Inspection on 24/11/09 for Greenways

This inspection was carried out on 24th November 2009.

CQC found this care home to be providing an Poor service.

The inspector found there to be outstanding requirements from the previous inspection report. These are things the inspector asked to be changed, but found they had not done. The inspector also made 7 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

Greenways 22/03/10

Greenways 08/12/08

Greenways 29/01/08

Greenways 02/08/07

Extracts from inspection reports are licensed from CQC, this page was updated on 13/03/2010.

Key inspection report Care homes for older people Name: Address: Greenways Marton Road Long Itchington Nr Southam Warwickshire CV47 9PZ     The quality rating for this care home is:   zero star poor service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Sandra Wade     Date: 0 1 1 2 2 0 0 9 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 38 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 38 Information about the care home Name of care home: Address: Greenways Marton Road Long Itchington Nr Southam Warwickshire CV47 9PZ 01926633294 F/P01926633294 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Kirkley Limited care home 27 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 27 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category (OP) 27 Date of last inspection Brief description of the care home 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 people. The home offers personal care to people over the age of 65 years. The home is not registered to take people in any other categories. People needing nursing care receive this from the visiting community nurses. An extension has recently taken place to add another three bedrooms to the home. There are local shops which are around a 15 minute walk from the home and there are Care Homes for Older People Page 4 of 38 Over 65 27 0 0 8 1 2 2 0 0 8 Brief description of the care home public transport links to Leamington Spa, Rugby and Southam within a five minute walk from the home. The bus stop being located by the village pond. There is a door into the home which has level access for wheelchairs and people with mobility problems although this is not the main entrance. Accommodation for people is provided over two floors and all bedrooms are for single occupation, several 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 also a relatives room where people can meet in private. There is one shower/wet room and four bathrooms with assisted facilities such as bath chairs to support people into the bath. There is garden and patio area where people and 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. At the time of this inspection the fees for the home were up to £364 to £485. These are published in the Service User Guide. Extra charges are made for hairdressing and chiropody. Fees are subject to change and should therefore be confirmed with the service. Care Homes for Older People Page 5 of 38 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: zero star poor service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our 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 over two days these being on 24.11.09 and 2.12.09. The first day between 7.35 and 8.20pm and the second day between 8.15am and 4.20pm. Two people who were staying at the home were case tracked but specific care issues relating to other people were also reviewed. The case tracking process involves establishing an individuals 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 peoples care helps us understand the experiences of people who use the service. Care Homes for Older People Page 6 of 38 A completed Annual Quality Assurance Assessment (AQAA) was received from the service prior to the inspection detailing information about the care and services provided. Questionnaires were also sent out to people living in the home their relatives, visiting professionals and staff to ascertain their views of the service. Information contained within the AQAA and outcomes of surveys have been included within this report as appropriate. Records examined during this inspection, in addition to care records, included staff training records, staff duty rotas, kitchen records, accident records, financial records, complaint records, quality monitoring records and medication records. People were observed in the lounge/dining areas to ascertain what daily life in the home is like. A tour of the home was undertaken to view specific areas and establish the layout and decor of the home. Care Homes for Older People Page 7 of 38 What the care home does well: What has improved since the last inspection? The format of care plans has been reviewed so that there are now clearly identified areas for recording the needs of people, the staff support required and the dates when these needs should be reviewed. This should help staff in meeting the needs of people effectively. Two new bath chairs have been purchased to help assist people into the baths. A patio area has been created behind the conservatory with a raised flower bed so that people can access this easily if they wish to do some planting in the finer months. Care Homes for Older People Page 8 of 38 Three new bedrooms have been created as part of the extension works to the home so that more people can be accommodated. Some of the bedrooms have been refurbished with new decoration and soft furnishings to make these more pleasant for people. The wooden ramp on the first floor now has a non slip coating and hand rail to help ensure people can use this safely. Some changes to staffing arrrangements have taken place including more hours dedicated to the