Inspection on 01/11/06 for Perth Green House

This inspection was carried out on 1st November 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. 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

Perth Green House 12/09/08

Perth Green House 24/09/07

Perth Green House 08/02/06

Perth Green House 11/08/05

Perth Green House 29/09/04

Perth Green House 05/05/04

Similar services:

Turret Villa Retirement Home

Moor House

Mendip House

Beaconsfield Court Care Home

Little Sisters Of The Poor

Manor House

Middleton Hall Ltd

Middlesbrough Intermediate Care Centre

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Perth Green House Inverness Road Jarrow Tyne and Wear NE32 4JX Lead Inspector Miss Andrea Goodall Key Unannounced Inspection 1st, 2nd & 30th November 2006 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Perth Green House DS0000037978.V321520.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. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Perth Green House Address Inverness Road Jarrow Tyne and Wear NE32 4JX 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) 0191 4893007 F/P South Tyneside MBC Moira Workman Care Home 30 Category(ies) of Mental Disorder, excluding learning disability or registration, with number dementia - over 65 years of age (2), Old age, of places not falling within any other category (30), Physical disability over 65 years of age (5), Sensory Impairment over 65 years of age (2) Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. The service may from time to time admit persons between the ages of 60 and 65 years of age within the OP category of registration. One person under the age of 65 may be admitted in the PD category of registration. 8th February 2006 Date of last inspection Brief Description of the Service: Perth Green House is registered as a care home for older people and is operated by the Local Authority. The home was purpose built in the 1970s and was originally designed as a long-term residential care home for 35 older people. However, the service has been changing over the past couple of years, and since the last inspection an application by the home for variation to registration has been approved. Perth Green House now provides intermediate care services only, including rehabilitation, convalescence and short-breaks, in partnership with the Health Authority and Primary Care Trust. There are no long-stay residential places at Perth Green. There are now 30 places, of which 15 are for rehabilitation places, and the remaining 15 places provide convalescence and interim care (2 of which may be used for emergency placements.) The building is situated in a housing estate and is close to local amenities. All accommodation for service users is on the ground floor and there is level access into and around the building. The house provides single rooms to all service users. One bedroom has an en-suite facility. The radial layout of the corridors allows for separate self-contained units, each providing bedrooms, lounge, and bathroom, and all leading to a central large dining area. (On the second floor there are a number of offices for social and health care staff, with a separate entrance.) There are no charges for those people assessed for the rehabilitation service, which can last up to 6 weeks. There is no charge for the interim or the convalescence service for up to 6 weeks. The charge after this period is between £90.65 - £136.15 per week (depending upon Attendance Allowance benefits). Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was unannounced and took place over 2 visits. (A third visit was made to feedback the findings to the Manager.) During the visits time was spent talking with service users about their views of the service they were receiving, and the Inspector joined them for a teatime meal. Some time was spent looking around parts of the building. The rest of the time was spent with senior staff discussing the recent changes to the service, examining care records, health & safety records and staff records. Some months before this unannounced inspection, the Manager completed a Pre-Inspection Questionnaire, and comment cards were made available for service users and their relatives. Seven comment card from service users and 2 responses from relatives were received. Those comments are included within this report. There have been no formal complaints received about the service since the last inspection. However there have been 2 concerns received about the buildings security. As part of this unannounced inspection the quality of information given to people about the care home was looked at. People who use services were also spoken to, to see if they could understand this information and how it helped them to make choices. The information included the service user’s guide (sometimes called a brochure or prospectus), statement of terms and conditions (also known as contracts of care) and the complaints procedure. These findings will be used as part of a wider study that CSCI are carrying out about the information that people get about care homes for older people. This report will be published in May 2007. Further information on this can be found on our website www.csci.org.uk What the service does well: The service provides clear written information about the services it aims to provide. This includes a clear ‘contract’ and level of charges. A Service Users Guide (information handbook) is placed in each bedroom, and service users said that this information is “helpful”. Perth Green House provides a specialised service that helps older people to get fit to look after themselves after they have been ill in hospital or at home. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 6 While they are here people get excellent checks on their health care to make sure that they are going to be fit and well to go home. The service has specialist therapy staff on site and this means they can see service users to plan their care and see their progress. It was clear from discussions with service users who were due to return home that they had received good support to regain some independent living skills, such as managing medication, making hot drinks and snacks. One service user said, “It’s a good place to get better, rather than hospital”. In discussions with service users said that their rights to privacy and dignity were respected during their stay at Perth Green. Service users described staff as very kind and helpful. Visiting relatives were generally positive about the service, as were 2 relatives comment cards. For example, one relative stated, They couldnt ask for better care and attention. Its 110 by all staff. First class. Most service users people commented favourably on the meals, particularly about the lunches, stating, It’s very good. Its helped to get me back on my feet. Service users know how to complain and they have clear information about this. Several service users commented that the building is always clean. One service user said, The cleaners do a good job. What has improved since the last inspection? What they could do better: The Service Users Guide needs some amendments so that it is very clear about the current services available within Perth Green House, and should clearly outline that all service users have an initial 48 hour health care assessment when they arrive here. Also health and social care professional should be clear about this assessment when describing to prospective service users. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 7 Perth Green must obtain a copy of each service users assessment of needs before it can make a decision about whether the service can meet their needs. Care plans should include clear details about the support a service user requires, and should show how well they are progressing towards each of those goals. Also daily records should give meaningful details of the well being of service users Some of the people staying here said that teatime meals could be better. The building must have better security to ensure the safety of the people who stay here, including locked entrance; monitored access of visitors; and locks and restrictors to all windows. There are still 2 baths that are not right for the people who stay here. These should be replaced with suitable baths. People staying here said that the plastic protective covers on duvet were uncomfortable and the service should think about alternatives. Care staff should have more training in rehabilitation and promoting independence because that’s what the service aims to provides. The service should be reviewed by the Provider to make sure it is doing what it aims to do for people. Some service users may need independent support to complete questionnaires to encourage them to say what it was like for them, and to get any suggestions for making it better. The service must tell service users that their possessions are not covered by Perth Green’s insurance during their stay here. 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. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 8 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3 & 6. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Service users have clear written information about the services provided at Perth Green House. However some service users have been admitted without the service being provided with a full assessment of their needs. Perth Green aims to provide a specialist intermediate service, but is disadvantaged by its traditional long-stay care home status and taskorientated care. EVIDENCE: Perth Green House does have very brief Statements of Purpose for each of the 3 services it proposes to provide, that is rehabilitation, convalescence and interim care. The Statement of Purposes briefly outline the aims and objectives Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 10 of the differing services, however the font style of the information is difficult to read. However there is very clear information for potential service users of the rehabilitation unit in a Service Users Guide. This is written in plain English and includes descriptions and photographs of the accommodation and types of therapy people might receive here. In this way potential service users of the rehabilitation service have good information about what to expect from the service before they arrive. This is particularly important for the people who use the Perth Green service, as they usually do not have the opportunity to visit the service before their stay here. There is now a Service Users Guide for the Interim services, which is also reasonably detailed, but it still refers to a short break service, which is no longer provided here. The Manager confirmed that this is to be updated. In the meantime, service users who took part in discussions were familiar with the Service Users Guide, which are kept in bedrooms for easy access, and they felt that these were informative and “helpful”. Each service user also signs and receives a copy of a ‘contract’ that clearly outlines the terms and conditions of their stay here. Information for service users includes details of the charges for the service after the initial 6-week period. All service users who are admitted to Perth Green are first assessed for 48 hours to determine which of the services they require e.g. rehabilitation, interim or convalescence. However this is currently not made clear in the Service Users Guide. It is not always made clear by the referring agency, as some people were given a misleading impression of what service they would receive. For example one person stated that, prior to their admission, hospital staff told them they would receive intensive rehabilitation and that their stay would be about 2 weeks. In this way, the service user was not made aware of the health assessment period that would determine what type of service they required, nor that the service does not provide intensive rehabilitation. That misinformation has led to that service user being dissatisfied with the service. The rehabilitation service is for older people who are recovering from illness, either from hospital or from home, who no longer need medical care but need support to regain daily living skills so that they can return home. This service may take up to 6 weeks. The convalescence service aims to prevent admission to hospital and to get people back into their own homes. The interim service aims to support people whilst awaiting necessary adaptations to their own home, or to provide a safe environment whilst awaiting admission to long-term care. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 11 The criteria for receiving any of these services is that the person must be over 65 years old, a resident of South Tyneside and be medically stable. The gatekeeper for admission to the service is the Registered Manager (or senior staff in her absence). Potential service users may be referred by a number of health or social care professionals. Assessments of the potential service user are carried out by a Care Manager and/or hospital Discharge Nurse. Discussions are then held with Perth Green management staff for a verbal decision on admission, subject to receiving a written assessment of needs. However there have been occasions over the past year when an admission has been agreed but the written assessment has omitted significant details of the persons needs. In this way a service user was admitted whose needs could not be met. There has also been at least one occasion when a service user has been admitted without a written assessment being received from a Care Manager. These situations compromise the ability of the service to provide the right care, but also compromise the success of the placement for the service user. These situations are also an offence under the regulations that Perth Green House is registered. At this time there is no statistical evidence of the success of each of the differing services as the service has only recently begun to record this. Throughout this inspection there were indications that Perth Green House still retains some of its historical long-term care status, whilst striving to provide a modern intermediate care service. For example, staff are still titled care assistants; the care staff role is task-orientated rather than enabling; the Service Users Guide still suggests that staff will manage medication, instead of promoting the independent living skills of service users; and there are still archaic, inappropriate bathing facilities within the home, which are not conducive to service users learning to manage this on their return home. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9 and 10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Care plans are not detailed enough and are not reviewed to show whether a service users is meeting their goals. Service users have excellent health care screening during their stay. Information for service user does not encourage or promote them to take responsibility for their own medication, even though all service users are assessed for this. Service users felt that they are treated with dignity, though some parts of the accommodation does not support this. EVIDENCE: Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 13 There is an individual plan of care for each of the service users that come to stay at Perth Green House. These are based on a range of assessments of needs, such as moving & assisting, nutrition, continence, falls risk and medication. For people receiving a rehabilitation service there are also therapy assessments and therapy plans that are put into place by the Occupational Therapists and Physiotherapists. However, of the sample examined most care plans did not include guidelines of the support that service users needed to work towards their goals/needs. For example, some care plans had one-word needs such as bathing with no details of the support required. There was no evaluation of how the service user was progressing towards each specific goal. The daily reports were repetitive and mostly meaningless, for example fully independent in all areas despite a number of care needs. For people receiving a rehabilitation service there are also therapy assessments and therapy plans that are put into place by the Occupational Therapists and Physiotherapists, to be supported by care staff. However there were no reports by care staff of the progress of a service user towards their therapy goals. There are weekly reviews of service users by senior staff which report an overview of each persons well being, but these do not relate specifically to numbered care plan goals or needs. It was clear from discussions with service users who were due to return home that they had received good support to regain some independent living skills, such as managing medication, making hot drinks and snacks. However there was no demonstration in their care plans of the support they had received, or their progress towards independent living. The people staying here get excellent health care screening by all the relevant health care professionals. There is an Occupational Therapist and a Physiotherapist based at Perth Green House. There are twice-weekly GP visits for those receiving a rehabilitation service. All service users can retain their own GP input depending on the catchment area, or they can join the local GP practice as a temporary patient. There are Rapid Response nurses, Falls Lead Nurse, and Overnight Nursing Team on site at the home for advice or referral. The home also has good links with the Continence Advisor, Speech and Language Therapists, Stroke Unit and Community Psychiatric Nurse. All service users are assessed on admission for dental, ophthalmic and chiropody needs and visits arranged as necessary. In this way service users health care needs are fully met during their stay at Perth Green House. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 14 The Service Users Guides still refer to the management of peoples medication as their choice and states we will be pleased to take responsibility for your medication……..The choice is yours. This does not encourage or promote service users continued skills in managing their own medication for their return to their own home, and could even de-skill them. In fact, all service users are assessed for their ability to manage their own medication on admission. It was evident that some people do manage this, and the some people have staged support with this towards managing it independently. Where medication is managed by the service, it is securely stored and administered appropriately. In discussions with service users it was evident that they felt that their rights to privacy and dignity were respected during their stay at Perth Green. Service users described staff as very kind and helpful. All bedroom doors now have a key so that service users can choose whether to lock their bedroom door or not. There is a pay phone cubicle in a main corridor where service users can make telephone calls in private. This area is large enough for wheelchair access. The home also has a portable phone that can be taken to bedrooms for incoming calls. Some service users also have their own mobile phones. One bathroom in the office corridor is still used by staff to bathe service users. This does not support their dignity due to its location; its inappropriate, archaic design; and the poor state of décor in this room. (By the time of the last visit this room had been taken out of action.) Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 15 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): 12, 13, 14 and 15. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users are able to continue their own lifestyles during their stay, although there are limited recreational activities. Service users can maintain good contact with their relatives. Service users can some choice, such as how to spend the day, during their stay. Service users stated that meals are usually of a good quality. EVIDENCE: Apart from those who have some input into their rehabilitation, service users tend to spend the day as they choose within the building. There is an activity sessions on each evening, such as quizzes and bingo, and these are advertised in the main dining room. There are TV lounges in each of the units where most people socialise. It was stated that service users are occasionally offered some opportunities to go out to local shops, but this tends to be part of rehabilitation plan and would depend on staffing levels. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 16 In discussion service users said, Sometimes we have activities, but it depends who is staying here as to whether much goes on. Some times people are very quiet. Several service users said that staying at Perth Green made them motivated to “get better and get home again.” One person said, “It’s a good place to get better, rather than hospital.” The people who stay here are from all areas of South Tyneside so tend not to be involved in the local community around Perth Green. Instead they would rely on relatives to support them to go out. Prior to their discharge home they are supported by an OT or Physiotherapists to try a visit to their own house. There is a clear visitors policy in the Statement of Purpose that encourages visiting, but preferably not at mealtimes. There was a steady stream of visitors to the building throughout the day. Visiting relatives were generally positive about the service, as were 2 relatives comment cards. For example, one relative stated, They couldnt ask for better care and attention. Its 110 by all staff. First class. Service users can make choices about how they spend their day, although for some people this may be led by their therapy sessions. Several service users had chosen to spend time in the privacy of their own bedrooms during these visits. There were some mixed comments about the food at the Perth Green. Most people commented favourably, particularly about the lunches, stating, It’s very good. Its helped to get me back on my feet. Another service user said, The very good food is the best thing about the service, even though I have a special diet, although I get jealous watching others enjoy the home made cakes! However at the teatime meal some service users were disappointed with their unappetising meal and very small portions. The choice was bread and a banana, or a very small piece of lasagne, which was served alone on a tea plate. Some rehabilitation service users do have occasional therapy sessions involving cooking, but only if this is assessed as an area of need. There are also occasional baking or cooking sessions as part of the activities programme. However peoples potential independence in this area is not maximised. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 17 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): 16 and 18. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Service users know how to complain and they have clear information about this. Staff have training in adult protection so that they know what to do if they suspected abuse. EVIDENCE: The Complaints Procedure is widely advertised around the home in easy-toread print. It is also in the Service Users Guide. It is also available on a cassette, and in Braille, for anyone with a significant visual impairment or other reading difficulties. There is a portable cassette player so that the tape could be listened to in the privacy of a bedroom. There have been around 8 minor complaints since the last inspection, some about missing laundry and 2 from service users who did not want to leave this short-term service. In this way, it is clear that service users feel able to make comments and complaints. All the complaints have been recorded, which suggests that the home takes verbal comments seriously. However some record of complaints were very brief and the details were not very clear. Also one service user had raised concerns about another agency, Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 18 which Perth Green staff passed to a Care Manager, but this could have involved adult protection procedures. The majority of staff, including ancillary staff, have had training in the local POVA (Protection of Vulnerable Adults) procedures, so should know how to report suspected abuse. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 19 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): 19, 21 and 26. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The accommodation is generally warm and comfortable, but the building has poor security so the safety of service users is compromised. There are enough bathrooms but some of the baths are the wrong type for the people who stay here. The home is clean and hygienic. EVIDENCE: Perth Green House was built in the 1970s as a residential care home. It has a radial design of 5 corridors with a large central dining room. Rooms in one corridor and all the first floor accommodation are used wholly for offices for the many social and health professional that are based in this building. The accommodation for service users is on ground floor level only so it accessible for people with mobility needs. The sample of the building examined was warm, clean and generally comfortable. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 20 However, the security of the building is very poor. The entrance is left unlocked until late at night and there is no monitoring of visitors. Although the service now has administrative staff based in the main office, their desk is not positioned so that the front entrance can be seen. In this way, there is still no clear reception service. Throughout these visits large numbers of visitors came and went but no checks were made to ensure they had legitimate rights to be there. Some rooms have large windows that are left open until late and are not lockable or fitted with restrictors. In these ways the protection and safety of the people who stay here is significantly compromised. Some relatives have also expressed their concerns to the Manager about the unsecured entrance and risks to the safety of service users. Those relatives were informed by Perth Green staff that an “open-door” policy is required by CSCI. However that is incorrect, as there is no such policy, and is not required by CSCI. In fact, previous inspection reports have also criticised the poor security of the building. The nature of the short-term, high-admission service means that there is invariably some wear and tear to the building. Since the last inspection a couple of bedrooms have had new carpets fitted. However the accommodation remains rather worn in places, for example: chipped Formica to old vanity units in bedrooms; cracked bath panels; and flooring is lifting in toilets. The service does not have on-site maintenance staff. Instead the Manager has to formally request the input of contracted maintenance services for every minor repair. This means there is no immediate attention to the building, so there are potential delays in repairs being addressed. Some service users commented on the plastic protector covers to duvets, which they found uncomfortable and too hot even with a cotton cover on top. The premises still contain 2 archaic medi-baths (sit-in baths), which are inappropriate for this service, and present potential health & safety risks (due to hot water running directly onto a seated service user). The Manager commented that there are proposals for these baths to be replaced with appropriate baths. The hot water to one bath (in the rehabilitation unit) has been consistently under the guideline temperature for some time and is too cool to bathe in. In this way 3 baths are not satisfactory for use by service users. At the end of this inspection the medi-baths had been taken out of action and the thermostatic blending valve to the bath in the rehabilitation unit was being replaced. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 21 Several service users commented that the building is always clean. One service user said, The cleaners do a good job. The areas of the building that were examined during this inspection were clean, and there were no unpleasant odours. Most staff, including housekeeping staff, have had training in Infection Control. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 22 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): 27, 28, 29 and 30. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The service provides enough staff to meet personal care needs but not sufficient to support service users fully with their therapy plans. Service users are protected by the robust recruitment procedures of the service. Staff have good training opportunities, but do not have accredited training in rehabilitation or promoting independence. EVIDENCE: Perth Green House now provides 30 places for older people (up to 5 of whom may have physical disabilities), where they may receive rehabilitation, convalescence and/or interim services. There are 4 wings of accommodation within the building. Staffing levels are 5 care staff on duty throughout the day and evening. This allows for one staff on each corridor with one floating care staff. Over night there are 2 care staff on waking duty (and one senior staff sleeping-in). At all times of day there is also at least one senior or management member of staff on duty. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 23 There are also sufficient domestic, laundry and catering staff to manage the housekeeping and catering needs of the people who live here staying here. At this time care staff are titled care assistants. They are responsible for a number of housekeeping tasks, such as changing beds and cleaning commodes, that seems unrelated to care or to the specialist rehabilitation and convalescence services that the home aims to provide. During discussions with therapists and with care staff, it was indicated that such tasks reduces the time that care staff have to support service users with their therapy plans. The Manager stated that 2 Technical Instructor staff would be commencing employment at Perth Green in the New Year. These 2 new staff will work in support of the therapy plans. It is good practice that most care staff have attained a care qualification, that is NVQ level 2 or 3 in Care. However they do not have certificated training in rehabilitation or promoting independence. The Manager stated that care assistants are to be renamed support workers and that refresher training in rehabilitation is to be provided within the service. The service is managed by South Tyneside Social Services Department, which operates robust recruitment and selection procedures. There have been few changes to staff, although around 4 vacant posts are to be filled by new appointments. Staff personnel files demonstrate that all required checks and clearances are in place before new staff begin work at the service. Senior staff commented that there are good opportunities for training for staff, and there are individual and group training records for all staff members. The Manager demonstrated that staff training analyses are carried out and any gaps identified are met through the training section of the Social Services Department. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 24 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): 31, 33, 35 and 38. Quality in this outcome area is adequate This judgement has been made using available evidence including a visit to this service. The Manager is fit to be in charge of this intermediate care service. The views of service users are sought, but there is no formal system of reviewing whether the service meets its aims. Service users’ possessions are not safeguarded by the lack of security and lack of insurance cover. The health & safety of service users is protected by staff training and practices. EVIDENCE: The Manager has many years experience in social care and residential settings. She has attained a number of appropriate qualifications including NVQ level 4 in Care and has recently completely the Registered Managers Award. She is Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 25 responsible for all aspects of the management of the care service, and is the gatekeeper for all admissions. Since the last inspection the service now benefits from a part-time administrative post. There is a clear line of accountability within this service and within the organisation. A representative of the organisation is required to visit the service at least once a month and report to the CSCI on their findings. A specific quality assurance system has still not been designed for this service. In this way there is no formal review to ensure that aims of the service and its statement of purpose are being met. In the meantime service users views are sought via a questionnaires that they are offered prior to their discharge from the service. The Manager stated that there remains a poor response to the questionnaires, around 25 . In some cases, care staff have supported service users to complete the questionnaires. However this affects the credibility of those responses as service users may not feel able to be fully candid of the service in front of staff. Most people continue to manage their own financial affairs (or have representatives to do this for them) during their short stay at Perth Green House. However the home can provide secure storage for small amounts of personal monies if requested to do so by service users. An appropriate record is kept of the management of this money and this was signed by the service user and the Manager. It is not made clear to service users, or their representatives, that their possessions, including monies, are not covered by Perth Green Houses insurance during their stay. This recently came to light after a service user had a cassette player stolen from the bedroom they were staying in. Staff have statutory training in all health & safety matters. There are always First Aiders on duty. The premises are subject to at least annual health & safety audits and there were no health & safety hazards noted at the time of this visit. Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 26 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 3 2 X X 2 HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 x 18 3 2 X 2 X X X X 3 STAFFING Standard No Score 27 3 28 2 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 3 Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 27 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 OP1 Regulation 5 Requirement The Service Users Guide must be amended to make clear the current services available within Perth Green House, and must clearly outline the 48-hour health care assessment that determines the service that people will receive. Perth Green must obtain a copy of each service users assessment of needs before admission, in order to make an informed judgement about whether the service can meet their needs. (Where the admission is an emergency placement by Rapid Response nurses the admission process should be completed within 48 hours of the service users arrival). Care plans must include: the specific care goals/needs of each service users; clear details the support required; and a review of progress towards each of those goals. Security measures must be put into place to ensure the safety of DS0000037978.V321520.R01.S.doc Timescale for action 01/01/07 2. OP3 14(1)(b) 01/01/07 3. OP7 15 01/01/07 4. OP19 13(4)I & 23(1)(a) 01/01/07 Perth Green House Version 5.2 Page 28 5. OP21 12(1)a & 23(2)j 6. OP21 13(4) & 23(2)c j. 7. OP27 18(1)Ii 8. OP33 24 9. OP35 12(2) the people who stay here, including locked entrance; monitored access of visitors; and locks and restrictors to all windows. The 2 inappropriate medi-baths must be replaced with suitable bathing facilities for use by people using a rehabilitation and short-break service. (Previous timescale of 01/07/06 not met.) In the meantime the medi-bathroom in the office corridor must be taken out of use as it is inappropriate, undignified, and in a poor state of decoration. Hot water to the bath in the rehabilitation unit must achieve a satisfactory and safe temperature of around 43° C. (Previous timescale of 11/02/06 not met.) The service must ensure that the role of care staff, and their training, is conducive to the aims of the intermediate service it intends to provide. An effective quality assurance system must be put into place. (Previous timescales of 30/11/04, 1/11/05 and 01/05/06 not met.) The service must make clear to potential service users that their possessions are not covered by Perth Green Houses insurance arrangements, so that they can make an informed decision about whether and how to store their personal possessions during their stay. 01/03/07 01/01/07 01/04/07 01/03/07 01/01/07 Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 29 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. Refer to Standard OP1 OP3 Good Practice Recommendations The Statement of Purpose should be reproduced in easyto- read print. Perth Green must ensure that the health and social care professionals who refer service users to Perth Green, inform potential service users of the initial 48 hour health care assessment that will determine the level of service that is required. Daily records should provide a meaningful account of support provided and the well-being of a service user. The Service User Guide should be amended to reflect that a risk assessment is used to determine whether a service user can manage their own medication during their stay. Consideration should be given to a reviewing the quality of teatime meals. Consideration should be given to service users comments about plastic quilt protectors, and alternatives should be sought. The title of care staff should be changed, as planned, to reflect their role. Consideration should be given to the use of independent advocacy services to seek the views of service users as part of the services quality monitoring. 3. 4. OP7 OP9 5. 6. OP15 OP19 7. 8. OP27 OP33 Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection South of Tyne Area Office Baltic House Port of Tyne Tyne Dock South Shields NE34 9PT 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 Perth Green House DS0000037978.V321520.R01.S.doc Version 5.2 Page 31 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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