Inspection on 02/08/07 for Greenways

This inspection was carried out on 2nd August 2007.

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

The inspector made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

Greenways 22/03/10

Greenways 24/11/09

Greenways 08/12/08

Greenways 29/01/08

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

CARE HOMES FOR OLDER PEOPLE Greenways Marton Road Long Itchington Nr Southam Warwickshire CV47 9PZ Lead Inspector Sandra Wade Key Unannounced Inspection 08:05 2nd August 2007 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 DS0000068642.V339427.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 DS0000068642.V339427.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenways Address Marton Road Long Itchington Nr Southam Warwickshire CV47 9PZ 01926 633294 F/P 01926 633294 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) Kirkley Limited Mrs Carole Mary Webb Care Home 27 Category(ies) of Old age, not falling within any other category registration, with number (27) of places Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered to provide care and accommodation for 27 service users over 65 for reasons of old age. Not applicable – first inspection under new ownership Date of last inspection Brief Description of the Service: Greenways was originally a domestic dwelling and has been converted into a residential care home. It is situated in the quiet village of Long Itchington and can accommodate up to 27 elderly residents. The home offers personal care services only to people over the age of 65 years who are in the category of old age. The home is not registered to take residents in any other categories. Residents needing nursing care receive this from the visiting community nurses. Medical services are provided by local GPs. An extension of 6 bedrooms was completed in April 2003 and further works are imminent for the home to be extended further. There are local shops which are around a 15 minute walk from the home. Public transport links are not near to the home. Accommodation for residents is provided over two floors, and all bedrooms are for single occupation, eight of the rooms have ensuite facilities. There is a communal dining room and one large lounge with two small quiet areas in the home. There is one shower room and four bathrooms which have bath chairs to assist people into the bath. There is a door into the home which has level access for wheelchairs and people with mobility problems but this is not the main entrance door to the home. There is currently a large garden with a grassed area where residents can sit in fine weather and there are other sections of garden which will form part of the new extension to the home which is imminently planned. The home is set back off the main road through the village. There is parking to both the front of the home and in a car park which is accessed down the side of the garden area. The owners are involved in running the home and there is a full time manager and a team of carers and ancillary staff. The fees for the home range from £450 - £470. Extra charges are made for hairdressing (£5 – 18) and chiropody (£10.00). No charge is made for newspapers and service users are expected to provide their own toiletries. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The focus of inspections undertaken by us is upon outcomes for people who live in the home and their views of the service provided. This process considers the homes capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This unannounced inspection took place from 8.05am to 7.55pm. Before the inspection the manager of the home was asked to complete an Annual Quality Assurance Assessment (AQAA) detailing information about the services, care and management of the home. Upon the receipt of this a number of questionnaires were sent out to service users and their families to ask their views about the home. Six questionnaires were returned from relatives. Information contained within the AQAA and questionnaires is detailed within this report where appropriate. Two people who were staying at the home were ‘case tracked’. This involves establishing an individual’s experience of staying at the home, meeting or observing them, discussing their care with staff and relatives (where possible), looking at their care files, and focusing on outcomes. Tracking people’s care helps us understand the experiences of people who use the service. Records examined during this inspection, in addition to care records, included staff training records, the Service User Guide, staff duty rotas, social activity records, kitchen records, accident records, financial records, health and safety records and medication records. The manager was present to support the inspection process throughout the day and the new owner was also at the home for part of the day. A tour of the home was undertaken and the inspector spent time speaking with residents, visitors and staff within the home. What the service does well: Staff are friendly, approachable and caring and residents were positive in their comments about the staff. A visitor to the home stated staff are “helpful” and “nice” and described the home as “homely”. The owners play an active part in the management of the home to ensure service users receive good standards of care. Visitors to the home are made welcome and are able to visit residents when they choose. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 6 Resident choices in how their care and services are delivered are well documented so that they can maintain some of their usual routines and independence. The home is spacious and suitable equipment to support older people is available such as wheelchairs, handrails, ‘sit on’ weigh scales etc. There is a family room that residents can use to receive visitors as opposed to using their bedroom. Resident’s benefit from homemade cooking and meals look appetising. Residents said they enjoyed the food provided. There is a range of large print books available for residents to read if they wish. Residents look well cared for and staff ensure their privacy and dignity is maintained. Effective recruitment systems are in place to ensure the home employ staff who are suitable and deemed safe to work with older people. Several positive comments were made about the home within comment cards received from relatives including: “X is cared for very well”, “the staff are friendly to visitors and caring to residents”, “physical care exceeds expectation” What has improved since the last inspection? The home has appointed a member of staff specifically to provide social activities within the home. More shelving has been fitted in the laundry room so that this area is better organised to prevent items being stored on the floor. Some of the kitchen equipment has been replaced such as the water boiler, oven and fridge as well as new hand washing facilities for staff to maintain good hygiene. Hanging baskets have been placed across the front of the building to improve the outlook of the home. One of the bedrooms in the home has had new windows fitted. Work is in progress for a new assisted bathroom to improve facilities available to people with mobility difficulties. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 7 A maintenance book has been introduced so that staff can report any maintenance tasks in the home which require attention so these can be managed promptly. Some work has commenced on clearing areas of the garden which have become overgrown with the increased rainfall and difficulties getting work done in poor weather conditions. What they could do better: Care plans are in need of review to ensure all residents’ needs are clearly identified and met. Some actions are required in regard to medication management to ensure records are clear and confirm agreed practices with GPs and professionals. Records of meals provided need to be recorded for those people with special dietary needs to demonstrate these are being given. Policies and procedures in the home need to be reviewed to ensure there are clear procedures on adult protection, violence and aggression and equal opportunities so that staff are clear on their responsibilities. Threadbare carpets need attention to prevent the risk of residents tripping and falling. Risk assessments need to be developed in regards to issues which impact on the health and safety of residents. This includes hot radiators, lack of window restrictors on upstairs windows, use of door wedges. Clear actions need to be demonstrated to manage or reduce the risks to residents. Fridges and freezer temperatures in the home are not being monitored consistently to confirm food is being stored and safe levels for residents to eat. Record keeping in the home needs review in regards to: • • • • • Ensuring he Service User Guide contains full information required about the home. Maintaining records of professional input to service user care. Ensuring there is a clear complaints procedure. Ensuring duty rotas contain full names and details of care hours allocated to other services. Ensuring training records available confirm all training completed by staff in the home. Infection control procedures within the home are in need of review to ensure residents are not put at risk through insufficient hygiene practices. This in particular applies to use of hand towels in communal areas, staff using the kitchen as a walkway to their office, hand washing facilities being available in Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 8 the laundry, gloves and aprons being available in “dirty” areas such as the laundry and suitable facilities being available for staff to do the ironing so this is not done in the kitchen. 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 DS0000068642.V339427.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 DS0000068642.V339427.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): Standards 1,3 and 4 were assessed. Quality in this outcome area is adequate. Information about the home is not sufficiently detailed to ensure service users can make informed decisions on whether to stay. Service users are assessed prior to their admission but records do not always reflect this or show that all needs identified can be met. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A combined Statement of Purpose and Service User Guide are available in the home and these give details of the care and services provided. The manager advised that plans were in place to develop a brochure for the home. It was not evident that the Service User Guide contained a Statement of Terms and Conditions for the home, a summary inspection report or current information of our address and telephone number as required. This information will need to be provided to ensure prospective service users have sufficient information to make an informed decision to stay at the home. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 11 Assessments of service users are carried out prior to their admission to the home but records are not routinely kept on care plan files to clearly show the assessments carried out and the needs identified so that staff can access this. The manager confirmed that the home does not currently write to service users to confirm that following their assessment the home can meet their needs. The manager agreed to address this so that residents know their needs can be met by the home prior to their admission. Greenways DS0000068642.V339427.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): Standards 7,8,9 and 10 were assessed. Quality in this outcome area is adequate. The care needs of residents are generally being met but deficiencies in records make it difficult to confirm this is happening consistently to maintain the health of the residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Two service users were case tracked and other care plans viewed in brief. Care plans are in place for each service user and risk assessments have been developed as appropriate. Risk assessments seen included fall risks, risks of poor nutrition, and risks associated with skin breakdown which may cause pressure sores. Service users have care plans detailing how their personal care should be managed and records seen clearly stated what the person could do for themselves and what support from staff was needed. One person for example was able to wash their top half and this was documented which is good practice as this helps the resident to maintain some independence. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 13 A care plan relating to a pressure sore contained limited information in regards to how severe this was, where it was located and how it was being managed. It was however written in the care plan notes that the district nurses were visiting the resident to redress the pressure wound each week. A record of the visits was not available in the care plan to confirm this. The manager advised that records relating to the management of the sore were being kept by the district nurse. The home should keep clear records in regard to pressure areas so they can discuss and monitor the progress of the wound with the district nurse. Staff also need to be aware of any additional actions they may need to carry out to aid the healing process such as changes in position to aid pressure relief on the wound. Staff also need to monitor that the dressing stays intact and know what actions should be taken if it comes off. Care plan information listing the service users needs is currently kept on one page which means if there is a change to one of the needs listed, it is difficult to alter the paperwork and clearly state staff actions required to meet the changed needs. It was found care plan reviews were indicating “no change” when there had clearly been changes in the persons health and needs. The assessment records completed for one resident contained information that was not transferred onto a care plan. A resident was identified to have arthritis, backache and painful knees. Medication records showed that this person was refusing painkillers and there was a period of time when the person’s behaviour became verbally aggressive at night. This change in behaviour had not been identified through the care plan review process and it was not clear whether the reasons for this person’s behaviour were linked to pain or other psychological reasons. One person in the home was noted to have a bandage on their leg. The care plan records for this resident did not show the wound to the leg or detail when this had happened. A member of staff was asked what had happened and did not know immediately but remembered and came back later to advise the inspector how the injury had happened. Care plan records need to be kept upto-date so that staff are aware of wounds and can provide consistent care. Care plans indicated the service users wish to see a chiropodist on a 12 weekly basis but records on the file did not demonstrate this was happening. A person newly admitted to the home did not have any care plans in place although they had been in the home for a few days. Assessment records detailed their needs in regards to bathing, showering, dressing, medication, toileting and risk of falls but this information had not been transferred into care plans to show how staff should manage these care needs. This person’s medical history had also not been completed so that their health care needs could be addressed. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 14 Staff had completed daily records to show the care they had been giving and it was evident from these records that one person had some health care needs that required attention and they were also in a lot of pain despite taking painkillers. It was not evident that this person’s pain was being managed effectively as the resident stated to the inspector they were in constant pain and the painkillers were not fully effective. The manager agreed to review this matter. Although care plan records are in need of attention residents in the home looked well cared for and were smartly presented. Those residents spoken to during the inspection said that they were happy in the home. One person said “I can get up when I want and staff come to help me”. A comment card received from a relative states “X is cared for very well”, another stated “physical care excellent”. Another relative commented “X is very comfortable with the way they are cared for and has a good rapport with the staff”. Since the last inspection the provider has purchased ‘sit on’ weighing scales so that the weight of those residents who are unable to weight bare can be taken and monitored which is good practice. A review of medication was undertaken. Medications are stored in lockable boxes which rest within a trolley. The trolley is stored within a room to ensure the safe storage of medications. A medication had been prescribed for “one or two” tablets to be given. Staff were signing the Medication Administration (MAR) to say the medication had been given but it was not clear if this was for one or two tablets. A suitable protocol needs to be implemented to ensure records are clear in regard to this matter. An injection prescribed for one resident stated this should be given every 3 months. It was not clear from the records when this was due. Staff said they rely on the District Nurse to advise them of this. Records should show clearly the date it is due to prevent any oversight in this being administered. Some medications were on the MAR but were not available such as Codydramol. Staff said that this was because the resident no longer needed them. If the GP has agreed these can be stopped then suitable arrangements need to be made to remove them from the MAR to prevent any confusion or staff error when administering medications. Controlled drugs in use in the home were audited and found to be correct in accordance with records in place and were safely stored. Staff had been recording the receipt of these in a book but it was evident from viewing the book that insufficient information was being completed. This was discussed Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 15 with the manager with a view to an appropriate controlled drugs register being purchased or devised. The MAR stated that 28 tablets were available at the beginning of the prescribing period but it was found that there were additional boxes of tablets available that had not been carried forward on the MAR. The MAR charts must accurately reflect the number of tablets/capsules available at the beginning of each prescribing period so medication can be effectively audited to check residents have received their medication as prescribed. Records showed that one person was refusing paracetamol and on discussing this with staff it was apparent that the resident was not actually refusing it but had been prescribed an alternative painkiller and did not require the paracetamol. This should be reviewed with the GP and removed from the MAR if considered appropriate. One person had been prescribed a medication which stated “swallow whole”, staff said that the GP had agreed this could be crushed. Information in the home regarding this medication suggested it is a slow release or modified release tablet which means the drug is slowly released over a 24-hour period. Crushing the tablet prevents this from happening. The home will need to take appropriate action to address this matter with the GP/Pharmacist. The MAR chart had been signed to say that one resident had taken their medication but this was still available in the in the blister pack suggesting this had not been given. Staff confirmed this was an error and the resident had not been given their medication. Staff said that they were administering insulin to one resident and had been deemed competent to do this by the district nurse. Records in place signed by the district nurse were not fully clear in showing that all staff who are administering this are competent. The manager confirmed that all staff who were giving insulin had been deemed competent and she agreed to follow this up with the district nurse to ensure clear records are in place. Throughout the inspection staff were seen to be treat residents with respect and their privacy and dignity was maintained. Greenways DS0000068642.V339427.