cleaning of the home to make sure this is pleasant and hygienic for people. Menus have been updated to include more information about choices available to people. What they could do better: Care plans need to be developed promptly following a persons admission so that staff are aware of their care needs and how these need to be met. Risk assessments need to be developed when it is identified there could be a risk to the persons health or safety so that people can be confident suitable actions will be taken to ensure their care needs are met appropriately. Suitable systems need to be developed for monitoring people who are at risk of poor nutrition so that staff can ensure their health is maintained effectively. Records need to clearly demonstrate any advice sought or given by professional visitors such as the GP or district nurse to ensure staff provide a consistent approach to managing care needs such as pressure sores. A review of social activities and mental stimulation is required to ensure people are able to pursue their hobbies and interests where possible to help maintain their health and wellbeing. Comments received included boredom and lack of stimulation is a major problem. The home needs to demonstrate that regular snacks and drinks are being provided in accordance with peoples wishes and needs. Further consideration needs to be given to the times when drinks are provided to ensure people are receiving these as often as they would like and at times of their choosing. Staffing arrangements need to be reviewed to ensure there are sufficient numbers of staff to support the care needs and services provided to people effectively. This includes sufficient numbers of senior carers to support each shift, consistent staffing arrangements across weekdays and weekends and sufficient hours to make sure laundry is managed effectively consistently. The number of staff with a National Vocational Qualification needs to be increased to make sure there are suitable numbers of appropriately trained staff to support people in the home safely and effectively. Care Homes for Older People Page 9 of 38 All accidents and incidents that impact on the wellbeing of people in the home need to be reported to the Care Quality Commission as required. This is so people can be confident these are being managed appropriately to safeguard people living in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line 0870 240 7535. Care Homes for Older People Page 10 of 38 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 38 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Detailed information about the home is available to ensure people can make informed decisions on whether to stay. People are assessed prior to staying at the home to ensure their needs can be met. Evidence: The AQAA states that the service have updated their Service User Guide containing information about the home and that they have been encouraging people to visit the home and join in tea or lunch. A detailed Service User Guide was available detailing information about the care and services provided. We were told this is provided to people who are interested in staying at the home. Some of the information in this guide was in small print which could be difficult for people to read. The provider said this would be addressed when the guide is further updated. We were told arrangements would be made to produce this in other languages if required. Care Homes for Older People Page 12 of 38 Evidence: Two care files were viewed to confirm an assessment of their needs was carried out prior to them coming to live at the home. It was evident that full assessments of their needs had been undertaken so that this information could be used to develop appropriate care plans directing staff how to support their needs. A visitor asked about their experience of assisting their relative to choose a care home and the assessment process said I went to two homes and one would not let us in, we came here and were asked to look around and they invited us to look at the lounge and meet residents. The manager spent a lot of time with us and we had a chat in her office When X arrived they took X to their room and asked X about all their needs and how they liked their food. The visitor was happy about how this process has been managed and said the girls that are here are lovely they really are. Care Homes for Older People Page 13 of 38 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience poor quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be sure that their care needs will be met consistently or promptly. Evidence: The AQAA states that the service feel something they do well is the completion of care plans. The AQAA states they are person centred and easy to understand. Staff were observed to be friendly and supportive towards people living in the home and people looked clean, well kempt and their hair and nails were clean. Staff had some knowledge of peoples needs and how these should be met but there were differing views in some cases. Care plans were not up-to-date or sufficiently detailed to make sure staff were able to provide a consistent approach to delivering care. We found that some people were placed at risk of poor health due to care needs not being regularly reviewed and their care needs not being identified and met. Comment cards received from staff showed that two felt they always received up-todate information about the care needs of people they support and two felt they Care Homes for Older People Page 14 of 38 Evidence: usually did. Two staff stated they felt the ways in which they share information about people in the home always worked well and two