Inspection on 24/09/07 for Perth Green House

This inspection was carried out on 24th September 2007.

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

Perth Green House 12/09/08

Perth Green House 01/11/06

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 nic shaw Key Unannounced Inspection 9.30am 24, 25 September & 11October 2007 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.V351327.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.V351327.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.V351327.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. 1st November 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. It provides intermediate care services only, including rehabilitation, interim and healthcare, in partnership with the Health Authority and Primary Care Trust. There are no long-stay residential places at Perth Green. There are 30 places, of which 15 are for rehabilitation and the remaining 15 provide healthcare 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 home 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 healthcare service for up to 6 weeks. The charge after this period is between £94.45 - £408.79 per week (depending upon Attendance Allowance benefits). Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection was a key unannounced inspection. This means that all of the core national minimum standards were looked at. Judgements were made about whether aspects of the service were “excellent”, “good”, “adequate” or “poor”. In order to help with this the manager was asked to complete an “Annual Quality Assurance Assessment” (AQQA) for Perth Green House. This is a self assessment of how well she thinks the service is doing. It asked her to look at what she thinks the service does well, what has improved and what could be done better. This was received some time before a three day site visit to the service. During the three day visit, which took place in September and October 2007, time was spent talking to senior staff and support workers as well as some of the service users staying at that time. A meal was shared with three service users and the building and staff records were looked at. On the last day of the inspection time was spent with senior staff and the home’s line manager to feedback to them the findings of the inspection. As well as the AQQA, in order to help with the assessment of the service, a number of questionnaires were sent out to service users before the site visit. None were returned to the Commission For Social Care Inspection ( “The Commission”)before the end of the inspection. During the visit time was also spent focusing upon four service users with very different needs. This is known as “casetracking” and involved looking at what it was like, from their point of view, staying at Perth Green House. This included talking with those service users, observing staff’s care practices with them and checking that information obtained from discussion and observation was accurately recorded in the care records. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 6 What the service does well: What has improved since the last inspection? A service user Guide has been developed for each of the three services available at Perth Green House. The manager now always gets a copy of each service users’ assessment before they are admitted to the home. This is so that she can make sure that the service can meet their needs. Staff now carry out a medication risk assessment. This is so that people who are able to look after their own medicines get the support they need to do so. Service users said that the food was “smashing” with plenty of choices. Care assistants have been renamed support workers. This more appropriately describes what is expected of them in their work. The service no longer uses plastic protective covers on duvets for everyone as in the past people commented about them being uncomfortable. New furniture has been purchased for the dining area. Two technical instructors have been recruited. Their role is to help the service users with their therapy plans. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 7 Some of the staff have now had training in supporting people. This is about how the staff can best help service users to be independent, which is the main aim of the service. The service now makes clear to potential service users that their possessions are not covered by Perth Green Houses insurance arrangements. This will help people to decide whether and how to store their personal possessions during their stay. What they could do better: The Service Users Guide needs some amendments so that it clearly tells all service users that they will have an initial 48 hour health care assessment when they arrive here. It also needs to be up-dated to provide service users with the right address and telephone number of the Commission. All service users need to be provided with a copy of the contract so that they know what to expect from the service. People with dementia must not be admitted to the service. This is because Perth Green House is not registered to provide a service to this client group. There needs to be more information in the care plans, especially when someone needs assistance with eating and drinking. This is to make sure that service users receive the support they need. Some improvements need to be made to the medication procedures. For example, when staff give out medication they need to make sure that the service user actually takes it. The number and range of activities needs to improve and staff need more awareness of the service users food likes and dislikes. The building must have better security to ensure the safety of the service users, including locked entrance; monitored access of visitors; and restrictors to all windows. There are still two baths that are not right for the people who stay here. The two staff vacancies must be filled without further delay. This is so that the minimum staffing levels can be maintained at all times without current staff having to work excessive additional hours. There are some areas of potential risk to service users safety, which need to be addressed. For example staff need more regular fire instructions so that they know exactly what to do if there is a fire. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 8 Staff need more regular supervision. This is a one to one meeting with a senior member of staff and is a way of making sure that staff continue to do their job well. The manager needs to further develop her system for reviewing the service to make sure that it is doing what it aims to do for people. The home’s line manager also needs to visit the home at least every month and write a report for the manager about how they feel the service is doing. 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.V351327.R01.S.doc Version 5.2 Page 9 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.V351327.R01.S.doc Version 5.2 Page 10 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): 1,2,3,4&6 People who use this service experience poor outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Perth Green House is a specialist intermediate care service which supports service uses to maximise their independence and return home. Although service users have clear written information about the services provided at Perth Green House some people do not know about the terms and conditions of residency. Some service users are also being inappropriately admitted to Perth Green House, and therefore they cannot be assured that their health and personal care needs will be adequately met. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 11 EVIDENCE: Perth Green House offers three different types of care to potential services, interim, healthcare and rehabilitation. 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 healthcare 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. A Service User Guide has been developed for each of the three types of care. This provides clear information to potential service users and is written in plain English and includes descriptions and photographs of the accommodation and services at Perth Green House. Service users said that a copy of the Service User Guide was available to them in their bedrooms. It includes details of the complaints procedure, however, this needs to be amended to provide service users with the new address and telephone number of the Commission. The gatekeeper for admission to the service is the Registered Manager (or senior staff in her absence). Assessments are always obtained from the referring health professional. However, staff commented that on several occasions when they had said to the referring health care professional, such as care manager or hospital discharge nurse, they were unable to offer a potential service user a service, their decision was overruled by senior management. In addition to this one person receiving a service at Perth Green House at the time of the inspection had Alzheimer’s disease. In another service user’s assessment it was identified that they had “short term memory loss”. The complaints record showed that in July 2006 a service user had complained about another service user who had dementia “wandering around the building and going into bedrooms”. Perth Green House is not registered to provide a service to people with dementia, therefore by admitting people with this type of illness they are operating illegally. An immediate requirement notice was issued at the time of the inspection advising the service that they must not admit people with dementia. ( This process involves sending a letter sent to the owner and manager for anything which requires urgent attention). Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 12 There is a copy of “South Tyneside Agreement for the Provision of Care” held in the service user’s file. However, service users had not always signed this document. This also does not contain details of the new address and telephone number of the Commission. All service users who are admitted to Perth Green House are first assessed for 48 hours to determine which of the services they require e.g. rehabilitation, interim or healthcare. However, this is currently not made clear in the Service Users Guide. Perth Green House DS0000037978.V351327.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): 7,8,9&10 People who use this service experience adequate outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Care plans are poor and do not provide staff with the information they need to provide continuity of care. Although medication procedures protect people and generally service users have excellent health screening during their stay, one service user’s health care needs were not being fully addressed. Staff care practices preserve the service users dignity and privacy. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 14 EVIDENCE: A range of assessments are completed for each service user upon their admission to Perth Green House. These include assessments used to find out about an individual’s nutritional status and risk of developing pressure sores. In one service user’s file the risk assessments showed them to be at high risk of developing a pressure sore and very high risk nutritionally. Despite this, however, care plans had not been developed to inform staff of what they should do to meet this service users health care needs. Lunch was taken with this service user, where it was evident that they were experiencing difficulty eating and swallowing the meal. They also drank very little. Staff said that when a service user is at high risk of malnutrition they monitor the food and fluid intake for four days. Records showed that this had taken place, in part, for this person when