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): Standards 12,13,14 and 15 were assessed. Quality in this outcome area is adequate. Service users find the lifestyle in the home satisfies their social interests some of the time. Wholesome and appealing meals are provided which residents enjoy but records are not sufficient to show this happens consistently. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is currently no activities schedule in place to confirm activities planned. The manager advised that there are activities that take place in the home including one to one time with residents, reminiscence, exercises, outside entertainers – organ player and accordion player and bingo. The manager said if residents had participated in activities these would be recorded in individual care plans as opposed to a separate activity record. Care plan records contain a section to list social interests and hobbies but this section is not always comprehensive enough to support the resident to continue with these. One care plan file stated the resident enjoyed TV and listening to music but did not state any specific programmes they enjoyed or what type of music. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 17 Records in one file indicated the person wished to attend communion on a monthly basis. It was not clear from records in place this was happening. There had been no recent outside trips due to the poor weather. The manager said they celebrate individual birthdays and have a DVD player as well as CDs and videos for residents to listen to music and watch films in the home. It was noted that the screen on the TV in the lounge is small in comparison with the size of the lounge and the number of residents who may wish to watch it. A bookcase in the corridor contained numerous books and the majority of these were large print to enable easy reading for the residents which is good practice. The notes of a recent resident meeting showed that social activities had been discussed and a few ideas were suggested such as a barbeque, trip to the safari park and a stall at the local carnival. During discussions with residents at the home, one said that they did “sit around a lot” but the days “went quickly”. They confirmed that some activities are provided such as scrabble, bingo, board games but also acknowledged the weather had not been good to be able to go into the garden. A comment card from a relative stated “staff required for personal interaction with residents, activities are arranged but they all need time spent just talking to one person”. Another relative stated “I feel they would all benefit from a more jolly atmosphere”. The manager acknowledged that the provision of social activities was an area that needed to be improved and advised the home had allocated the role of part time activity co-ordinator to a current member of staff. She advised this person would be rotad to work 4 – 5 hours per week just to provide social activities to the residents. On the day of inspection this person came on duty during the afternoon and engaged residents in a game of cards. Family and friends are made welcome to the home and this was observed on the day of inspection. A comment card received from a relative stated “X has plenty of visits from family and friends”. Another relative comment card states “it is particularly warm and friendly, providing an excellent environment which feels like home”. It was evident that staff respect the choices of residents as far as possible. Staff were observed to always ask residents if they wanted something rather than just giving it. Care plans indicate resident choices in terms of times they like to get up and go to bed, food dislikes and preferred drinks etc and also indicate what residents like to do for themselves to support their Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 18 independence. The staff within the home are predominantly female but there is one male carer if residents have specific wishes regarding gender care. It was not evident that residents are asked if they prefer male/female carers. At lunchtime the meal served was liver and onions or chicken casserole with mixed vegetables, cabbage potatoes and cauliflower. The pudding was homemade summer fruits sponge, apple pie with custard or toffee whips. The cook confirmed that the meals are decided each day and these are usually then recorded on a menu planner. The menu planner had not been completed for the week of inspection. The cook said that she would be happy to plan meals on a monthly basis and to prepare a menu to this effect so it was clear what meals would be provided. Menus were not on display in the home so that residents knew what meals were available. The cook said these are usually written on a chalk board but they had ran out off chalk. Staff confirmed that residents are asked each day what they would like to eat and it was evident that one resident had something different to what was indicated on the menu which demonstrates the home do accommodate alternative choices if residents wish. A resident spoken to knew what the meal of the day was and said that sandwiches were for tea, they said they get plenty of drinks and there was enough choices offered. Other residents spoken to confirmed they liked the food in the home and that they are given choices. The cook said that she knew those residents that needed special diets and would prepare specific puddings for those with diabetes. As records of meals were not always being kept it was difficult to be sure that all residents on special diets were receiving them. At lunch time one resident was noted to have a fully liquidised meal. Each item had not been liquidised separately to make it look appetising. The cook said this person would not eat it if each item is done separately and they had tried this several times. The care records for this person did confirm they required their meals fully liquidising. Residents who needed support with eating were seated in an area in the dining where there was a level of privacy. This was carried out sensitively and the residents were not rushed. The cook said they had recently had a new cooker, toaster, microwave and water heater and all equipment in the kitchen was fully working. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 19 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): Standards 16 and 18 were assessed. Quality in this outcome area is adequate. Systems for managing complaints and abuse are in need of improvement to ensure these are fully effective to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: A “ Suggestions and Complaints” procedure is in place and this is displayed on the notice board in the resident lounge. It was not evident this is being managed effectively. The manager said they had received one “concern” since the last inspection and details of this had been placed on the file of the resident it concerned. If complaints are not recorded in a central location there is a risk staff will not recall who has made a complaint and issues may not be monitored or followed up. There should be a clear system in place, which residents and visitors feel at ease to record any concerns or suggestions in line with the homes policy on this. The manager showed the inspector forms that are used to record any complaints received which are kept in the office. The manager acknowledged that staff frequently received compliments but these were not recorded. Any concerns received should be recorded to show the date received, how it was investigated, timescales for this and any responses or outcomes and whether the complaint was upheld to show complaints are being managed effectively. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 20 The complaints procedure in the Statement of Purpose does not give full names and contact numbers of staff to contact in the event of a complaint and also does not detail our contact name and number as required. The procedure does not state the stages and timescales for dealing with a complaint or that it will be investigated within the 28 day timescale as stipulated in the care standards. Comment cards from relatives showed that two out of four knew how to make a complaint. One person wrote “never had any reason to complain assume there is a procedure in place”. A visitor to the home stated that they felt confident in approaching the manager with any complaint if they needed to but they “had never really had a complaint”. It was not evident that the home has a copy of the local authority policy for adult protection and it was not clear that all staff know how an allegation of abuse should be managed. The manager acknowledged that staff were due to update their knowledge on abuse awareness. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 21 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): Standards 19, 21, 25 and 26 were assessed. Quality in this outcome area is poor. The home is subject to ongoing refurbishment to improve the environment. Areas of the home require attention so that it is safe for residents including some attention to infection control practices so that effective hygiene can be maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Greenways is imminently due to be extended to accommodate an additional seven bedrooms with ensuite facilities. It is also planned to fit a disabled toilet and change the configuration of the dining area. There are also plans to fit ensuite facilities to a further two bedrooms. Due to these imminent works there are areas of the garden which are overgrown but which will form part of the new extension to the home. There remains an attractive grassed garden area for residents to enjoy and there are plans for this to be improved with finer weather. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 22 Currently the home has 27 single bedrooms eight of which have an ensuite facility. Bedrooms viewed looked pleasant and homely; one resident commented that they felt their bedroom was “fair”. Accommodation for residents is provided over two floors and there is level access within the home for wheelchair access. There is a communal dining room and one large lounge with two small quiet areas. There is one shower room and four bathrooms which have bath chairs to assist people into the bath. There are 8 communal toilets situated around the home for residents. The main door entrance has a lip, which would be difficult for wheelchairs to negotiate; there is however a side door with a ramp, which allows for easier access. Handrails are available around the home to aid mobility and wheelchairs and hoists are available to support the care needs of the residents. There are areas of the home, which are well-maintained and other areas which are not. For example the carpets need attention in the corridors, which are frayed and worn, and some with visible holes making these a potential trip hazard, which could impact on the safety of the residents. Tape had been applied to some areas of the carpet but this had come loose. The Annual Quality Assurance Assessment (AQAA) forwarded by the manager confirms that the dining room is to be made bigger and new flooring provided but does not mention any planned action in regard to addressing the flooring in corridor areas. This matter requires immediate attention. The green carpet in the corridor was stained and in need of cleaning. The door to this corridor was being held open by half a brick, which could present a trip hazard to residents as well as preventing effective fire safety. The carpet in the small upstairs corridor, which leads from the front door, was also stained. There is a pleasant lounge and dining area and bedrooms viewed were attractively decorated and clean and tidy. The home has created a “family room” with seating where residents can go during family visits as opposed to going to their bedroom. This has proved to be very successful and was in use several times during the inspection. Various areas of the home were being used to store items making it look untidy. This applied to the first floor corridor where tubes, covers and excess chairs were stored and wheelchairs in the downstairs corridor, which were blocking a door. The hot tap in one of the upstairs bathrooms did not work, the whole tap twisted around when attempts to turn the tap on were made. There was also Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 23 no hand drying facilities or soap. Toiletries were being stored in here despite a notice from the manager for these to be returned to rooms. Radiator covers are not in use within the home and radiators are not of a low surface temperature type. In addition there are storage heaters in use around the home, which are not low surface temperature and would present a burn risk to residents when in use. At the time of inspection the heating was not on so residents were at low risk of burns however this matter will require attention before the winter months to ensure this health and safety risk is managed. Suitable risk assessments must be devised detailing appropriate action to be taken. The