staff felt this usually worked well. Care files were requested for two people living at the home but we were only given one set of care plans. The manager told us that she had not developed care plans for the person requested. This person had been in the home for several months so it was not clear how staff were supporting them in meeting their needs. Staff said that they relied on information given an handovers each day and that records were kept of handovers. These records were viewed but contained limited information and would not have been sufficient for staff to be clear on how care should be delivered. Social services had carried out an initial assessment of this person just prior to them coming to live at the home. This information showed they had a multiple lumbar compression fracture and they were to wear a back brace to support them. The manager told us that the person should be wearing it. There was no care plan making this instruction clear to staff or detailing why it was important for the person to wear the brace. Staff spoken to about the back brace gave differing responses about how this should be managed and what it was for. One person stated they had it on all the time but that was when they were walking they do not have to wear it when not mobilising. Another stated X should wear it at all times, X wears it now. Staff were not sure why this brace must be worn but all said information about the persons problem was available in the persons hospital notes. When asked if failure to wear it could result in any damage to the person, we were told that the person kept complaining of pain and they dont know if X did something to their ribs before they came here and cant remember off hand what the reason was they have to wear this. It was not evident that the person was wearing the brace or that any action had been taken to pursue this matter with the GP to establish if there could be any risks to the persons health by not wearing it. The lack of care plans and clear instruction to staff was raised with the manager. As this inspection took place over two separate days, action was taken by the manager to ensure by the second day a full set of care plans were devised for this person. These contained instructions to staff on the back brace including that the person was to wear it at all times. The manager also agreed to follow-up with the GP any risks associated to the person if they refused to wear it. We were told during the inspection that a person had climbed over their bed rails and Care Homes for Older People Page 15 of 38 Evidence: had fallen to the floor along with the back rest that was on the bed and the mattress. The file for this person was requested to determine if a risk assessment had been agreed around the use of the bedrails. There was no risk assessment on the file to show that all risks associated with the use of bed rails had been considered. There were no clear written agreements for their use with the person or their family. The use of bedrails can be seen as a form of restraint and it is therefore important that risks associated with their use are fully considered as well as seeking consent by the person or their family. The homes policy in regards to the use of bedrails stated that written consent should be sought, the home therefore had not followed this policy. The manager told us that she thought the person had fallen out of bed once when they first came into the home and this was the reason the bedrails were put in place. She stated the use of the bedrails had been discussed with staff and the family and the family had verbally agreed to their use. A family member spoken to confirmed they had agreed to the use of bedrails but as records had not been completed to confirm this, it was not clear that the risks associated with the use of these had been fully discussed with them. The second file requested for case tracking showed that the person had started to lose weight from March 2009 when they were 8 stone 2lbs. Their weight reduced every month following this until they weighed 6 stone 7lb in October 2009. There was no evidence from the records in place that any actions had been taken to follow up the significant weight loss of this person. One member of staff spoken to said that the person spent most of the time in their room and occasionally they had to encourage them to eat. Another stated they had not noticed any deterioration, X eats well and drinks well. We were told by the manager that no food or fluid monitoring charts were put in place because X seemed to be eating what we were giving them. A nutritional care plan was in place but this made no reference to any actions that should be taken to address the weight loss. The care plan also had not been reviewed since April 2009 to ensure up-to-date information on this persons nutritional health was documented. Staff told us that this person had also developed a pressure sore and the district nurse had been in to treat this. This also was not indicated in the care plan which showed the skin was healthy. This care plan also had not been reviewed since April 2009. As the care plan had not been updated there was no clear instructions to staff about how the pressure sore was to be managed. For example there was no information about what should happen between district nurse visits such as what happens should the Care Homes for Older People Page 16 of 38 Evidence: dressing become soiled or fall off or how personal care should be given and if creams needed to be applied etc. It was also not clear what actions staff should take to help prevent the pressure sore from deteriorating further. On visiting the person it was