP35 21 OP35 Regular staff meetings should be held. Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 33 Commission for Social Care Inspection Lancashire Area Office Unit 1 Tustin Court Portway Preston PR2 2YQ 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 Greenways DS0000005926.V338421.R01.S.doc Version 5.2 Page 34 - 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. 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