Inspection on 29/01/08 for Greenways

This inspection was carried out on 29th January 2008.

CSCI found this care home to be providing an Adequate service.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Greenways 22/03/10

Greenways 24/11/09

Greenways 08/12/08

Greenways 02/08/07

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 Unannounced Inspection 29th January 2008 08:15 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.V358516.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.V358516.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.V358516.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. 2nd August 2007 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 and several pubs within a five to fifteen minute walk from the home. There are public transport links to Leamington Spa, Rugby and Southam within a five minute walk from the home with the bus stop being located by the village pond. 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/wet room and four bathrooms with assisted facilities such as bath chairs to support 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 planned new extension. 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. At the time of this inspection the fees for the home were not detailed in the Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 5 Service User Guide. The provider stated that the fees are currently £370 £470 and was able to provide a copy of a contract confirming the minimum charges. Prospective residents should ask if these are subject to change. Extra charges are made for hairdressing and chiropody. No charge is made for newspapers and residents are expected to provide their own toiletries. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 1 star. This means the people who use this service experience adequate quality outcomes. 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 home’s capacity to meet regulatory requirements, minimum standards of practice and focuses on aspects of service provisions that need further development. This is the second unannounced inspection that has taken place at Greenways for this inspection year and commenced at 8.15am to 7.15pm. Three people who were staying at the home were ‘case tracked’. The case tracking process 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, kitchen records, accident records, financial records, complaint records and medication records. The inspector chose to observe residents by sitting in the lounge during the morning to ascertain how their care and services are provided. A tour of the home was undertaken to view specific areas and establish the layout and décor of the home. What the service does well: Visitors to the home are made welcome and are able to visit residents when they choose. Staff are friendly, approachable and caring and residents spoken to said they were happy in the home. The owners play an active part in the management of the home to ensure residents receive good standards of care. Resident choices in how their care and services are delivered are well documented so that staff know how they can support the resident to maintain some of their usual routines and independence. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 7 The home is spacious and suitable equipment to support older people is available such as wheelchairs, handrails, ‘sit on’ weigh scales etc. 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. On the day of inspection there was a happy atmosphere in the home with residents and staff regularly interacting with one another. What has improved since the last inspection? There have been numerous improvements made since the last inspection and this are detailed below:Door wedges have been removed and magnetic door closures fitted. These hold doors open but release in the event of the fire alarm sounding. The staff room has been temporarily relocated so that staff do not have to walk through the kitchen to access this and the home can maintain good infection control procedures. A new bathroom has been fitted with a Parker Bath to assist the less able residents. Carpets that were threadbare and damaged have been repaired. A sky light has been fitted into the kitchen to improve ventilation and light and new kitchen equipment has been purchased to help provide a better environment for staff as well as an improved service to the residents. A new handwash sink has been fitted in the laundry so staff can wash their hands to maintain hygiene. The format of the care plans has been changed so that staff can more easily access important information about residents. This is in the process of being implemented for all residents. The management of terry towels in bathrooms and toilets has been reviewed. These are now colour coded and are regularly changed to maintain good hygiene and infection control infection. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 8 Several beds have been replaced for the benefit of the residents. Areas of the garden have been cleared to make this more pleasant for the residents. Some radiator covers and window restrictors have been fitted to prevent burn/fall risks to residents. Medication audits have been introduced to ensure medication is managed more effectively. What they could do better: Care plans are in need of further review to ensure all resident care needs are documented with staff actions to meet these needs and to prevent any oversight in the provision of care. Risk assessments need to be up-to-dated when care needs change to ensure staff manage care needs safely. Advice of GPs and District Nurses needs to be sought promptly when medical needs are identified to ensure these are managed effectively. A review of medication management is needed to ensure this is managed safely consistently. Some attention is needed in regard to addressing health and safety. This includes talking prompt action if fridge/freezer temperatures show they are operating above appropriate levels for the safe storage food, organising a legionella check and arranging electrical portable appliance testing so it is clear portable