water was too hot in one of the upstairs rooms and water generally upstairs was hotter than downstairs. The manager said that taps have got thermostatic mixing valves so that the temperatures can be regulated within safe levels. It was not evident that water temperatures are being monitored. This should be done to ensure water outlets always operate within safe guidelines and do not present a scald risk to residents and also to check the water is hot enough for residents to wash in. During the inspection a person in work clothing was walking through the kitchen when prepared food was on the trolley. This is poor practice as the kitchen is classed as a “clean” area and standards of hygiene need to be maintained. An ironing press was being stored in the kitchen and staff confirmed ironing was done in the kitchen at night. The staff office is based at the end of the kitchen and staff access this through the kitchen. As the kitchen is classed as a “clean” area, staff should not use this area for duties other than catering as this is poor infection control practice. A hand wash sink is available in the kitchen with a hand drier but it was not evident that a hand wash sink is available in the laundry so that staff can wash their hands to maintain good hygiene. The manager advised plans were in place for this to be addressed. The laundry has three washing machines and two driers to support the laundry needs of the home. Baskets were clearly labelled for dirty and clean washing and there were numbered baskets for each service user. There were no gloves and aprons in the laundry to maintain good infection control practices. Toilets within the home have hand towels as opposed to paper towels, which can harbour bacteria when used by several people, and prevent good hygiene. The manager was advised to review the use of these to ensure good hygiene and safe infection control practices within the home. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 24 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): Standards 27,28,29 and 30 were assessed. Quality in this outcome area is adequate. There are sufficient care staff available to meet the needs of residents but it is not clear that all staff have completed the required training to ensure residents are cared for safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The home aims to have three carers on duty during the day and evening and two carers on at night, which is considered sufficient numbers to care for the residents. The manager works in a supernumerary capacity five days per week. There are two cooks who split the responsibility for the kitchen so that there is one cook on each day to cook for the residents. A cleaner works in the home five days per week from Monday to Friday, staff confirmed that carers carry out any cleaning duties required at weekends. Duty rotas confirm the above staffing levels but do now show which staff are carrying out the laundry duties or cleaning duties at weekends. Duty rotas also do not show full names of staff so there is a clear audit trail. The manager showed the inspector task sheets, which list various tasks each day that the carers are required to do including the laundry. The manager confirmed the task routine worked very well and helped to ensure the home ran effectively. Although the task sheets detail what is to be done each day, it shows the laundry is to be done between 1pm – 6pm. It is not clear how much of the Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 25 carers time is actually spent on the laundry so that it is clear this does not impact on the care hours available for the residents. The home will need to ensure there are clear infection control policies in place in regard to carers carrying out cleaning and laundry duties to prevent any risk of infection being passed to residents. Six comment cards were received from relatives. Four people said that they felt the care home “always” met the needs of their relative and two stated they felt the home “usually” did. A visitor the home said that staff were “helpful” and “nice” and acknowledged they can be “busy” but knew exactly what the needs of their relative were. Duty rotas show that on some occasions staff are working two shifts from back to back ie from 6pm – 10pm and 10pm - 8am. The Working Time Directive requires that there is an 11-hour break within every 24hr shift. Staff can become tired and less effective when working long hours and this practice should therefore be reviewed. A review of staff records was undertaken to confirm recruitment practices carried out. Records in place showed that all required information had been collected such as two written references, a criminal record check and suitable identification papers. One file did not show a clear history of the persons employment. Good records are in place in regards to induction training and it was evident the home have started to implement the “Skills for training Common Induction Standards”. These standards incorporate training in a number of areas linked to the care of residents and training is completed over a number of weeks. This allows new staff to build up their competencies so they can provide safe care to the residents. There was no “at a glance” training schedule available to confirm staff training undertaken and training planned. The manager said that all staff had done fire training and training on moving and handling was due to take place late July. The manager also said staff training on infection control and health and safety was in need of updating. Staff spoken to confirmed they had completed all statutory training such as moving and handling, first aid and fire training within the last 12 months as required. The manager confirmed there are 21 care staff employed at the home and of these, nine have achieved a National Vocational Qualification (NVQ) II in Care to help them provide more effective care to the residents. Two staff were in the process of completing this and two further staff were planned to complete Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 26 the training so that the home can meet the care standard for 50 of staff to achieve this. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 27 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): Standards 31, 33, 35 and 38 were assessed. Quality in this outcome area is poor. The inspection process has identified a number of areas for action to ensure the health and safety of the residents can be maintained. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Greenways were taken over by new owners in December 2006 but the manager of the home has remained the same. The manager has worked in the home for approximately 11 years and therefore has extensive experience of working with older people. The manager also has attained a ‘National Vocational Qualification IV in Care’ and the ‘Registered Managers Award’ so is suitably qualified to manage the home. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 28 The manager acknowledges there is a lot of work to be done to meet the recommendations and requirements made during this inspection but it was evident she is committed to working with the new owners to address these as soon as possible. It is acknowledged that the extension proposals for the home have delayed some works being undertaken and plans in place will significantly improve the environment and safety of the home for the residents. Service user meetings and staff meetings are held in the home on a quarterly basis so that they can contribute to decisions regarding the management and running of the home. The last resident meeting was held in April 2007 and the notes of this meeting show that items discussed included having cooked breakfasts, times of evening meal, outings for the summer and any other questions. A resident had raised a question about the availability of bank staff as the home had been short staffed on a Sunday. The manager had responded to this and had documented that the resident was happy with the answer given. A staff meeting was held in the home in April 2007 and notes of the meeting show that night staffing was discussed. The manager had asked staff if they had anything they wished to discuss and it is documented that all staff felt happy with what had been discussed. A quality satisfaction questionnaire has not been completed since the new owners took over but the manager said this will be done. She is aware that any outcome results will need to be made available to residents and their representatives with details of any actions taken as appropriate. A review of service user monies and personal allowance records was undertaken to ensure these were being managed by the home appropriately. All money was found to be accurate in regards to records and money available and details of transactions had been clearly documented. It was not evident that receipts have been maintained for each transaction and action will need to be taken to address this. Health and safety records were viewed to confirm checks carried out. The lift had recently received a service check. The hoist and one of the baths had recently been checked and deemed safe to use and the manager said she would check if the chair on the upstairs bath required a service. A fire risk assessment was in place although it was not evident the home were carrying out safe fire procedures. Door wedges were noted to be in use all around the home, which do not meet with safe fire precautions. Doors would remain open in the event of a fire allowing smoke and fire to spread putting residents and staff at risk. If doors Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 29 are required to be kept open, suitable door retainer devices should be used which are linked to the fire alarm. There was no copy of the last electrical wiring certificate in the home although documentation on file suggested a check had been done. The manager said she had arranged for an electrician to come out to the home to carry out another check. Water temperature records were not available to confirm hot water temperatures are operating consistently at safe levels. Thermostatic mixing valves are fitted but regular checks still need to be made to ensure these are operating safely. The manager agreed to address this. No fridge and freezer temperatures had been recorded for the day of inspection or the days preceding this. Records for the previous month were also not available although the cook stated they had been done. The home was therefore not able to demonstrate that the fridges and freezers were operating at safe levels for the storage of food. There were no records in place to confirm a legionella check had been carried out. The manager confirmed electrical portable appliance testing was due to be done. There is no policy in the home for the management of violence and aggression or in regard to equal opportunities; the manager was advised to address this as soon as possible so that staff are clear on the homes expectations of them in these areas. The upstairs windows did not have window retainers to protect residents from leaning and falling out of them. The manager was advised to undertake risk assessments in regard to this matter and to take prompt action to address this. As stated in the environmental section of the report, there are areas of carpet that are threadbare and therefore pose a trip hazard to residents. Radiator covers/risk assessments are not in place to ensure residents will be protected from burns from the hot surfaces. The manager said there was no gas in the home. Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 30 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 X 3 2 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 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 1 2 X 2 X X X 1 1 STAFFING Standard No Score 27 2 28 2 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 2 X 2 X 2 X X 1 Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 31 Are there any outstanding requirements from the last inspection? N/A 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 Requirement A review of care plans is to be undertaken to ensure all residents’ needs are clearly identified with staff actions required to meet these needs. Records must also demonstrate needs have been met. A review of medication management is required to ensure this is managed safely consistently. This includes: Staff only signing for medications given. Ensuring that all medications available are indicated on the MAR chart. Ensuring an appropriate register is in place to record controlled drugs in use in the home. Ensuring records are clear whether one or two tablets have been given when these have been prescribed, “one or two as required”. Ensuring the self administration Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 32 Timescale for action 31/10/07 2. OP9 13(2) 30/09/07 procedure allows for regular competency checks to be carried out to make sure residents are able to safely continue to take their own medication and are taking this as prescribed. Ensuring any agreements made with GPs on changes to medication including how this is given is clearly recorded on the MAR. Entries must be signed and dated as appropriate. Immediate action is taken to review the practice of crushing slow release or medium release tablets, which prevent the tablet from working, as