Inspection on 05/01/06 for Greenways

This inspection was carried out on 5th January 2006.

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

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

Other inspections for this house

Greenways 13/01/09

Greenways 09/01/08

Greenways 16/07/07

Greenways 30/05/06

Greenways 05/10/05

Greenways 02/02/05

Greenways 27/04/04

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

CARE HOMES FOR OLDER PEOPLE Greenways 720 Preston Road Bamber Bridge Preston Lancashire PR5 6AL Lead Inspector Val Turley Unannounced Inspection 5th January 2006 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 3 SERVICE INFORMATION Name of service Greenways Address 720 Preston Road Bamber Bridge Preston Lancashire PR5 6AL 01772 339083 01772 339083 Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Ark Care Services Limited Mrs Sandra Clements Care Home 29 Category(ies) of Old age, not falling within any other category registration, with number (29) of places Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 5th October 2005 Brief Description of the Service: Greenway is a residential care home providing 24-hour personal care and accommodation for 29 older people. The home is owned by Mr and Mrs Ajisebutu who also own a second home in the South of England. The home is located in a residential area on the outskirts of Bamber Bridge, close to all local amenities and the motorway network. The home is a two-story building. Accommodation is provided in single bedrooms, the majority of which have ensuite facilities, comprising of a wash hand basin and WC. Although the rooms are pleasantly furnished, service users are also able to take personal possessions with them when they come to live at the home. Bedrooms are located on both the ground and first floor. There is a passenger lift. Accessible toilets and bathrooms are located on both floors near to bedrooms and living rooms. There are three dining areas; two of these are combined lounge with a dining area. A separate conservatory is also available. The home is a no smoking home. Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection that took place over one day in January 2006 by one regulatory inspector and one pharmacist inspector. The inspection involved discussion with service users living at the home, also discussion with and observation of the staff working there, an examination of records, policies and procedures and a tour of the premises. What the service does well: What has improved since the last inspection? What they could do better: Some improvements must be made to management of medication in the home to ensure that the health, safety and well being of the service users. Some action must be taken to ensure that routine repairs are attended to in a timely manner to ensure that the environment is safe for both service user and support staff. The registered provider must ensure that all necessary checks are undertaken on prospective employees with a view to the protection of service users. Some additional work must be undertaken through surveys and Regulation 26 visits to the home by the provider to ensure that the home is run in the best interests of the service users. Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 6 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed at this inspection. EVIDENCE: Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 9 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 9 Records were not referred to when administering medication, putting residents at risk of not receiving their medicines as prescribed. EVIDENCE: Medication policies and procedures were available within the home but the ‘homely remedy’ policy needs to be reviewed to reflect current practice. One resident is supported to self-administer an inhaler; care staff had recently reviewed this, but written assessment of safe self-administration had not been completed. Trained carers administer all other medication. The morning medication round was almost complete on arrival at the home but the medication administration records (MARs) were not referred to or completed at the time of administration. The MAR were generally up-to-date but comparison of the medicines received and remaining stock for one resident indicated the some doses of calcium tablets were omitted at the beginning of the MAR period. There were also some inaccuracies in the recording of administration. Hand-written MAR entries and amendments were not signed, independently checked and countersigned to reduce the risk of transcription errors. The central medication storage was secure and generally orderly but creams prescribed for one resident were in-use for other residents. Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 10 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 15 The home provided a choice of well-balanced meals that were enjoyed by the service users in one of three pleasant dining areas. EVIDENCE: The service users spoken to on the day of the inspection stated that they enjoyed the food at the home very much. They stated that they felt that they could ask for a drink or a snack at any time if they wished. One of the service users said ‘I don’t have to ask for anything there is always plenty to eat and they are always coming round with drinks. The food is good’. During the inspection the staff were observed to offer drinks to the service users and also ask them what their preferences were for the evening meal. The lunchtime meal was observed to be relaxed and unhurried with staff being sensitive to the support needs of the individual service users. A choice of meals was available at lunchtime and this was displayed for the convenience of the service users. The home had three dining areas allowing service users to choose where they preferred to eat. Discussion took place with the cook who demonstrated a knowledge and interest in the dietary needs and preferences of the individual service users with a view to ensuring they received a wholesome and balanced diet. Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 11 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): None of these standards were assessed at this inspection. EVIDENCE: Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 12 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 The home was clean, well decorated and hygienic with appropriate policies and procedures in place, prompt action is not always taken to ensure that a safe environment is maintained for the service users and staff. EVIDENCE: The home was clean and comfortable and well decorated and furnished. A number of routine maintenance jobs remained outstanding from October 2005. These had not been attended to as the home no longer employed a maintenance man and the registered manager had not been given the authority to contract the services of local trades people to attend to any repairs. This approach to maintenance adopted by the registered provider leaves service users in a position of potential risk. The laundry at the home was conveniently situated so that soiled articles did not have to be carried through any food preparation areas. The laundry door was fitted with a keypad to ensure that service users were unable to access the room. The laundry was well equipped and the home had appropriate policies and procedures in place in respect of the control of infection ensuring as far as possible the safety of the service users. Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 13 The registered manager was not aware if the home complied with the Water Supply (Water Fittings) Regulations 1999 and it was recommended that enquiries be made with regard to this. Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 14 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 29 The standard of some of the vetting and recruitment practices is poor, with appropriate checks not being carried out, potentially leaving service users at risk. EVIDENCE: This standard was inspected as an immediate requirement notice was issued at the previous inspection when concerns were raised over the recruitment practices of the registered provider. Both the provider and the manager carry out the recruitment of staff individually. At this inspection the files of those staff recruited by the registered provider since the issue of that notice were examined. The register provider had not undertaken all of the necessary checks on the prospective employees prior to their appointment and had not given the registered manager an opportunity to ensure that all of the necessary documentation was in place prior to the commencement of employment. The service users were therefore potentially placed at risk. Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 15 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 33 and 35 The service users views and wishes must be taken into consideration to ensure that the home is run in their best interests. The home has clear procedures in place in terms of service users monies however a policy should be developed to confirm this and to ensure that the service users financial interests are protected. EVIDENCE: The home had been awarded the Investors in People Award which is a quality assurance award accredited by an outside body. The manager made a number of checks within the home on a regular basis to ensure that documentation including care plans were kept up to date. Policies and procedures had been recently reviewed and updated to ensure as far as possible the safety and well being of the service users. The registered provider must visit the home on at least a monthly basis to inspect the home and consult with service users, their representatives and staff in order to form an opinion of the standard of care provided. A written Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 16 report of this visit must be provided to both the registered manager and the Commission for Social Care Inspection. The registered provider had undertaken a survey of the service users views of the home in November 05. At the time of the inspection these had not been published and the manager was unaware of the findings and been unable to act on any concerns or worries, which may have been raised. The views of families and involved health and social care professionals involved in the home should also be sought allowing an opportunity for the registered manager to act upon any concerns which may be raised or to consolidate any practices which are regarded as beneficial to the service users. Requirements identified within the previous inspection had not been acted upon by the registered provider and this lack of action left the service users potentially at risk. The home did not have any dealings with service users monies with relatives or solicitors having the responsibility for this. The home should develop a policy, which clarifies their approach and expectations in respect of this. Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 17 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X X X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 X 8 X 9 2 10 X 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 X 17 X 18 X 1 X X X X X X 2 STAFFING Standard No Score 27 X 28 1 29 1 30 X MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X X 1 X 2 X X X Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 18 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 OP9 Regulation 13(2) Requirement Timescale for action 06/01/06 2 3 OP9 OP9 4 5 6 OP9 OP19 OP29 7 OP33 The provider must ensure that all medication records including those for; • Administration • Assessment of selfadministration and, • The receipt of medicines into the home are complete, clear, accurate and up-to-date. 13(2) The provider must ensure good practice in the management of the medication rounds. 13(2) The provider must audit the management of prescribed external preparations (creams). Creams must not be ‘shared’. 13(2) The provider must review the homely remedies policy and procedure. 23(2)(b) The premises must be kept in a good state of repair both externally and internally. 19(1)(b)(c The registered person must not )Sched 2 employ a person to work at the home unless the necessary checks have been made. 24(2) The results of service user surveys must be made available DS0000005926.V264673.R01.S.doc 06/01/06 06/02/06 06/03/06 28/02/06 28/02/06 28/02/06 Greenways Version 5.1 Page 19 8 OP33 26 to interested parties. The registered provider must inspect the home on at least a monthly basis and provide a written report to both the registered manager and the Commission for Social Care Inspection. 31/01/06 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 2 3 4 5 6 Refer to Standard OP9 OP9 OP9 OP26 OP33 OP35 Good Practice Recommendations A name and initials/signature list for staff authorised to handle medication should be maintained. Handwritten MAR entries should be signed, checked and countersigned. Consideration should be given to the inclusion of residents’ photographs with the MAR. The home should comply with the Water Supply (Water Fittings) Regulations 1999. The views of families and involved health and social care professionals should be sought. A policy outlining the homes approach to the management of service users monies should be developed. Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 20 Commission for Social Care Inspection North Lancashire Area Office 2nd Floor, Unit 1, Tustin Court Port Way Preston PR2 2YQ National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenways DS0000005926.V264673.R01.S.doc Version 5.1 Page 21 - 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. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!