appliances are safe to use. Attention is also needed to some hot water and hot radiators in the home to ensure these do not present a potential burn/scald risk. Hot water services in some of the bedrooms needs to be improved so that the hot water is sufficiently warm enough for resident’s to have a wash. Some attention is needed to record keeping including: • • • • • updating the Service User Guide ensuring assessment records are accessible preferably on care plan files keeping records of food provided for those residents with special dietary needs so it is clear they are receiving a suitable diet a clear training schedule showing all staff have completed the required training clear duty rotas showing sufficient hours are allocated to laundry and cleaning DS0000068642.V358516.R01.S.doc Version 5.2 Page 9 Greenways The provision of social activities and stimulation needs further review to ensure all residents receive sufficient opportunities to access social activities and stimulation to maintain their wellbeing. 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.V358516.R01.S.doc Version 5.2 Page 10 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.V358516.R01.S.doc Version 5.2 Page 11 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 and 3 were assessed. Quality in this outcome area is adequate. Information about the home is not sufficiently detailed to ensure residents can make informed decisions on whether to stay. Prospective residents are assessed prior to their admission to ensure their needs 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. It was not evident that the Service User Guide has been updated to include a Statement of Terms and Conditions for the home, which usually details the fees and a summary inspection report. This will need to be actioned so that prospective residents have the information they need to help them make a decision on whether to accept a placement at the home. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 12 Assessments of residents 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. Assessments show the needs of the service user than need to be transferred into care plans and staff therefore need access to this information. Since the last inspection action has been carried out to write to residents following their assessment to confirm the home can meet their needs. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 13 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: The manager advised that since the last inspection, seven of the care plans have been reviewed and updated to new records. The inspector randomly selected three residents to case track including one with a new style care plan. In one file the Social Worker assessment completed prior to admission of the resident showed that they had been diagnosed with dementia – there was no mention of this in any other part of the care records. Records did state that the person had short term memory and there were some behavioural issues when delivering personal care but these had not been detailed in a specific care plan so that staff know to monitor this and can identify effective ways to manage this. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 14 The care plans were documented over 3 sheets and contained statements of need. These were not consistently dated so it was not clear if they were recent. It was also not clear if they had ever been reviewed to determine any changes in needs or staff support. Care plans detailed information in relation to sight, hearing, communication, oral health, foot care, hair (frequency of washing), mobility and personal care so that staff knew how to support residents in these areas. This was also the case for the other resident care plans viewed. The care plan for mobility detailed equipment needed to support the resident and also stated they were at risk of falls and had fallen in their room. A risk assessment had been completed to show how this risk was to be managed. The sheet on the care plan for staff to record falls had not been completed so that staff could effectively monitor these. A fall for this resident had been recorded in the accident book but the record did not say how it happened, if there were any injuries or what staff did about it. The manager agreed to review this. The personal care record stated that the resident was reluctant to have a bath or shower but preferred a shower. Records kept of baths and showers given showed that the resident was mostly being given baths which does not demonstrate their wishes are being respected. Staff are not routinely recording a daily record and night record to show the care needs of residents are being met and to demonstrate how staff are supporting them. It is good practice for this to be done each shift including the night shift so a picture of the residents health and support can be established over a 24 hour period. The weight of residents is being undertaken monthly and no concerns were noted regarding the weight and nutrition of residents in the home. Care plan records of the three residents case tracked showed that residents have access to specialist services if needed including the GP, district nurse, optician and chiropodist. In one care plan, the daily record stated that the resident saw the GP but did not say why although the doctors visit sheet confirmed this. Daily records should contain sufficient information to allow the next member of staff taking over the residents care to establish a clear picture of their needs. A bath and shower record viewed for one resident showed they had developed a sore area on their right side. It was not evident that a care plan had been devised showing how this should be managed to prevent this deteriorating further. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 15 The daily record entry when this was first noted states “almost broken” and ”Sudocream applied”. It was not evident from care plan records that the advice of the doctor or district nurse had been sought in regards to treating this. The record states that the manager advised staff to observe twice daily and Sudocream to be applied twice a day. This information should be in a care plan as staff may not read back on daily records to ensure these instructions are followed. A daily entry for the following day states that cream was applied to the “left” side which is the opposite side to the sore. On viewing the medication records it was not evident that Sudocream had been prescribed for this resident. It was also not clear what cream was being applied to this sore. The manager was able to locate the cream being used and it was evident the cream prescribed had been obtained a week after the sore had been identified. The cream was not written on the Medication Administration Record (MAR) for staff to know this was available and to be able to demonstrate this was being applied as prescribed. The risk assessment for pressure sores had not been updated following the identification of this sore to ensure staff managed this risk appropriately. The bath/shower record for this resident showed they were having these infrequently for example twice in October, twice in November, once in December and twice in January. The manager said that all service users are supported by staff where appropriate to have a wash each day. It was evident from reading this person’s care plan file that they had been prone to a rash on their skin. The daily records showed that a rash was discovered on 23.1.08 and despite this being itchy there was no evidence this had been reported to the GP. Daily records showed that staff were applying a cream to this rash but it was not clear what cream or if this cream had been prescribed for the rash. There was no care plan in place for the management of the rash and the manager said that she had not been made aware of this rash by staff. The falls sheet in this care plan file showed several falls but there was also an entry that stated the resident “still has pains in knees and hip” it did not state whether on this occasion the person had fallen and it was also not evident prior to this entry that the resident suffered with pain to their knees and hip. Staff later confirmed that this was one of the reasons they were on constant pain killers. Care plan files contained a sheet stating the dates a care plan had been reviewed but it was not evident what had been reviewed. Each care need Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 16 should be independently reviewed and any changes to care needs and support clearly indicated as part of the review. The manager acknowledged there was further work to be done to bring care plans up-to-date and to ensure care plans accurately reflect the care needs of the residents. Despite care plans being 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. In regard to medication management, there were concerns identified at the last key inspection to this home which resulted in a follow up inspection being scheduled. This was completed in October 2007 specifically to review medication. This inspection identified that most of the requirements in regard to medication management had been addressed. There were however, additional issues requiring attention which resulted in further requirements being made. The review of medication carried out at this inspection has again noted that the majority of requirements have been addressed in regard to medication but there are additional items needing review. Medications are stored in lockable boxes which rest within a trolley. The trolley is stored within a small room along with the excess medications and medications for return. Regular audits are being carried out to ensure medication received, given and remaining are correct. Since the last inspection the manager has devised a letter for the GP to sign in regard to ‘Domestic Remedies’. This is in relation to any ‘over the counter’ medications that residents wish to use so that approval can be sought where appropriate from the GP to ensure they are safe to give with prescribed medicines. One person had been prescribed Senna but this was not available to give. Risperidone had been signed for as given on the MAR but this was still in the packet. The amount of Paracetamol remaining from the previous month had not been carried forward to the beginning of this prescribing period so that it was clear how many tablets staff were starting with. Sometimes one tablet was being given and sometimes two, the MAR was difficult to read where staff had squeezed “1” or “2” alongside signatures. The home should have a protocol in place for managing this so that the MAR does not become illegible and staff Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 17 can easily audit how many have been given to the resident and how many are remaining. Abbreviations on the MAR such as “LL, RL” had not been defined so that it was clear to all staff what these meant. Staff explained this stood for left leg and right leg. Eye drops to be used within 28 days had not been dated when opened so that staff knew when to dispose of them. Controlled drugs in use in the home were audited and found to be correct in accordance with records in place and were safely stored. Records of these had been completed appropriately. Throughout the inspection staff were seen to be treat residents with respect and their privacy and dignity was maintained. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 18 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 good. Service users find the lifestyle in the home satisfies their social interests sometimes. Wholesome and appealing meals are provided which residents enjoy. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There are some social activities provided in the home but these are limited and further work is needed to ensure all service users benefit from various types of social stimulation. There is an Activities Co-ordinator who works for 4 – 5 hours per week to help plan and provide these. The inspector discussed the provision of activities with this member of staff to establish how they are organised. At the time of the inspection there was no activity schedule showing planned activities for each day. The Activities Co-ordinator explained that she normally will go into the lounge and ask residents what they would like to do. Social activities are not provided every day. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 19 In the Summer staff will take residents out for a walk although but this is done on a one-to-one basis. The inspector was informed that recently eight residents went to a pantomime which they had really enjoyed. There is an outside entertainer that staff refer to as the “music man” who comes in once a month. One resident said that they did join in bingo sometimes and confirmed there was an outside entertainer who provided music. They said that staff did “their best” to help entertain them. The atmosphere in the home on the day of inspection was a happy one with residents chatting amongst themselves and with staff. There were occasional bouts of laughter and residents were observed to be at ease to make requests of staff. The home receives regular visits from the church and communion is organised for those service users who request this. This was confirmed in care plan records. The home celebrate some cultural days including St Patrick’s Day and St George’s Day. The manager said that staff are due to start training on Equality and Diversity to help provide them with a broader understanding of how they can better support residents. Care plan records contained good information about the choices of service users in regards to how they wish their care and support to be given. Records were specific in regards to personal care in regards to what residents could do for themselves to maintain their independence and what staff needed to do to help support them which is good practice. One record viewed stated that the resident liked to look smart and choose what they want to wear each day and records described the clothes the resident liked to go out in. This resident was observed to go out in the clothes as stated in their care plan demonstrating staff are respecting their wishes. Records in relation to social care described the television programmes the resident enjoys and also their wishes in terms of their religious needs. There is a television in the main lounge but this was too quiet for the inspector to hear. Another resident in the lounge said they enjoyed the television when they can see it and hear it. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 20 Other choices included times they like to get up, whether they wanted an early morning drink, whether they wanted breakfast in their room or dining room and times they like to go to bed. Families are able to visit when they wish and it was evident they are made to feel welcome by staff. One visitor to the home praised the friendly staff and the way they looked after their relative. At around 8.50am there were several of the residents up and some in the process of getting up. Breakfast was being served and consisted of cereal and toast. Staff were friendly in greeting service users as they came into the dining area and residents also greeted one another with a smile and a chat. There is an orientation board in the lounge which details the day, season and weather to inform residents. As the morning progressed it was evident at around 10.30am residents were ready for another hot drink. Several residents enquired what time it was and whether it was time for the tea trolley. One asked a member of staff if it was tea time and they said “not yet” but did not offer to make them one. The timings of drinks was discussed with the manager with a view to residents having the opportunity to have drinks sooner and when they wish. At lunch time the meals looked appetising and the residents seemed to enjoy them the second choice offered to the main meal was a jacket potato with cheese and to follow, a pineapple upsidedown pudding which the cook had made. A resident spoken to said that the food provided was “very good” and “there are not great choices but I get enough”. A resident who needed support with eating was seated in an area in the dining room where there was a level of privacy. This was carried out sensitively and was not rushed. Menus are written on a blackboard which is not ideal as this is not very clear for service users to read. The menus held by the cook did not show that there are two meals prepared to give service users a choice each day. The manager agreed to address this. Records are kept of meals that each person has so it is clear they are receiving a varied and nutritious diet. It was not clear how staff cater for those people with special dietary needs such as those with diabetes. A snack meal is provided after the evening meal so that residents don’t feel hungry in the evenings and there is not too longer gap before breakfast. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 21 There were sufficient stocks of both fresh and dried/tinned produce in the kitchen but some of the foods stored in the fridge were not covered such as cream and juice. Some of the foods were also not labelled and dated so that it was clear to staff what the foods were and when they need to be disposed of. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 22 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 good. Systems for managing complaints and abuse are in place but need further review to ensure these are fully effective to safeguard residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There have been no complaints received by us or the home since the last inspection. A “ Suggestions and Complaints” procedure is in place and this on display in the home. Any complaints received are documented on a complaints form and investigated by the manager as appropriate. Copies of the forms were seen to confirm these are available to staff if needed. It was advised that the complaints procedure be reviewed so that any person who wants to put a complaint in writing to the manager or provider is clear who to address this to and where to send it. Those residents spoken to during the inspection were happy with their care in the home and had no complaints to report. It was not evident that the home has a copy of the local authority policy for adult protection to ensure the correct procedures are followed in the event of Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 23 an allegation of abuse. The home did however have a policy in place detailing the types of abuse and staff responsibilities in reporting this. It was advised that the homes procedures for managing abuse are made more accessible to staff working in the home as opposed to keeping them in a file amongst other policies and procedures which might take time for staff to find if needed. Since the last inspection action has been taken to arrange staff training in the abuse awareness and carers were aware of their responsibilities to report this to a senior member of staff if observed or reported to them. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 24 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, 25 and 26 were assessed. Quality in this outcome area is adequate. The home is pleasant, comfortable and homely and is subject to ongoing refurbishment to improve the facilities and environment. Areas in regard to water and heating are in need of improvement to ensure the home is fully safe for residents. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Greenways has plans to extend the home 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. The provider explained that there had been some delays in progressing work due to changes needed to the plans but it was expected this work could go ahead soon. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 25 Since the last inspection there has been some work undertaken to clear areas of the garden but there are some areas of the garden that will form part of the new extension to the home. There is an attractive grassed garden area for residents to enjoy and there are plans for this to be further improved with finer weather. There is a comfortable lounge and dining area with varied seating which is well utilised by the residents. Currently the home has 27 single bedrooms eight of which have an ensuite facility. Bedrooms viewed looked clean, pleasant and homely. One resident said they were “happy with everything” in the home including their room. The provider said that since the last inspection there have been around ten beds replaced and they were also decorating bedrooms as they were vacated. 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/wet room and four bathrooms which have bath chairs to assist people into the bath. Since the last inspection one of these bathrooms has been refurbished and a new parker bath fitted. 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. The carpet in this area of the home is stained and marked. The provider acknowledged this and commented that the berries from a tree outside of the door were partly to blame as these were being trodden into the carpet and staining it. The provider advised this carpet would be replaced when the new extension works commence but in the meantime it will continue to be cleaned. Action has also been taken to repair other carpets noted as in need of repair at the last inspection. Handrails are available around the home to aid mobility. Wheelchairs and hoists are available to support the care needs of the residents. Since the last inspection the door wedges have been removed and new door closures fitted around the home so that these automatically close in the event of a fire. The staff room has been temporarily moved to upstairs so that staff no longer use the kitchen as a walkway and staff are also now discouraged from walking through the kitchen. The provider said that kitchen staff had welcomed this change as it did not disrupt them when working. There have also been other works undertaken in the kitchen in that a new sky light has been fitted so that Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 26 the kitchen has better ventilation and light, a new oven, two new hobs and a microwave have also been purchased. Some of the items being stored around the home at the last inspection have been removed but there are still further items that could be removed such as fires and cupboards which are on the first floor corridor. The hot tap in one of the upstairs bathrooms still does not work, the whole tap twisted around when attempts to turn the tap on were made. Action has been to fit radiator covers in some areas of the home but further work is needed to ensure all heaters and radiators in the home are either of a low surface temperature or are suitably risk assessed to show how the risk of hot surfaces are to be managed. In one bedroom the radiator was found to be scalding hot and the residents chair was situated next to it. There were many areas where the heating was not on so residents were at low risk. The water was too hot in one of the upstairs bathrooms, in one bedroom the tap continually was dripping. In one of the toilets upstairs there was limescale around the tap and there was no lampshade on the light. Water was not very warm in some of the upstairs rooms and the manager confirmed they used jugs of water from the hotter taps when providing personal care to service users. The provider acknowledged there was work needed to improve hot water services to the home and advised this was in the process of being addressed. The provider said that taps have got thermostatic mixing valves but due to some of these being painted over, it was proving a problem to adjust them so that the temperatures can be regulated within safe levels. It was not evident that water temperatures are being monitored, the provider stated that the plumber for the home had been asked to do this. This should be done regularly 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. 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 are baskets for personal items for each service user. Gloves and aprons were available to maintain good infection control practices and since the last inspection a new hand wash sink has been fitted so that staff can wash their hands. A resident spoken to said the laundry was “done beautiful” and was happy with the laundry service provided. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 27 Toilets within the home have hand towels as opposed to paper towels. These can harbour bacteria when used by several people and prevent good hygiene. Since the last inspection the home has introduced a colour coded towel system whereby hand towels are removed and washed and changed to different colours throughout the day. This helps to prevent the build up of bacteria and allows for better management of hygiene. Window restrictors have been fitted to the upstairs windows where they could be an element of risk of service users falling from windows. They are not on all upper windows. The provider has undertaken a risk assessment in regards to this matter and stated that risks have been considered in regard to the remaining windows. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 28 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 four carers on duty during the morning and three during the afternoon/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 someone available to cook each day for the residents. Since the last inspection the home has employed a Kitchen Assistant for three days a week to support the cook and care staff said this had made a big difference and freed up more of their time 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 consistently show full names of staff so there is a clear audit trail. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 29 It is not clear how much of the 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. Since the last inspection action has been taken to review the shifts staff work to ensure staff are working exceptionally long hours. Residents and visitors to the home were complimentary of the staff. A resident said they like to spend time in their own room but carers were “very good”, “lovely” and “pop in all the time”. A visitor commented that the staff were approachable and friendly. A member of staff said that they thought the staffing for the home was sufficient but they felt the Kitchen Assistant was needed seven days a week and not just three as care staff really noticed the difference when they were not on duty. The manager advised that there are 24 carers employed by the home. Eleven of these have completed a National Vocational Qualification (NVQ) II in Care to help them provide more effective care to the residents. 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. In one file it was difficult to establish the start date to confirm all checks had been done before they commenced employment with the home. Records in place confirmed that induction training is carried out which incorporates the Skills for training Common Induction Standards”. It was found that staff were not completing this immediately upon their recruitment. The Skills for Care induction standards include 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. An at-a-glance training schedule is in the process of being devised to show all training that staff have completed. The manager said that six of the staff have recently done moving and handling training and other staff are due to do this. The training records were not fully up-to-date to be able to confirm all staff have completed statutory training as required. This includes food hygiene, first aid, moving and handling and fire training. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 30 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 31,33,35,36 and 38 were assessed. Quality in this outcome area is adequate. The inspection process has identified a number of areas for action to ensure the health & safety and best interests 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.V358516.R01.S.doc Version 5.2 Page 31 On the day of inspection both the manager and provider were available in the home. It was evident through actions taken since the last inspection and during discussions with them, that there is a strong commitment to raising standards further within the home. It is acknowledged that the extension proposals for the home have delayed some works being undertaken, plans in place will however significantly improve the environment and safety of the home for the residents. There have been no staff meetings or resident meetings since the last inspection. This is something that should be considered to ensure there are strong communication links particularly with the ongoing changes occurring within the home. These meetings give outside representatives and residents an opportunity to be involved in making decisions relating to the running of the home. The manager said that staff regularly speak with residents and visitors to the home so that they are kept informed of what is happening. There is no formal quality monitoring system in place for this home such as quality satisfaction surveys. There should be a system in place to assess the views of residents, families, gps, professional visitors or outside representatives of the care and services provided by the home. Formal staff supervision is taking place although this has not been achieved six times per year for each member of care staff as required. The manager said that a member of senior staff has been allocated to undertake this to ensure this standard was achieved. On speaking to the member of staff concerned, they confirmed that they were aware of the frequency that supervision should take place. They stated that supervision contracts had been implemented and a discussion was held in regard to implementing a supervision schedule. A review of service user monies and personal allowance records was undertaken to ensure these were being managed by the home appropriately. There were some errors in the records checked which were due to miscalculation. Money available either was correct when recalculating the amounts on the records or exceeded the amount it should be. Receipts available were only for recent transactions and the manager stated that she had only just started to keep them. The provider agreed to set up a regular audit of records to ensure any errors are identified and rectified and also to check receipts are in place for each transaction made on behalf of the residents. Current storage arrangements of service users money could be improved to increase security. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 32 Health and safety records were viewed to confirm checks carried out. The five year electrical wiring check had been completed. The hoists in the home had been checked and were next due for a service in April 2008. The lift had been checked in November 2007 to ensure this was safe. Records of temperatures of hot water taps in service user bedrooms and communal areas of the home were not in place to ensure these were at a safe level. The provider said these are to commence. The majority of taps tested by the inspector were not too hot that they would scald. Electrical portable appliance testing and legionella checks have not been done, the provider gave a commitment for these to be carried out. The provider will need to ensure that all health and safety checks are carried out promptly to safeguard service users. Fridge and freezer temperatures had been recorded but the temperatures for the fridge were above the recommended guidelines. The provider felt that staff had been using the thermometer incorrectly and agreed to look into this matter. Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 33 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 3 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 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X X X X X 2 3 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 1 X 2 2 X 1 Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 34 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement A review of care plans is to be undertaken to ensure all resident needs are clearly documented in care plans with staff actions required to meet these needs. Records must also be dated and demonstrate needs are being met. Risk assessments must be reviewed when care needs change to show how risks to the resident are to be managed safely. This includes risks of developing pressure sores. Specialist support such as the advice of GP’s/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. A review of medication management is required to ensure this is managed safely consistently. This includes: DS0000068642.V358516.R01.S.doc Timescale for action 31/03/08 2. OP7 13(4) 28/02/08 3. OP8 13(1) 31/03/08 4. OP9 13(2) 28/02/08 Greenways Version 5.2 Page 35 Ensuring that all medications available are indicated on the MAR chart. Not met outstanding from 02/08/07 and 31/10/07 Also ensuring: All medications available at the beginning of the prescribing period are clearly indicated on the MAR. Dating eye drops when opening so it is clear when they need to be disposed of. Medication prescribed is available. Medications are given and signed for as prescribed. The MAR is legible so that it is clear what medication has been given. This in particular applies to those medications where it is prescribed for “one or two” to be given as required. Any abbreviations on the MAR must be defined so it is clear to staff what they mean. 5. OP38 13 Records of fridges and freezer temperatures must be maintained accurately to demonstrate food is being stored at safe levels and the food is safe for residents to eat. All health and safety checks must be undertaken within the required timescales to safeguard residents. Prompt actions is required to organise checks for: 28/02/08 6. OP38 13 31/03/08 Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 36 Legionella Electrical Portable Appliances 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 and a summary inspection report. 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. The provision of social activities and stimulation needs to be further reviewed to ensure all residents receive sufficient social stimulation to maintain their wellbeing. The home need to ensure suitable records are kept of meals provided to people with special dietary needs such as diabetes to demonstrate they are receiving a suitable diet. Foods in the fridge need to be suitably covered, labelled and dated so that it is clear what they are and when they need to be disposed of. 5. OP16 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 and addresses. It is advised that the home obtains a copy of the Local Authority Safeguarding Referral process so that this is accessible to staff should an allegation of abuse be made. Action needs to be taken to fix the hot tap in the upstairs bathroom so that this works properly and residents and DS0000068642.V358516.R01.S.doc Version 5.2 Page 37 2. OP3 3. OP12 4. OP15 6. OP18 7. OP19 Greenways staff can wash their hands in warm water. 8. OP19 Where excess equipment is stored around the home such as heaters and cupboards, it is advised a suitable storage location is found to improve the surroundings for service users. 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. Duty rotas need to show full names of staff so that there is a clear audit trail. Duty rotas should make it clear who is undertaking cleaning and laundry duties in the home consistently including weekends. This is so it is clear this does not impact on carer time with residents. 11. OP30 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. Induction training should be provided promptly following the employment of new care staff to ensure carers can work safely with residents. Further action is required in regard to hot radiators in the home which should be of a low surface temperature. Risk assessments should be devised where this is not the case to show how this risk is to be managed. 9. OP25 10. OP27 12. OP30 13. OP38 Greenways DS0000068642.V358516.R01.S.doc Version 5.2 Page 38 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.V358516.R01.S.doc Version 5.2 Page 39 - 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. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. 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