evident they were sitting on a pressure relieving cushion and had creams available to treat any sore areas to their skin (although these creams were not on the Medicine Administration Record (MAR) to show they had been prescribed). The manager told us that the district nurse had provided these but as they were not on the MAR there were no clear instructions to staff on how they should be used. The person stated they were fed up but on the whole I am happy. They said they had been given some food and told they had to to eat it when asked if they liked the food they said its ok I suppose. Staff said that this person preferred their own company and liked to stay in their room. Comment cards received from relatives showed that two out of three felt that the service usually supports the care of their relative/friend in a way they expected or agreed. A visiting professional indicated on their comment card that peoples health care needs are usually appropriately monitored, reviewed and met by the care service. A review of medication was undertaken and on the whole this had been managed well. In some cases the amount of medicine available at the beginning of the prescribing period had not been documented on the MAR. This made it difficult to audit the person had received their medicines as prescribed. In one case there was one tablet missing and no clear explanation for this, one suggestion was the two must have been given on one day but records did not show this. In one case the MAR had been signed from 2.11.09 up to 24.11.09 and then all signatures crossed out with no explanation as to why this was. Staff told us that this was an error and the medicine had not actually been given. The medicine bottle was produced to confirm this but concerns were raised that staff were originally signing the MAR to confirm the medicine had been given when it had not. The privacy and dignity of people who use the service was being respected. Some people chose to stay in their rooms and staff respected their privacy. Those who chose to stay in communal areas where treated with respect by staff and were escorted to their rooms or bathrooms when attending to personal care. Care Homes for Older People Page 17 of 38 Evidence: Care Homes for Older People Page 18 of 38 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Some social activities are being provided but the range and frequency of these do not meet with peoples wishes and choices. Meals are provided which people enjoy although the timings of drinks and snacks are not always in accordance with peoples choice. Evidence: The Service User Guide states that the home has an Activities Co-ordinator who works closely with the residents to involve them in activities. This also details social activities that take place including hairdressing and a visiting volunteer who carries out manicures on Tuesday afternoons, a keyboard entertainer twice a month and bingo, dominoes and various games including snakes and ladders, cards and a quiz. We were told during the inspection that there is no Activities Co-ordinator but social activities do take place. These are displayed on an Activity Schedule in the home. The activities schedule for November showed that the hairdresser visits on a Monday and manicures take place on Tuesday afternoons. Other activities listed included film afternoon, morning exercises, visit from college students, skittles and dominios. We were told that birthdays are celebrated with a buffet tea and on the second day Care Homes for Older People Page 19 of 38 Evidence: of inspection this took place. We also observed the organ player and the volunteer person undertaking manicures with people during the afternoon. Although there are social activities provided there were long periods of the day when people were sat in their chairs resting with their eyes closed. The large screen television was on in the morning but the sound was down so nobody could hear it. Later in the day televisions at both ends of the lounge were put on but on different channels. This meant people sitting in the middle of the room could hear the televisions from both sides. One person was clearly not happy about this and mentioned it to staff who responded by saying that people wanted to watch different things and the televisions were left like this. We were told that social activities do take place but if care staff do them they can be called off the floor which means people then do not get maximum benefit from the activity taking place. The manager said that the home would benefit from an Activity Co-ordinator and this was something they were looking into. One person asked about what they do during the day said nothing and when you have got nothing to do it is a long day. A visitor to the home said a singer had come into the home to provide entertainment to people and they had seen people do chair exercises which they had enjoyed. Comment cards received by us showed that two out of five people felt there were always social activities they could participate in, two people reponded there are sometimes and one person responded there are usually. Comments included more activities and stimulation are needed, they do not seem to make enough effort to keep everyone happy and fulfilled. Relative comments include: could provide more mental stimulation and encourage greater social interaction, residents spend a lot of time just sitting, very little stimulation physically and mentally. During the morning there were several people sitting in the lounge and at 10am one person asked the manager if they could have a cup of tea. The manager asked large or small and promptly provided them with a drink. At around 