Inspection on 14/04/05 for The Green

This inspection was carried out on 14th April 2005.

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 made no statutory requirements on the home as a result of this inspection and there were no outstanding actions from the previous inspection report.

Other inspections for this house

The Green 18/05/06

The Green 29/09/05

The Green 27/09/04

The Green 15/04/04

Similar services:

Trevaylor Manor

Stallcombe House

Stroud Lodge

The Woodmill

Woodland Vale

Bolealler House

Claremont Nursing Home

Althea Park House

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

CARE HOMES FOR OLDER PEOPLE The Green Drump Road Redruth Cornwall TR15 1LU Lead Inspector Lynda Kirtland Unannounced 14 April 2005 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 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. The Green Version 1.10 Page 3 SERVICE INFORMATION Name of service The Green Address Drump Road Redruth Cornwall TR15 1LU 01209 215250 01209 313375 Telephone number Fax number Email address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Cornwall Care Limited Mr Alan Johnston Care Home 45 Category(ies) of Dementia - over 65 years of age (45), Mental registration, with number Disorder, excluding learning disability or of places Dementia - over 65 years of age (45) The Green Version 1.10 Page 4 SERVICE INFORMATION Conditions of registration: Service users to include up to 45 adults aged over 65 with dementia (DE(E)) (31.01.05) Service users to include up to 45 adults aged over 65 with a mental illness (MD(E)) (31.01.05) To accommmodate one named service user outside the registered categories of the home (31.07.03) To accommodate one named service user outside the registered categories of the home (11.05.04) To accommodate one named service user outside the registered categories of the home (30.11.04) To accommodate one named service user outside the registered categories of the home (14.02.05) Total number of service users not to exceed a maximum of 45 (31.01.05) Date of last inspection 27 September 2004 Brief Description of the Service: The Green is one of eighteen homes owned by Cornwall Care Ltd. It is registered to accommodate forty five older people suffering with dementia, or mental disorder, plus to provide care and accommodation for three named service users out of registration category. It provides a service to those in need of personal care and who are over retirement age. Admissions are on a planned bases and emergency admissions are avoided whenever possible. Other services that The Green can provide are respite care, and a day care facility. The Green is a purpose built two storey building in its own grounds. Inside the home are seven ‘wings’, which comprise of service users bedrooms, access to toilet/bathing facilities and a lounge/dining room, which is also equipped with a small kitchenette area. There are three double bedrooms and the remaining rooms are for single occupancy. Lifts allow access to both floors and thus accessibility to all parts of the home for service users. There is a large communal lounge area on the ground floor. A safe garden area is accessible to all service users . The home is close to local amenities and a short distance from Redruth town. The Green Version 1.10 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspector visited The Green on the 14 April 2005 and spent the day at the home. This was an unannounced visit. On the day of inspection 35 service users were resident in the Green. The inspector met with 17 service users and 3 representatives, a number of staff and the registered manager to gain their views on the service that The Green provide. In addition the inspector examined records, policies and procedures and toured the building. This report summarises the findings of this inspection. What the service does well: What has improved since the last inspection? Since the previous inspection The Green has extended the home which has resulted in The Green being able to provide care and accommodation to a further 16 service users. The new extension has been registered and service users are gradually moving into the new wings that have been created at the home. This has also meant that the registered manager has needed to recruit additional, suitable staff and provide appropriate training to ensure that there is sufficient staffing on duty at all times. Feedback from staff and service users The Green Version 1.10 Page 6 was that staffing levels have increased and all felt that there were sufficient staffing levels within the home at all times. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The full report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The Green Version 1.10 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Standards Statutory Requirements Identified During the Inspection The Green Version 1.10 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 2,3,5 Prior to admission, service users and their representatives participate in a pre admission assessment with members from the management team to identify individual care needs. The Green discusses with service users and their representatives the suitability of providing a trail period of stay within the home. The trial visit is planned and undertaken at the service users pace. Emergency admissions are avoided wherever possible. EVIDENCE: The Green Version 1.10 Page 9 From discussion with service users and their representatives, plus inspection of service users files it was evident that they are consulted in the Greens pre admission assessment. Care needs identified by the referring professional assessments were incorporated in the assessment process and transferred to care plans This assessment is detailed and identifies the service users individual physical, emotional, social, educational and leisure needs and how the home would aim to address them. A months trail period is offered to all new service users after which a review is held with all parties present to consider if the placement is appropriate and if so that a long term placement will be provided. As The Green now have the provision to admit a further 16 service users to the home the registered manager stated that this process has been planned gradually so that current service users in the home have not been ‘overwhelmed’ by a number of new service users being admitted at the same time. Service users and their representatives commented that the admission process to the home was carried out in a ‘planned’ and ‘sensitive’ manner. Service users files recorded the admission process and service users ‘settling in period’. Financial expectations and accountability are clearly stated in the service users contract with the home, which has been signed, by the service users or their representatives and the home, or referring local authority. Throughout the inspection the inspector observed staff that displayed great skill in communicating and providing personal and emotional care to service users. Staff training is a priority to Cornwall Care Ltd and the staff commented