CARE HOMES FOR OLDER PEOPLE
Greenways Salisbury Road Darwen Lancashire BB3 1HZ Lead Inspector
Mrs Jennifer M Turner Unannounced Inspection 22nd November 2005 11:00 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 DS0000034755.V253239.R01.S.doc Version 5.0 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 DS0000034755.V253239.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service Greenways Address Salisbury Road Darwen Lancashire BB3 1HZ 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) 01254 701954 www.blackburn.gov.uk Blackburn with Darwen Social Services Mrs Louise Anne Turner-Hope Care Home 28 Category(ies) of Old age, not falling within any other category registration, with number (28) of places Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. The service should, at all times, employ a suitably qualified and experienced manager who is registered with the CSCI. 22nd November 2004 Date of last inspection Brief Description of the Service: Greenways is a purpose built home situated in Darwen near to Sunnyhurst Woods. The home is registered for 28 residents - 23 reside in the main area of the home and five are accommodated in an Intermediate Care Unit situated on the 1st floor of the home. This Unit is managed separately from the main area of the home. The building is surrounded by lawns and patio areas. There is a small area for parking cars at the front of the home. Greenways is a twostorey building but due to the layout of the building the rear elevation is 3 storeys high. Bedrooms are situated on both the ground and first floors, as are bathing and W.C. facilities. On the ground floor there is a large dining room that is used for social events, and there are a number of small lounges. Smokers are catered for. A passenger lift connects the two floors. There is easy access for wheelchair users at the front door. The home is close to a bus route into Darwen Town Centre, and is approximately one mile from the main shopping centre. Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. This unannounced inspection took place on 22nd November 2005 between 11am and 5.45pm. Information was obtained by talking with two members of the management team, eight staff members, seven residents and two visitors in the main part of the home, two staff and four residents in the Intermediate Care Unit, by examining a variety of records and walking around the home. Views were obtained from residents and staff on a variety of topics and information was also obtained by case tracking. Three residents and three relatives completed comment cards. Views have been recorded collectively where the answers obtained were similar. Any specific or differing comments have been recorded in the main body of the report. The inspector’s notes have been retained as evidence of the inspection. At the time of the inspection the home had occupancy of 20 residents in the main area of the home and 4 in the Intermediate Care Unit. The Fax number of the home is:- 01254 777574 The email address of the home is:greenways@blackburn.go.uk The web site of the home is:www.blackburn.gov.uk What the service does well:
Pre admission assessments ensure that staff at Greenways can provide the required care for new residents. The Intermediate Care Unit offers a service to five residents. Residents spoken with were enjoying the experience and the opportunity to return to their own homes. Residents are encouraged to be involved with the setting up and reviewing of their care plan. This ensures that they are aware of what decisions are taken in relation to their care. Resident’s healthcare needs are identified and met.
Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 6 The comprehensive policies and procedures relating to the administration of medication ensure that medication practices protect both staff and residents. A variety of areas were available for residents to entertain their visitors. Their privacy was respected. They commented that, “staff knock on my door before coming in” and “the doctor sees me in my room”. The record of meals served showed that balanced and nutritious meals were offered. Residents commented that “I enjoy the food” and “there’s always enough”. Adult Abuse procedures were in place and used effectively to protect the residents. Ongoing training was evidenced. This ensures that a well-trained workforce cares for residents. Staff said that there was “plenty of training available”. Residents felt confident about approaching staff if they had any concerns and commented, “we don’t need meetings to tell the staff anything”. Residents’ finances and belongings are maintained securely. Staff receive the appropriate amount of formal supervision. competent workforce. This ensures a What has improved since the last inspection?
Some medication practices had been improved ensuring further safe practices. Redecoration of the hallway and the replacement of carpets in the hall and main downstairs and upstairs corridors were underway. This ensured a pleasant environment for the residents and staff. A new doorway has been “knocked through” at the end of the downstairs corridor and a ramp installed to give easy access into the garden. This ensured that residents were able to access an “exhibition garden” that had been awarded to the residents at Greenways from the Royal Horticultural Society Flower Show at Tatton Park. Residents said it was “nice in the summer” but “it had cost a lot of money”. The provision of a minimum of two double electric sockets in each residents bedroom has gone out to tender. This will ensure that there are sufficient sockets available for the variety of electrical appliances that residents use. Water testing in respect of the prevention of Legionella had taken place. This ensured a safe environment for residents and staff.
Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 7 What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS
Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 9 Choice of Home
The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1;3;6 Assessment documentation was sufficient to ensure that the needs of residents were met upon admission. The Intermediate Care Unit provided a holistic approach enabling residents to feel confident when returning to their own homes. EVIDENCE: A copy of the Statement of Purpose and the Residents Guide were on display in the reception area. Although they had been reviewed, there was no indication relating to when this had taken place. A copy of the complaints procedure needed to be included in these documents. Once completed, copies of the Statement of Purpose and Residents Guide should be forwarded to the Commission. Care managers or health officials provided assessments for all residents, including emergency admissions. These had been evidenced in resident’s files and formed the basis of the residents care plan. Members of the management team visited the prospective resident to carry out an assessment and invited them to visit the home. Confirmation of the placement was given verbally. It is required that placements are confirmed in writing.
Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 10 The Intermediate Care Unit accommodated 5 residents in single bedrooms. Documentation relating to the Unit was available Support was provided from a multi-disciplinary team of Carers, Physiotherapist, Occupational Therapist and a District Nurse. The Co-ordinator, Physiotherapist and Occupational Therapist carried out Pre admission assessments. Various reviews were carried out after the 1st, 3rd and the 5th week that was prior to discharge. Case notes indicated that residents were involved in all stages of their care plans and reviews. Risk assessments were documented. Residents spoken with felt that the whole experience had been beneficial and were eagerly awaiting discharge home. Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 11 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7;8;9;10 Care plans showed residents involvement and contained the information required by staff to meet the needs of the residents. Medication policies and procedures were good. Residents were treated with respect. EVIDENCE: Risk assessments in respect of the prevention of falls were evidenced in care files. Care plans were drawn up with the involvement of the residents and reviewed on a monthly basis. Residents or their representatives were encouraged to sign the monthly review to indicate that they had been involved. If they were unable to sign, this had also been indicated. Records showed that residents also signed the 6 monthly departmental reviews. There was evidence on resident’s files that nutritional screening had taken place at the time of admission when a “kitchen notification” form had been completed. Dietary information and weight gain/loss had been recorded and reviewed monthly. Staff stated that District Nurses were involved if a resident was at risk of developing pressure sores. Both District Nurses and the Continence Advisor carried out assessments in respect of continence products. A variety of different types of pressure relieving devices were in evidence.
Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 12 Access to health professionals was evidenced during examination of the care plans. Policies and procedures for all aspects of medicines management were in place. A policy supporting self-medication was in use. This was particularly evident in the Intermediate Care Unit. The recommendations made during the previous inspection had been actioned. Clear accurate records were seen. Storage of medicines was appropriate, secure, clean and tidy. The storage and recording of Controlled Drugs complied with current legislation. Evidence was seen that staff responsible for the administration of medication had completed appropriate medicines management training. Medication reviews were prompted in line with the National Service Framework for Older People. It was evident from observation and discussion with residents and staff that privacy and dignity were respected at all times. A pay phone was available in the residents’ kitchenette. Jack plugs were evidenced in some bedrooms and one resident did have a private telephone line. Residents said that their mail was delivered to them unopened and staff were available to assist them if required. Staff spoken with, had a good awareness of issues surrounding privacy, dignity and respect. Comments on “Residents Comment Cards”, received prior to the inspection, stated that those residents who had completed the cards had felt that “staff treated them well and that their privacy was respected”. Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 13 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 12;13;14;15 Cultural, social and recreational interests were offered. Contact was maintained with family and friends. Residents had some control over their lives. Food served was nourishing and well presented. EVIDENCE: Residents made a variety of comments relating to activities. Comments made on residents’ comments cards ranged from “Yes/Sometimes/No” in response to whether the home provided suitable activities. Residents spoken with also gave various responses. The assistant manager indicated that the list of activities had been removed from the notice board during the recent redecoration. Some residents felt that the music in the dining room “was too loud”. A volunteer was involved on a weekly basis to provide activities. One relative commented via the comment card “there should be more going on not just once a week”. The inspector observed that some residents were watching television or were listening to their radios, either in the communal areas or in their own rooms. Communal and individual activities in which residents participated were recorded in their files. Residents told the inspector that their visitors were made welcome and they were able to see their friends or relatives in any area of the home. There was a small quiet lounge where residents could take their relatives should they wish.
Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 14 Information relating to Greenway’s policy in respect of visiting appeared in the Residents Guide. Representatives of different spiritual faiths visited the home. Part of the admission process included arrangements for resident’s financial affairs. Whenever possible relatives were encouraged to administer the finances on the resident’s behalf. Information in respect of the Advocacy service was available. Residents had access to their records according to the Data Protection Act. Residents who spoke to the inspector had not accessed their records other than being involved in care planning. The choice of menu was shown on a chalkboard in the dining room. Residents were able to choose at the mealtimes what they preferred. They were also able to have a drink when they wished and the cook confirmed that cakes were freshly baked. Comments on residents comment cards indicated that they enjoyed the food although one relative commented that they did not feel that the food was “up to scratch”. Other relatives spoken to made positive comments about the meals. All residents spoken to during the inspection expressed their satisfaction with the food and the food sampled during the inspection was tasty and nutritious. Meal times were unhurried and staff were observed to give support to the residents in a pleasant and dignified manner. The cook was advised that any prescribed food supplements should be recorded on the medication administration records. Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16;18 There was a complaints procedure for residents and their families to voice their concerns. Abuse procedures were in place to protect residents from possible abuse. EVIDENCE: There had been three complaints dealt with internally and these had been attended to swiftly and thoroughly. The home had a complaints procedure, which was accessible to the residents although it did not state the time period for complaints to be dealt with. Residents spoken to stated that they would speak to the manager if they had concerns and complaints. There were also a number of letters and cards of appreciation received by the staff from relatives. There was a comprehensive corporate policy and procedure that had been produced by Blackburn with Darwen Borough Council to assist the staff in respect of Adult Protection. In-house training was ongoing throughout the department and the assistant manager indicated that most of the staff had completed this. Staff spoken with were aware of the different types of abuse and were clear about their responsibilities in respect of “whistle blowing”. There was a policy in place to guide staff when facing verbal and physical aggression from residents. Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 16 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19;20;24;25 Residents live in a safe, well-maintained environment. EVIDENCE: There was a programme of routine maintenance. Some refurbishment and renewal of carpets was taking place. A record of health and safety checks for equipment and building maintenance was kept. Residents said they liked to sit out “at the front during the nice weather”. A video intercom was in operation at the front door. A variety of lounges were available downstairs and residents sat where they chose and were observed to move around freely. One of the lounges was designated as a “smokers” lounge. In addition there was a “quiet/visitors” lounge. The dining room was large enough to cater for all residents and was used for visiting entertainers and some social activities. The décor of the home was bright and cheerful, the lighting domestic in character. Outdoor space was safe and accessible to residents with flat access at the front door and a ramp at a side entrance to the garden.
Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 17 Records on resident’s files indicated that they had signed a document if they had not wished to be provided with the minimum furnishings in their bedroom. Residents’ rooms were bright and personalised. All were carpeted apart from one and a risk assessment was in place. Lockable storage was available in resident’s rooms and residents said that keys were issued for these and their bedroom doors. The assistant manager indicated that if residents did not wish to have keys then this was documented on their files. The provision of a minimum of 2 double electric sockets in each residents’ room had now gone out to tender. All upstairs windows had been fitted with window restrictors. Lounge and dining room windows at the front of the home were near to the ground and these had received an appropriate risk assessment. Radiators and pipe work were guarded. Mixer valves were fitted to sinks. The hot water taps were tested randomly and the water temperature was found to be satisfactory. Documentation was available to indicate that Legionella testing had been carried out. Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 18 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27;29;30 The skill mix and numbers of staff met the residents’ needs. Recruitment practices needed some more attention. The variety of staff training undertaken meant that residents’ needs were met. EVIDENCE: From the staffing rota and observation, there were sufficient care and ancillary staff on duty to meet the needs of the residents. In addition an extra cook was employed on a temporary basis and a member of staff from the departments domiciliary care service was working in the home. Staff indicated that the manager increased staffing levels whenever the needs of the residents warranted this. There were mixed comments received on relatives comment cards relating to the number of staff on duty from “not enough” to “enough”. Five staff files were examined. An outside organisation acted as the “umbrella” organisation in respect of Criminal Record Bureau (CRB) checks. There was no evidence that checks had been made on the “Protection of Vulnerable Adults” (POVA) register. Staff said they had a copy of the General Social Care Council Code of Conduct. Contracts and job descriptions were seen on the staff files examined. Volunteer recruitment and selection was the responsibility of the Volunteer Manager at Jubilee House. Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 19 Training records indicated that staff received comprehensive induction training in line with National Training Organisation (NTO) targets. Following induction it was stated that staff would move onto National Vocational Qualification (NVQ) training. Staff spoken to at the time confirmed they had received a variety of training opportunities, including NVQ. Details of training undertaken by staff were recorded in their personal training files. Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 20 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33;35;36 Quality assurance systems were in place. Residents’ finances were handled securely. Staff receive appropriate supervision. EVIDENCE: A business plan and an annual development plan for the home was made available. There was evidence that the home had achieved the required standard of the Blackburn with Darwen Quality Assurance Scheme. Although feedback from residents, relatives and other professionals had been obtained from the annual satisfaction questionnaires, these were not dated. Other information was gained from residents meetings. The information was collated in the Residents Guide. Policies, procedures and practices were reviewed via the department’s policy section and the homes management team. There was no evidence that a representative of the department visited the home on a monthly basis. Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 21 Clear evidence was seen to show that residents were able to maintain their own finances according to their pre-assessed ability. Residents’ monies, which were kept by the staff on behalf of residents, were checked against written records. Monies were kept separately and were correct. Written records of all transactions were seen. There were appropriate, secure facilities for the safe storage of all valuables and cash. Staff informed the inspector that they were offered the required amount of supervision from the management team and received a written copy of the supervisor’s notes. Supervision covered the required elements. The examining of staff files evidenced supervision. Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 22 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 2 X X 3 HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 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 3 3 3 X X X 3 3 X STAFFING Standard No Score 27 3 28 X 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 2 X 3 3 X X Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 23 Are there any outstanding requirements from the last inspection? NO 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 OP1 Regulation 4;5; Schedule 1 14 (1)(d) Timescale for action The registered person must 31/12/05 ensure that the Statement of Purpose and the Service Users Guide include all the required elements of this standard. The registered person must 31/12/05 confirm in writing to the prospective resident, that having regard to the assessment, the care home is suitable for the purpose of meeting the residents needs in respect of their health and welfare. The registered person must 31/12/05 ensure that the home is visited under the requirements of this regulation and the appropriate report completed and a copy forwarded to the CSCI. Requirement 2 OP3 3 OP33 26 (2-5) RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Good Practice Recommendations Standard 1 OP1 The Statement of Purpose and Residents Guide should be dated when reviewed and copies of the reviewed documents should be forwarded to the CSCI.
Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 24 2 3 4 5 6 OP12 OP15 OP16 OP29 OP33 A variety of social activities should be made available to all residents. All prescribed nutritional products should be recorded on the Medication Administration Record when taken by the resident. The complaints procedure should contain the time limit in which a complaint will be responded to. The results of staff POVA checks, made during the recruitment process, should be retained in the home. Questionnaires should be dated when completed. Greenways DS0000034755.V253239.R01.S.doc Version 5.0 Page 25 Commission for Social Care Inspection East Lancashire Area Office 1st Floor, Unit 4 Petre Road Clayton Business Park Accrington BB5 5JB National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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