they were first admitted, however these records were incomplete and not always dated. It was also unclear as to the aim of monitoring food and fluid intake in this instance as no further action had been taken after the four days when clearly this person was still at risk. The service user’s initial assessment indicated that they needed to be provided with supplements and porridge four mornings each week and scrambled egg the remaining three, as recommended by the dietician, yet there was no evidence that these recommendations were being carried out by staff. An immediate requirement notice was issued to the person in charge at the time of the inspection requiring that these issues be addressed. (During the feedback meeting the deputy manager confirmed that this care plan had been reviewed to ensure that this service users needs were being adequately addressed). Staff complete what is called an “easy care “ document with service users when they arrive at Perth Green House. This is used to find out about the service users care needs and consists of a number of tick boxes. The completed documents seen provided very basic information. Some information had not been completed accurately. For example, in one service user’s initial assessment it was stated that they had cataracts yet the “easy care” document indicated that they had no difficulties in this area. For one person with dementia there was little information in their care plan about how staff were to meet their needs other than to offer “constant prompts”. This particular person needed to use a Zimmer walking frame when walking and staff said that they needed to remind them about this, yet there were no risk assessments or risk management strategies in place in relation to this. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 15 An excellent aspect of the service is the on site nurses, occupational and physiotherapist as well as a GP who visits twice each week. There are regular meetings held with different health care professionals who closely monitor the service users progress towards achieving their therapy goals. There are rapid response nurses, falls lead nurses, and an 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. Service users said that they felt their health care needs were met at Perth Green House. A new medication risk assessment tool is now completed when service users are admitted to the home. This is used to find out about the support each person needs with their medicines, however, it does not include all prescribed medication such as creams and inhalers. Some service users said that they looked after their own medicines and that the staff had written down the name of each tablet and the time that this needed to be taken, which had really helped them. When a service user arrives at Perth Green House the staff record details of their medication including name, strength of dose and time to be administered on a medication administration record (MAR). For those service users unable to look after their own medication, senior staff administer this. A medication round was observed. Staff who administered the medication did not make sure that the service user had taken this. One service user was left with their tablets, which they clearly had difficulty swallowing. Eventually staff had to support them to leave the dining area so that they could take their tablets in private. The person administering the medication had previously signed the MAR sheet and was not aware that this person had not in fact taken their medication. A random audit of medication confirmed that medication had been administered as per instruction on the pharmaceutical container, however, two paracetamol could not be accounted for. Although senior staff complete a weekly audit of all medication, no records are maintained of this. A small number of controlled medication is held in the home in a separate controlled drugs cabinet. A controlled drugs register is maintained and a brief audit of the medication held in stock corresponded to the records. There is a separate medication fridge and records are maintained of the temperature of this. However the temperature of the medication room is not monitored to make sure that medication is stored appropriately. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 16 Service users said staff “definitely respect dignity and privacy ” and always treated them with respect. This was observed when staff assisted service users with their mobility. This was carried out in a dignified way, with staff offering support at the service users own pace whilst sensitively encouraging service users to remain independent. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 17 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&15 People who use this service experience adequate outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Arrangements to provide activities and stimulation are limited with few opportunities being provided for services users to lead a fulfilled lifestyle whilst staying at Perth Green House. Service users ability to fully exercise choice and control over their lives is promoted by the daily routines of the home. Although service users are provided with a good, varied and well presented, choice based menu, some improvements to the mealtime arrangements are needed to fully promote the health and well being of the service users. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 18 EVIDENCE: There is no dedicated activities co-ordinator. Although there is an activities programme, displayed in the dining room, it is basic in content. This informs service users of what the planned activity is for that day, for example, a “quiz”, or “crafts”. Service users commented that this could be improved by including more information about the activities, for example, what type of craft sessions were on offer. They also said that the programme in its current format “did not attract them”. Everyone spoken to commented about the lack of activities and that if there was more to do then “it would help to pass the time”. One service user commented that “it was a long day” at Perth Green House . There was a steady stream of relatives and friends visiting the home and the arrangements for visiting are outlined in the Service User Guide. Service users said “ you can have visitors any time you want”. Service users are able to spend their days as they choose. Some people chose to spend time on their own in their bedrooms whilst others time in the communal lounges. Service users said “I can get up and go to bed when I like and have a bath or shower when I like”. As previously mentioned service users are encouraged and supported to maintain control of their medication. Everyone commented positively about the food. They said; “there’s plenty of it” “its great”, and “there is always a choice”. One service user said that they had diabetes and that there was always something provided for them on the menu. The menu is displayed on a board in the dining room and service users said that staff come round and ask them what they want to eat the day before. However, the menus on display in the small kitchenettes did not reflect the menu of that day and the print was very small and therefore difficult for people with a sensory impairment to read. The dining tables at lunchtime were nicely presented with table clothes and napkins. Condiments, tureens and individual teapots were also provided so that service users could help themselves. Staff were supportive to those people who needed assistance, however, in some instances did not have an awareness of the service users likes and dislikes. For example, one service user was provided with a salad. They asked for this to be put in a sandwich. Staff quickly responded to this request. However, the service user clearly did not like salad as they commented that they just wanted a plain sandwich. They did not in the end eat this. Another service user was experiencing great difficulty trying to chew and swallow their salad, which they also left. A third service user said that they just wanted soup to eat, yet they were brought a main meal and later a pudding. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 19 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&18 People who use this service experience good outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The home has a satisfactory complaints system. Complaints are handled appropriately and the outcomes used to improve the service. Policies, procedures and staff training ensure that the service users are protected from abuse and potential harm. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 20 EVIDENCE: The home has a complaints procedure, a copy of which is available to each service user in their bedroom in the Service User Guide. It is provided in easy to read print, and is available in Braille and on cassette for people who have a visual disability. It is also displayed around the home. However, although the complaints procedure provides details of how to contact the Commission this needs to be up-dated to include the new telephone number and address of the South of Tyne area office. There have been nine minor complaints since the last key inspection. The home has kept a full record of these including details of the investigation and any action taken. The service always responds to these within the agreed timescales. Service users said that if they had any concerns they would feel able to talk to any of the staff. One service user said “I would feel able to complain but can’t complain, they are all good”. The majority of staff are trained in safeguarding adults. There have been no safeguarding adult referrals made since the last inspection. This is as a result of lack of incidents rather than a lack of understanding about what incidents should be reported. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 21 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): 19,21,25&26 People who use this service experience adequate outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The accommodation is generally warm, clean and hygienic, however there are a number of maintenance issues which need to be addressed to ensure the safety of service users. There have been some improvements to the security of the building but further work needs to be done to fully protect the service users. Although there are enough bathrooms some of the baths are the wrong type for the people who stay and therefore do not suit their needs. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 22 EVIDENCE: Perth Green House was built in the 1970s as a residential care home. It has a radial design of five corridors with a large central dining room. Rooms in one corridor and all on 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 is accessible for people with mobility needs. The entrance to the home is left unlocked until late at night. Although the administrator’s desk is positioned in the office so that she can monitor who is entering the building, she is not always at her desk and when she is off duty, security of the building is dependent upon there being a member of staff in the office. Some rooms have large windows that are not fitted with restrictors, although one service user said that staff came into their bedroom room at about 7.00pm at night to close the window for them. On the day of the inspection visit there were several lights not working in communal areas and service user’s bedrooms. For example: five bulbs were not working in the dining area, two were off in the entrance foyer, three were off in the Oaks wing corridor and six were off in the Beeches wing. One service user’s overhead bed light was also not working. Senior staff said that this was because they had recently changed supplier and at the feedback meeting the deputy manager confirmed that this issue had now been addressed. Pipes in toilet areas are exposed and hot to the touch. 