that the training they receive assist them in their daily work. The Green Version 1.10 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 7and 9 Service users and their representatives are consulted in the implementation and subsequent reviews of their individual care plans. Care plans ensure that physical, emotional, social, educational and leisure pursuits are assessed and action to address the care needs are detailed for all staff to meet in a consistent manner. The medication at the home is well managed promoting good health. EVIDENCE: The Green Version 1.10 Page 11 From discussion with service users, their representatives, staff and inspection of documentation it was evident that individual care needs are identified appropriately. From inspection of service users files, and in discussions it is evident that the Green encourage service users and their representatives to express their views in the formation of their care plans. The care plans are detailed documents, which clearly identify service users skills and where assistance is needed. From this the care plan specifies what actions staff should take to ensure that the care need is approached in a consistent manner. Staff confirmed that they are more involved in the care planning and reviewing stages of the individuals care plan. The registered manager stated that corporate training is occurring in the development of care planning process, which will be cascaded to all staff. Health needs were not inspected in detail, however service users and their representatives commented that health needs are met by the staff at the home and by external professionals to a high standard. Records of all health professional visits are recorded in detail. The administration, storage and disposal of medication processes were inspected. From this the inspector noted the following: Cornwall Care Ltd medication policy is comprehensive and evidenced that delegated staff have read the policy; delegated staff receive annual training in the administration, storage and disposal of medication; A pharmacy agreement was seen, this was out of date (Nov 2003) and needs to be updated; Staff stated that they have a positive relationship with the pharmacist and can contact her for advice; A logbook regarding returned medication to the pharmacist was shown to the inspector and was signed appropriately; The controlled drug register was inspected and cross- referenced to a tablet count, all corresponded; Controlled drugs were stored correctly as was other medication; Records required were filled out correctly: The storage of creams prescribed to service users was inspected and was satisfactory; Inspection of service users files confirmed that the administration of medication is included in their individual care plans; Signed permission from service users or their representatives is gained in order that the home has authority to administer medication. The previous inspection required that the registered manager undertake regular auditing of the medication process this now occurs, along with the district nurse support in checking the storage of creams and administering any injections or dressing. The district nurse was complimentary in how the staffs at the home ask her for appropriate advice, and that they then act on the advice given. The district nurse stated that they are offering training in specific medical areas for to the Green, which has been received positively. The Green Version 1.10 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 12,13,14,15 The Green ensures that service users social, educational and leisure needs are identified and aim to provide a variety of activities in the home. Service users visitors are encouraged to visit their relative. The Green encourages service users to retain links with the local community. Cornwall care limited are reviewing the provisions of meals in all the homes, to ensure a high standard of dietary provisions are maintained. EVIDENCE: The Green Version 1.10 Page 13 From discussions with service users and their representatives they commented that there is ‘enough to do’ during the day at The Green. Service users recalled a variety of activities that are provided such as gardening, Chinese new year party, celebrations, hand massage, nail painting, games, keep fit and a annual holiday. In addition the home employs a day care coordinator as up to four service users a day attend. All service users in the home are encouraged to participate in the day care activities, which are held in the main lounge. The inspector observed a variety of activities occurring during the inspection. The Green has a certificate from the National Association for Providers of Activities for Older Persons Project dated 1.10.04 for their participation in this survey. The findings of which were positive in how The Green provides social, educational and leisure activities. The Green policies and documentation demonstrate that they aim to encourage service users to pursue their hobbies and interests, and individual interests are recorded in service user care plans. Residents meeting are not officially held; the registered manager stated that staffs individually discuss with service users and their representatives their views on the service that the home provides to ensure that it is meeting current need. Service users have opportunities to access advocates and some choose to have relatives act on their behalf. Relatives and service users stated that the home is welcoming to them. All service users made positive comments to the inspector in the variety and quality of food provided. It was evident from discussions with service users and their representatives and staff that there is a choice of main meal and that alternative meals will be provided. Kitchen staffs were aware of individual dietary needs. From the inspectors discussion with kitchen staff and documentation seen it was evident that the kitchen staff have a sound knowledge of dietary needs, catering and appropriate qualifications. The dining areas were furnished to a good standard. Cornwall Care ltd has provided training to all homes managers and chefs in the ‘Food Project’. This has focused on the nutritional and social aspects of food. It’s aim is to provide a service users focused meal provision encouraging meal times to be social occasions whilst allowing service users the opportunity to maintain their own independence and skills i.e. encouraging self serving of food, and to improve the presentation of meals. The home is purchasing new furniture 9ie serving dishes and trolleys) to implement this project. The inspector observed freezers and fridges to be well stocked. All appropriate paperwork was in place. A recent Environmental Health Inspection did not identify any issues. The Green Version 1.10 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 16 Cornwall care Ltd has a corporate complaints and whistle blowing policy. The Greens complaint policy is on display and the management team encourage service users and their representatives and staff to voice any concerns so that