10.15 another person said I would love a cup of tea but there were no staff in the lounge to hear them. At 10.30 the same person said out loud it is tea time yet. A member of staff replied not long. At 10.50am the tea trolley arrived and there were three people all at the same time asking for a cup of tea. During the last inspection the timings of the tea trolley were discussed with a view to making drinks available in accordance with the needs and wishes of people. It was not evident this has been fully addressed. Care Homes for Older People Page 20 of 38 Evidence: At lunch time most people sat in the dining room which leads off the main lounge. Meals provided looked hot and appetising and people seemed to enjoy them. People spoken to about their meal said it was not too bad, its not like you make at home though you cant complain another said I didnt eat today I didnt want any I had the mincemeat tart and custard and I liked that. Other people spoken to about the food said it was very very good and asked if there was a choice said gosh yes. Another person said the the food was very good, I ate the lot, they said I get enough that I like and eat it so cant grumble, at one time they did give us bacon for breakfast they indicated that now are only offered this on a Saturday. When asked if they would like this more often they said that would be nice. Other people said of the food its passible and its ok I suppose. Food records seen showed that people are being given choices but it was not clear whether there is always a snack meal being offered/provided in the evening. This is important because there may be a long gap between the evening meal and the next morning and some people may feel they need this additional snack. Comment cards received from people living in the home showed that three out of five people usually liked the meals and two people always did. Care Homes for Older People Page 21 of 38 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Procedures for managing complaints and abuse are in place and staff are aware of their responsibilities to help ensure the protection of people living in the home. Evidence: The AQAA states that all staff are aware of the homes policies and procedures regarding protection. A complaints procedure is in place and this is detailed in the homes Service User Guide and is also on display in the home. This did not contain full names, telephone numbers and addresses of people they would need to contact. An advocacy service had been detailed should people wish to have their complaint investigated by an external agency but the Care Quality Commission address and telephone number had not been updated and the Local Authority contact information was also not detailed. Comment cards received from people living in the home and their relatives showed that they all knew how how to raise a complaint about the home if they were not happy. Since the last inspection the home has received one complaint. This had been recorded on a complaints form and had been investigated by the manager. Staff spoken to said they had completed training in abuse and knew that this should Care Homes for Older People Page 22 of 38 Evidence: be reported to the manager. Some staff knew who the manager would then report it to but others did not, they said this information would be in a file in the managers office. Training records showed that the majority of staff have completing training in safeguarding people from the risk of abuse. There have been no allegations of abuse received in regards to this service. Care Homes for Older People Page 23 of 38 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is pleasant, comfortable and homely and is subject to ongoing refurbishment to improve the facilities and environment for people. Evidence: Since the last inspection there have been numerous improvements made to the environment to make the home more pleasant and comfortable for people. The AQAA for the service details these improvements which includes two new bath chairs, three new bedrooms, redecoration of three rooms, new patio behind the conservatory, new storage space in the kitchen and improvements to the wooden ramp on the first floor to make this safe for people to use. Kick panels had also been fitted to the bottom of some doors to prevent them from getting paint chipped when using wheelchairs. All of these improvements were seen during the inspection and further improvements to the home were being undertaken including corridors being repainted. The new bedrooms and decorated areas had been completed to a good standard although some of the door handle locks were identified to be inappropriate for the people using the service. There is a comfortable lounge and dining area with varied seating which is well utilised by the people living in the home. Accommodation for people is provided over two floors and there is level access within the home for wheelchair access. Bedrooms seen Care Homes for Older People Page 24 of 38 Evidence: had been personalised with peoples own possessions and were clean, tidy and homely. Access to the home for wheelchair users is still restricted to the side access. The manager told us that there are plans to make improvements to the homes main entrance so that wheelchair users will be able to access the home though this door. There is one shower (wet room) and four bathrooms which have bath chairs to assist people into the bath and there are eight communal toilets situated around the home. Handrails are available to aid mobility and there are wheelchairs and hoists to support those people who care needs require this. There were no unpleasant odours noted during the