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, leaving parts of the home showing signs of wear and tear, for example, the tiles in the laundry are cracked in places, some of the pull cords are dirty and need to be replaced, the cover is missing from the ceiling light in the laundry, the flooring in one of the kitchenettes is marked, the paintwork was also chipped in this area and two tiles were missing off the walls. The premises still contain two 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). Senior staff on duty said that on that day they were scheduled to be replaced, but this did not take place. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 23 Several service users commented about the cleanliness of the home saying it was “spotless”. Everyone said that they found their bedroom to be comfortable and warm and that the staff cleaned these areas every day. Service users said that towels are changed alternative days and one person said that when they arrived the staff asked them if they wanted the bed moved away from the window, which thought was considerate of them. Most staff, including housekeeping staff, have had training in infection control. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 24 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&30 People who use this service experience adequate outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. Although overall the minimum staffing levels are achieved there are not enough staff within the team to fully meet the needs of the service users. Staff are competent, trained and suitably experienced and the service operates a robust recruitment and selection procedure. This ensures that the service users are fully safeguard. EVIDENCE: On the first day of the inspection on the late shift there were only four staff on duty instead of five. There are two care staff vacancies, and these have been vacant for nearly two years now. With staff sickness and holidays staff have had difficulty covering the rota. The deputy manager was covering a nightshift. Staff said morale was low as a result of this commenting that there was only so much overtime they could do. Staff did, however, comment that the line manager always agreed to the provision of additional staff, above the minimum, if a service user was admitted with high care needs. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 25 Most care staff have attained an NVQ qualification in care at level 2 or 3. Two full time Technical Instructors have been employed by the service, one of whom is a qualified physiotherapist. Their role it is to support the service users with the implementation of their therapy plans. Six staff have completed a qualification in supporting people. A further two staff are working towards this. The training section of the Social Services Department carries out a training needs analysis. Any gaps in staff training are identified and the necessary training arranged to address this. Staff personnel files demonstrated that all required checks and clearances are in place before new staff begin work at the service. All service users spoke positively about the staff. They said “they are “very good”, “excellent”,“nice” and “I think they are wonderful”. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 26 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): 31,33,35,36&38 People who use this service experience adequate outcomes in this area. We have made this judgment using a range of evidence, including a visit to this service. The service users benefit from the management approach of the home, however, there are some areas of potential risk to service users safety, which need to be addressed. The procedures in place for safeguarding service users finances are sufficiently robust to protect people. Staff need more regular supervision and improvements need to be made to the quality assurance system to ensure that the aims, objectives and policies and procedures of the service are fully implemented. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 27 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 completely the Registered Managers Award. The manager is currently on sick leave and in the interim period the deputy manager has overall management responsibility for the service. There is now a full time administrator and there are clear lines 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 provide the manager with a written report following their visit. However, reports were only available for July, May and March 2007 and not monthly as required. Some of the staff have not received a regular supervision. A tick box quality assurance tool has been developed. This includes a series of questions such as “assessments suitable?” and “principles of care?”. There is a space available against each question, which the manager signs to show that she has looked at this aspect of the service as part of her quality audit. However, there is no further information available to show exactly what she has looked at, for example, how many assessments and whose and whether or not she spent time observing staff practices to ensure that the principles of care were being adhered to. The fire log book showed that fire drill’s are not held every six months and one member of staff had not received a fire instruction between 5th September 2004 and 6th September 2007. Personal allowance records showed that receipts are maintained for all transactions and that service users are encouraged to sign the transaction sheet. However, receipts are not issued for money deposited, which is good practise. Only one risk assessment had been completed for safe working practices, for . “loading and unloading the washing machine”. This had not been dated or signed. Some of the staff have not had food hygiene or up-to-date fire training. The deputy manager later confirmed that the latter training has been arranged. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 28 The home carries out internal maintenance checks and has contractors to service equipment. However, the portable appliances, which must be checked annually, had not been tested since 2005. An immediate requirement notice was issued at the end of the inspection about this. An appropriate record is maintained of accidents. Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 29 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 2 3 1 X 3 HEALTH AND PERSONAL CARE Standard No Score 7 1 8 2 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 2 17 X 18 3 2 X 2 X X X 2 3 STAFFING Standard No Score 27 2 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 2 X 2 Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 30 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 Timescale for action 01/01/08 2. 3. OP2 OP4 4. OP7 The Service Users Guide must be amended to clearly outline the 48-hour health care assessment that determines the service that people will receive. It must also be amended to provide service users with accurate information about how to make a complaint to the Commission. (Timescale not met 01/01/07) 5(1)( c ) Service users must be provided with information about the terms and conditions of residency. 3(4) Service users must not be Registrati admitted to the home who have on dementia. This is because the Regulation service has not been registered s (2001). to provide this type of care and cannot meet the needs of this specialist client group. 15 Care plans must include: the specific care goals/needs of each service user as well as clear details of the support each person requires. This is to ensure continuity of care is provided (Timescale not met DS0000037978.V351327.R01.S.doc 01/01/08 24/09/07 31/05/08 Perth Green House Version 5.2 Page 31 5. OP8 12(1)(a) and 15 6. OP9 13(2) 01/01/07). Care plans must be developed 24/09/07 for those service users assessed as at high risk of malnutrition. This is to ensure that their health care needs are fully addressed. Senior staff who administer 30/11/07 medication must make sure that service users have taken this before they sign the MAR sheet. Records must be maintained of the medication audits. Risk assessments must be completed for those service users who administer their own prescribed creams and inhalers. The above measures will help to fully protect the service users. Service users must be provided with a range of activities which meet their diverse needs and provide opportunities for stimulation and fulfilment during their stay. The complaints procedure must include the correct telephone number and address of the Commission’s South of Tyne area office. Security measures must be put into place to ensure the safety of the people who stay at Perth Green House, including locked entrance; monitored access of visitors; and restrictors to all windows. (Timescale not met 01/01/07). The maintenance issues discussed in the report must be addressed. The two inappropriate medibaths must be replaced with suitable bathing facilities for use by people using the service. (Previous timescale of DS0000037978.V351327.R01.S.doc 7. OP12 16(2)(n) 31/12/07 8. OP16 22(7)(a) 31/12/07 9. OP19 13(4)I & 23(1)(a) 31/03/08 10. 11. OP19 23(2)(b) 12(1)a & 23(2)j 30/11/07 31/03/08 OP21 Perth Green House Version 5.2 Page 32 12 13 14 OP25 OP27 OP33 13(4)( c ) 18(1)(a) 26 15 OP33 24 16 OP36 18(2) 17 OP38 23(4)(e) 18 19 OP38 OP38 23(2)( c ) 13(4)( c ) 20 OP38 18(1)( c )( I ) 01/07/06 not met& 01/03/07 not met.) The exposed hot water pipes must be addressed to fully safeguard the service users. The two staff vacancies must be filled without further delay. A representative of the organisation must visit the service at least once a month and provide the manager with a written report following their visit. This is to ensure that the home provides a good quality service to the service users. The internal quality monitoring systems must continue to develop. This is to ensure that the service’s stated aims and objectives are met. ((Previous timescales of 30/11/04, 1/11/05, 01/05/06 and 1/03/07 not met.) All staff must receive regular supervisions. This is to ensure that staff follow the policies and procedures of the service. All staff must receive a fire drill every six months. This is to ensure the safety of service users in the event of a fire. The portable appliances must be tested immediately to ensure that these are safe to use. The manager must ensure that risk assessments are carried out for all safe working practise topics and that significant findings of the risk assessment are recorded. The manager must ensure staff are provided with training in food hygiene and fire safety. This is to promote the health and safety of service users at all times. 31/03/08 31/03/08 31/10/07 31/03/08 31/03/08 31/12/07 24/09/07 31/03/08 31/03/08 Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 33 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 OP9 OP15 Good Practice Recommendations A record of the temperature of the medication room should be maintained. This is to ensure that medication is stored safely. The menus should be provided in a format appropriate to the diverse needs of service users. The service users dietary likes and dislikes should be recorded in their care plans. Receipts should be given to service users and their relatives when they give money to the service fro safekeeping. 3. OP35 Perth Green House DS0000037978.V351327.R01.S.doc Version 5.2 Page 34 Commission for Social Care Inspection South Shields Area Office 4th Floor St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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