they can be addressed. EVIDENCE: Cornwall Care Ltd has completed policies in respect of the complaints procedures. CSCI received an anonymous complaint in respect of staffing levels. An unannounced inspection was undertaken where it was acknowledged that due to the recent opening of the new wings, plus staff sickness and annual leave The Green was struggling to maintain appropriate staff levels. However The Green were taking appropriate actions to remedy this and in this inspection staff in particular commented that staffing levels were more ‘consistent’ and that there were ‘more staff on duty now’. (Please see staffing section for more details). From the inspectors discussions with staff and service users and their representatives all stated that they had ‘no grumbles or worries’ and that if they had they felt able to approach the management team for these to be addressed. From discussion with some service users they confirmed that they had a postal vote to use in the forthcoming general Election. The Green Version 1.10 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 19,20,21,22,23,24,25,26 The Green provides a good standard of décor and furnishings creating a comfortable and safe environment for those living there and visiting. EVIDENCE: From a tour of the home it was evident that The Green have invested considerably in the new extension of the home and are aiming to ensure that the older part of the home is maintained to the same standard. The Green has a continuous redecoration and maintenance programme to ensure that all parts of the home are presented and maintained to a good standard. Service users and their representatives all commented that they are pleased with the homes presentation and quality of furnishings. The Green has updated its garden area; the area is secure, safe and has raised flowerbeds to enable service users to participate in gardening activities if they wish too The Green has lifts, which allows access to all parts of the home. There is a mixture of lounge areas so that service users and their representatives can The Green Version 1.10 Page 16 choose where to sit, either in the quieter areas or the main lounge. In the main bedrooms are for single occupancy. All rooms inspected were clean and decorated to a good standard, were personalised and service users had the option to lock their rooms if they wish. The Green has suitable laundry facilities. Service users commented that the laundry service is ‘good’ and did not raise any issues in this area. There are suitable bathing and toileting facilities in the home. Aids and adaptations were evident to assist with mobility and transfers. There were sufficient sluicing facilities in the home. Service users representatives in particular were positive in their comments in how the home maintained cleanliness. From the inspectors observation this was confirmed. The inspector noted that in the new wings the call bell facility was in place but the cords had not been attached. This would make it difficult for service users to contact staff for help if they had for example a fall. The registered manager agreed with this and stated this would be rectified immediately. Due to this response a recommendation has been identified and not a requirement. The Green Version 1.10 Page 17 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 considers Standards 27, 29, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 27,29 The green ensures that suitable trained staffs are employed in sufficient numbers at all times. EVIDENCE: On the day of inspection six care staff plus a ‘float, domestics, handyperson, kitchen staffs, laundress, administrator and managers were on duty. At night there are three waking night staff plus a manager sleeping in. The Green has no staff vacancies. The registered manager has successfully employed sufficient staff so that the last wing in the home can now be filled. The Green will ensure that a minimum of one care assistant plus a float is present on all 7 wings in the home at all times. Due to the increase in numbers of service users extra domestic and kitchen hours have been implemented. The registered manager stated that ideally he would like to employ a further two staff to allow more individual time with service users but the current rota is sufficient. From discussion with staff they all commented that there had been an increase in staffing levels. Service users and their representatives shared this view. The inspector observed staffs that were competent in their work. Service users and their representatives were complimentary about the skills and attitude of staff; i.e. ‘they are caring’, ‘wonderful’, and ‘patient’ to name a few examples. From inspection of staff files it was evident that The Green follows Cornwall Care Ltd corporate employment processes. Staff files evidenced all necessary The Green Version 1.10 Page 18 documentation i.e. references, CRB/POVA checks. Staff commented to the inspector that they had completed an induction programme and some were due to attend Cornwall Care Ltd Introduction course. All stated that they felt supported in their work and raised no issues. The Green Version 1.10 Page 19 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 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for standard(s) 38 The Green ensures that the home is maintained to a safe standard for those who live or visit the home. EVIDENCE: Records held by the home are stored in a confidential manner and in line with the Data protection Act. From inspection of The Greens various documentation and maintenance certificates, this confirmed that inspections from the fire authority, environmental health had been completed. Equipment in the home had service records and Cornwall Care have comprehensive policies in the remit of health and safety, Legionella and COSHH. The fire plan of the home has been updated to include the new extension. Staffs have attended relevant training in the areas of fire, health and safety, manual handling and infection control. The Green Version 1.10 Page 20 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. Where there is no score against a standard it has not been looked at during this inspection. 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score x 3 3 x 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 x 9 3 10 x 11 x DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION 3 3 3 3 3 3 3 3 STAFFING Standard No Score 27 3 28 x 29 3 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x x x x x x x x x 3 The Green Version 1.10 Page 21 no Are there any outstanding requirements from the last inspection? 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 Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard OP22 Good Practice Recommendations the call bell facility should be accessible for service users The Green Version 1.10 Page 22 Commission for Social Care Inspection John Keay House Tregonissey Road St Austell Cornwall PL25 4AD National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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