inspection. Comment cards from people showed that three out of five felt the home was always fresh and clean and two people felt it usually was. Comments from people and their relatives included high standards of cleanliness cleanliness is good and serious issues with hygiene....that we hope will be sorted out as soon as possible. The laundry area was viewed. There were three washing machines and two driers to support the laundry needs of the home. Sufficient systems were in place for the collection of the laundry which included the use of red bags for heavily soiled items. A handwash sink was available in the laundry for staff to wash their hands and there were disposable aprons and gloves also available for staff to maintain good hygiene practices. Although no concerns regarding the laundry were raised by people living in the home, a relative told us that their experience of the management of the laundry had not been good. Their relative had experienced missing items, received wrong items in their room despite them being numbered or named and had received white items back from the laundry a dirty blue colour. This matter will need to be monitored by the home as appropriate. Care Homes for Older People Page 25 of 38 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who use the service cannot be confident there are always sufficient numbers of staff available or that staff are appropriately qualified to meet their needs. Evidence: On the day of inspection there were 25 people in the home. We were told by the manager that she aims to have three or four carers on the early shift, three carers on the late shift and two waking carers on the night shift. There are also specific staff to undertake laundry, cleaning and catering duties. In addition to these staff there is a member of staff whose designation is referred to as a Gordon. This person is listed on the duty rota as a support worker. The manager has told us previously that this person does the laundry, helps feed people, makes beds and completes some cleaning. Duty rotas viewed over a four week period showed that most of the time there are three carers on duty during the morning plus the support worker. At weekends this number is reduced to two carers plus the support worker. In the afternoon the numbers vary, sometimes between 1pm and 6pm there are two staff, sometimes three and sometimes one member of staff. The duty rotas for 15 November did not show any staff on duty between 1pm and 6pm. The managers hours were not consistently documented on the duty rota to demonstrate she is working in a Care Homes for Older People Page 26 of 38 Evidence: supernumerary capacity. These issues were discussed with the manager with a view to ensuring the duty rotas contain accurate information. During the inspection staff were seen to be busy attending to peoples needs, sometimes they did not always realise that people in the lounge wanted to say something to them. People spoken to said I think they could do with a few more staff , I dont know how they cope and staff are very attentive. Comment cards showed that three out of five felt they always received the care and support they needed and two felt they usually did Four out of five have indicated that staff were always available when they needed them and one stated they usually were. Comments received included As far as I am aware there is at times too few staff for the amount of residents. A comment card from a visiting professional stated the staff are warm and caring in their manner with residents and their relatives and they have indicated that they feel the manager and staff have the right skills and experience to support peoples health and social care needs. Staff spoken to gave varying responses when asked if they felt there were enough staff on duty. Comments included I think they could do with more at weekend, we have advertised for staff, weekends are a struggle at times, I think its ok, generally I would say so, it doesnt work out too bad to be honest, sometimes we might feel it if short staffed. Comment cards received from staff were positive in relation to their experiences of working in the home. Comments included: I love working at Greenways, the staff I work with are very friendly and helpful, it is a friendly environment for the residents and the home looks after the residents very well, the place is always clean and welcoming. The AQAA states the home has employed an external trainer to do training once a month. The training schedule for the home showed that staff have been attending training on a regular basis to update their skills. Training included first aid, moving and handling, mental capacity act, palliative care and safe handling of medicine. Some staff are still to complete food safety training but records showed further training had been booked for April 2010. Fire training was not included on the training schedule but the manager has subsequently confirmed that all staff completed this on 3 December 2009. Care Homes for Older People Page 27 of 38 Evidence: Since the last inspection efforts have been made to improve induction training for new staff. One member of staff had started training but training completed was not signed off on the records to confirm they had achieved the level of competency required. The manager told us that they are considering implementing a training package provided by an external agency which is based on the Skills for Care common induction standards. In the meantime any staff training required was being provided by the new trainer employed by the home. A new member of staff had training workbooks to show they had completed training in safeguarding, the Mental