it should. Ensuring clear records are in place to confirm the district nurse had deemed specific staff competent to administer insulin. The home must be able to demonstrate that suitable meals are being provided for people with special dietary needs such as diabetes. Records must be maintained as appropriate. A suitable procedure for dealing with Adult Protection must be in place. All staff must be clear on how to identify abuse and know their responsibilities in reporting or managing this. This is to ensure residents are safeguarded in the home. The carpets in the home must be maintained in a good state of repair to prevent residents from tripping and falling where this is threadbare. Risk assessments are to be devised with immediate effect in regard to this matter, which indicate a date for the carpets, Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 33 3. OP15 17(2) Sch4 30/09/07 4. OP18 13(6) 30/09/07 5. OP19 13 (3,4,) 31/08/07 which are threadbare to be replaced as required. Carpets must be maintained in a clean condition to maintain hygiene and prevent the spread of inspection. Records of fridges and freezer 10/09/07 temperatures must be maintained to demonstrate food is being stored at safe levels and the food is safe for residents to eat. The use of door wedges within 10/09/07 the home is does not meet with fire precautions and is to be reviewed and action taken with immediate effect. These prevent effective fire safety for the home. A risk assessment must be 10/09/07 undertaken in regards to the lack of window restrictors upstairs in the home. This must demonstrate suitable actions, which must be carried out to prevent the risk of residents falling from windows. 6. OP38 13 7. OP38 23 8. OP38 13(4) 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 OP1 Good Practice Recommendations The Service User Guide for the home needs to contain the Statement of Terms of Conditions for the home, a summary inspection report and up-to-date details of our address and telephone number. It is advised that assessment records are kept on care plan files so staff can access these and ensure the needs identified are transferred into suitable care plans. A letter is to be sent to service users following their DS0000068642.V339427.R01.S.doc Version 5.2 Page 34 2. 3. OP3 OP4 Greenways 4. 5. 6. OP8 OP12 OP14 7. OP16 8. 9. OP19 OP19 10. OP19 11. OP25 12. OP26 13. OP26 14 OP26 assessment to confirm the home can meet their needs. Records need to demonstrate specialist interventions such as district nurse visits and chiropody visits to show service users are receiving these services to support their health. The provision of activities needs to be monitored and reviewed as appropriate to ensure all residents receive sufficient social stimulation to maintain their wellbeing. Where service users have made specific choices such as wishing to attend communion monthly, records should demonstrate this is happening so that it is clear choices are being respected and met. The complaints and suggestions procedure for the home should be reviewed so this is more accessible to service users and visitors to the home. The procedure should contain clear contact names, telephone numbers, the stages in which the complaint will be investigated and indicate the timescale this will be done in accordance with the care standard. This is to demonstrate that complaints received will be managed effectively. Action needs to be taken to fix the hot tap in the upstairs bathroom so that this works properly and residents and staff can wash their hands in hot water. Where excess equipment is stored around the home such as wheelchairs in corridors, chairs on the upstairs landing, it is advised a suitable storage location is found so that doors and areas are fully accessible. A suitable location should be identified to undertake ironing so this is not done in the kitchen which is a food preparation area and should be available at all times for food preparation for residents as required. Hot water temperatures need to be regularly monitored to ensure these remain at safe temperatures and do not present a scald risk to residents. Water also needs to be checked to ensure this is sufficiently hot enough for residents to wash in. The kitchen is classed as a ‘clean’ area and the practice of care staff routinely using the kitchen as a walkway to their office should therefore be reviewed. The practice of ‘workmen’ entering the kitchen in work clothing also should also be reviewed. These practices could impact on the hygiene of the kitchen as well as present the risk of food contamination. A hand wash sink, gloves and aprons should be available in the laundry to maintain good infection control practices. The manager is advised to continue with plans to fit a hand wash sink in this area. A risk assessment is to be carried out in regard to DS0000068642.V339427.R01.S.doc Version 5.2 Page 35 Greenways residents using hand towels in communal bathrooms and toilets, which can harbour bacteria with continued use. A review of drying facilities is to be undertaken as appropriate to ensure effective infection control and hygiene management in the home. Duty rotas need to show full names of staff so that there is a clear audit trail. A review of cleaning hours should be undertaken so that there is cleaning support to the home at weekends and this does not impact on carer time with residents. A review of laundry services should also be undertaken to ensure it is clear how much time carers are allocating to laundry services and this is not impacting on the care hours available to the residents. It is advised that an “at a glance” training schedule is devising showing all staff training completed and planned each year. This is so that it is clear all staff have completed the required training to provide safe care and services to the residents. Radiators within the home need be risk assessed in regard to these being low surface temperature or guarded to prevent burn risks to residents. Suitable actions will need to be carried out before the Winter months to prevent this risk. Policies and procedures violence and aggression and equal opportunities need to be available in the home so that staff are clear on their responsibilities in regards to these matters. 15 OP27 16 OP30 17. OP38 18 OP38 Greenways DS0000068642.V339427.R01.S.doc Version 5.2 Page 36 Commission for Social Care Inspection Birmingham Office 1st Floor Ladywood House 45-46 Stephenson Street Birmingham B2 4UZ 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 DS0000068642.V339427.R01.S.doc Version 5.2 Page 37 - 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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