Capacity Act, deprivation of liberty and safe handling of medicine. The manager told us that there are five out of 16 staff who have achieved a National Vocational Qualification (NVQ) II in Care. This means the home are not achieving the 50 standard as required. The manager said that a further four staff were due to complete this training in the new year. This training helps staff to develop skills in identifying and responding appropriately to peoples needs. A review of two staff files was undertaken to determine the process used by the home for recruiting new staff and to confirm these are suitably robust to safeguard vulnerable people using the service. All the necessary pre-employment checks had been obtained for both people. It was not fully clear from the reference request in what capacity the person completing it knew the applicant. This should be completed so that is clear where possible references have been obtained from previous employers. Care Homes for Older People Page 28 of 38 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People cannot be confident that the service is always being managed in their best interests. Evidence: 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 (NVQ) IV in Care and the Registered Managers Award (RMA) so is suitably qualified to manage the home. Since the last inspection the manager has continued to update her training and has attended, medication, moving and handling, palliative Care, protection of vulnerable adults (POVA), mental capacity act and deprivation of liberty training. On the day of inspection both the manager and provider were available in the home. The manager confirmed that the provider makes regular visits to discuss issues relating to management of the home and provides any support required. Although since the last inspection the manager had taken actions to address some of the Care Homes for Older People Page 29 of 38 Evidence: requirements and recommendations made, it was clear from this inspection that there remain some improvements required to ensure the home are meeting the required standards. These are in relation to risk assessments and care planning. Actions are necessary to improve the quality of care afforded to the people who use the service and ensure their health is maintained effectively. Discussions with the manager and provider confirmed they are commited to ensuring further improvements are made to raise standards within the home. They accepted that actions in relation to the completion of risk assessments and care plans were needed to promote the health and welfare of people and that these must be given priority. There are some systems for monitoring the quality of care and services in place which include the provision of quality satisfaction surveys to relatives to seek their views on the care and services provided. Records showed that the provider had acknowledged comments made and the results had been published to show the outcomes of this. Information had not however been made available with the questions so that people could easily see the results for each question asked. Resident survey had not been undertaken and the manager told us this was something that would be introduced. We found that staff meetings were taking place and notes of one meeting showed issues regarding the management of the home were discussed. A resident meeting took place in October 2009 and the notes of this meeting showed the Christmas menu and party was discussed as well as afternoon teas and hairdresser visits. We received the following comments from surveys we sent to staff, visiting professionals, relatives and people using the service:for my particular needs there is nothing I feel the home needs to address I am comfortable, clean, happy and able to feel relaxed provides good care, good food in a pleasant environment in a very cheerful manner always someone to help you, good food, very kind a friendly home boredom and lack of stimulation is a major problem Care Homes for Older People Page 30 of 38 Evidence: a ramp to the front door is needed cleanliness is good, open visiting is very good carers are caring, courteous and extremely respectful of individuals needs Systems for managing peoples money are in place and monies and records checked for people were found to be correct. Receipts are issued to people for any transactions carried out on their behalf. We viewed the accident and incident records and found that some of those recorded should have been reported to us. This included the person who had fallen out of bed by climbing over the bedrails. The manager told us that she would more closely monitor these to make sure they are reported where appropriate. Information was provided in the AQAA to confirm the servicing and maintenance of equipment and records checked during the inspection confirmed checks had been carried out as required and were all up-to-date. We did find that the hot water temperatures were running higher than when last recorded. We used the homes thermometer to check hot water temperatures and the manager was advised these be rechecked to make sure there were no scald risks to people living in the home. Care Homes for Older People Page 31 of 38 Are there any outstanding requirements from the last inspection? Yes R No £ Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action 1 7 15 A further review of care 28/02/2009 plans is to be undertaken to ensure all resident needs are clearly documented as well as details of staff actions required to meet these needs and the care being provided. This is to demonstrate that residents are receiving the care and support they need consistently. 2 8 13(1) Specialist support such as 31/01/2009 the advice of GPs/District Nurses must be sought promptly to ensure resident health care needs are managed effectively. Records are to demonstrate any specialist support sought and given. Care Homes for Older People Page 32 of 38 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 7 15 A further review of care 01/12/2009 plans is to be undertaken to ensure all resident needs are clearly documented as well as details of staff actions required to meet these needs and the care being provided. This is to demonstrate that residents are receiving the care and support they need consistently. Remains Outstanding. Following continued non compliance this matter has been referred to the Regional Enforcement Team 2 7 14 Risk assessments must be 31/01/2010 undertaken for any person who is assessed as requiring bedrails or has bed rails fitted to minimise any potential risk. Care Homes for Older People Page 33 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action This is so that people who have bedrails fitted are not placed at risk of entrapment or other injuries. 3 7 15 All people that use the service must have a current and up-to-date care plan in place. This is to ensure their needs are identified as well the staff actions required to maintain their health. 4 7 12 When people lose weight that could be detrimental to their health, appropriate medical and/or healthcare advice must be sought and any action necessary taken. This is to ensure appropriate actions can be determined to maintain the health and wellbeing of the person. 5 8 12 Risk assessments must be 28/02/2010 undertaken where people choose not to use medical equipment prescribed for their use (such a backbrace) and these must be regularly reviewed to ensure information remains relevant and up-to-date. This is to ensure risks to peoples health are identified 31/01/2010 31/01/2010 Care Homes for Older People Page 34 of 38 Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action as well as any actions that can be taken to promote their health and safety. 6 8 13 Specialist support such as the advice of GPs/District Nurses must be sought promptly to ensure resident health care needs are managed effectively. Records are to demonstrate any specialist support sought and given. Remains Outstanding. Following continued non compliance this matter has been referred to the Regional Enforcement Team 7 37 37 All accidents and incidents which impact on the wellbeing of people must be reported to the Care Quality Commission. This is so we can be sure the service are taking appropriate action to safeguard people. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 01/12/2009 31/01/2010 1 1 The Service User Guide should be produced in large print to help ensure this can be easily read by people wishing to Care Homes for Older People Page 35 of 38 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations access the service. 2 12 Action should be taken to ensure people are receiving sufficient mental stimulation and social activities to satisfy their needs. This is so peoples health and wellbeing is maintained. The service should demonstrate that people are being consulted about issues concerning their care. This includes demonstrating they have been consulted on the food and social activities being provided to ensure these are being provided in accordance with their choices and wishes. The frequency and timings of drinks and snacks should be reviewed to ensure people are receiving these in accordance with their wishes as well as to maintain their health and wellbeing. The complaints procedure should contain up-tp-date contact names, addresses and telephone numbers so that people are clear on who they need to contact should they wish to raise a concern. A review of the laundry service should be undertaken to ensure laundry is being completed to an acceptable standard for all people living in the home. This includes: the correct items of laundry being returned to rooms, people receiving laundry items back in good time and ensuring white items retain their colour. This is so people can be confident that the service will manage their laundry effectively. Staffing arrangements should be reviewed in line with comments from people and staff to ensure there are sufficient staff available consistently to support the needs of people living in the home. Duty rotas need to clearly show all staff on duty and shifts worked so that it is clear there are sufficient staff to support the needs of people living in the home. This includes clear records of the hours the manager is working in a supernumerary capacity. The service should ensure that a minimum of 50 of staff attain a National Vocational Qualification II in Care to demonstrate there are sufficient numbers of staff suitably trained to care for people living in the home. Induction training based on the Skills for Care Common Page 36 of 38 3 14 4 15 5 16 6 26 7 27 8 27 9 28 10 30 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations Induction standards needs to be fully implemented and records need to demonstrate this so that people can be confident they are being supported by suitably trained staff. 11 33 Additional systems for monitoring the quality of care and services should be introduced. This includes auditing of care records to make sure peoples needs are being met. People living in the home should also have the opportunity of completing quality surveys so their comments can be considered in organising care and services the home provide. Care Homes for Older People Page 37 of 38 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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