Inspection on 17/10/06 for The Green

This inspection was carried out on 17th October 2006.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is (sorry - unknown). 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 no outstanding requirements from the previous inspection report, but made 1 statutory requirements (actions the home must comply with) as a result of this inspection.

Other inspections for this house

The Green 15/09/08

The Green 21/01/06

The Green 06/10/05

The Green 10/03/05

The Green 23/08/04

The Green 01/03/04

Similar services:

Clover House

Parkside

Park Lodge

Mere Hall View

St Bonaventures

Hudson Road

Whitewalls

Home Farm

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

CARE HOME ADULTS 18-65 The Green Bromborough Pool Bromborough Wirral CH62 4TT Lead Inspector Peter Cresswell Key Unannounced 17 and 19 October 2006 09:30 th th The Green DS0000019008.V305903.R01.S.doc Version 5.2 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 The Green DS0000019008.V305903.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 Adults 18-65. 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 DS0000019008.V305903.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Green Address Bromborough Pool Bromborough Wirral CH62 4TT 0151 643 8567 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) Wirral Autistic Society Patricia Sarah Anne Hood Care Home 10 Category(ies) of Learning disability (10) registration, with number of places The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: Date of last inspection 21st January 2006 Brief Description of the Service: The Green is a large house consisting of four flats that are accessible to one another and share the same main entrance. Two of the flats accommodate two service users, and the other two flats are for three service users each. All of the residents have single bedrooms. Each flat also has a bathroom and a kitchen with a dining area and either a through or separate lounge. There is a patio and a garden at the rear of the home. The home is close to local shops and to public transport services and overlooks the open space of The Green in Bromborough Pool Village. Parking is available on the road outside the home. The home is run by Wirral Autistic Society who have several care homes for adults with a learning disability in the area. The society provides a range of services and facilities, which are used by the service users at The Green. The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This inspection included an unannounced site visit followed up by a second brief visit when the inspector was able to speak to some of the service users. He toured the home and spoke to the Registered Manager and other members of support staff. He examined records including care plans, a sample of medication records, staff recruitment files, training records and safety records. The Registered Manager did not return a CSCI pre inspection questionnaire before the site visit. What the service does well: What has improved since the last inspection? What they could do better: 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 Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 6 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–5) Individual Needs and Choices (Standards 6-10) Lifestyle (Standards 11-17) Personal and Healthcare Support (Standards 18-21) Concerns, Complaints and Protection (Standards 22-23) Environment (Standards 24-30) Staffing (Standards 31-36) Conduct and Management of the Home (Standards 37 – 43) Scoring of Outcomes Statutory Requirements Identified During the Inspection The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 7 Choice of Home The intended outcomes for Standards 1 – 5 are: 1. 2. 3. 4. 5. Prospective service users have the information they need to make an informed choice about where to live. Prospective users’ individual aspirations and needs are assessed. Prospective service users know that the home that they will choose will meet their needs and aspirations. Prospective service users have an opportunity to visit and to “test drive” the home. Each service user has an individual written contract or statement of terms and conditions with the home. The Commission consider Standard 2 the key standard to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2 and 5. Quality in this outcome area is good. Prospective service users are assessed before they come to The Green, making sure that the home can meet their needs. Service users have access to information on the home, though some of it needs to be updated. EVIDENCE: No new residents have been admitted since the last inspection but the files examined all had evidence of assessments done when the residents were admitted. The Wirral Autistic Society – the owners – have well established procedures for the assessment of prospective service users. The home has a service user guide in the form of an attractively presented and clearly written leaflet. The leaflet does not include all of the information required by the Care Homes Regulation 5 or that needed to meet National Minimum Standard 1.2. It would be advisable to redraft the guide and include information on how service users can get, for instance, CSCI reports on the home. All of the files examined had copies of contracts which had been signed by the service user and a carer/relative acting on their behalf. Fees are negotiated individually, mainly with local authorities, and range from £876 to £1672 a week, reflecting the nature and level of the support provided in each case. This latter package includes on-to-one support. Residents are placed at The Green from local authorities all over the country. The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 8 Individual Needs and Choices The intended outcomes for Standards 6 – 10 are: 6. 7. 8. 9. 10. Service users know their assessed and changing needs and personal goals are reflected in their individual Plan. Service users make decisions about their lives with assistance as needed. Service users are consulted on, and participate in, all aspects of life in the home. Service users are supported to take risks as part of an independent lifestyle. Service users know that information about them is handled appropriately, and that their confidences are kept. The Commission considers Standards 6, 7 and 9 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7, 8, 9, 10. Quality in this outcome area is good. Care planning reflects the assessed and changing needs of service users though care plans do need to be kept fully up to date. EVIDENCE: Residents’ files included an enormous amount of useful and relevant information about the resident and their needs. This included some psychologists’ reports, pen pictures, behaviour management plans, risk assessments and care plans. The care plans were detailed and covered all aspects of the residents’ lives. Reviews are carried out regularly and residents, relatives, key workers and other relevant professionals are invited to attend. The annual reviews in particular are recorded in commendable detail and the dates of reviews are noted on the care plan or other relevant documents such as risk assessments. However, the actual care plans had not in very case been amended to include any changes agreed at the review and this could potentially be misleading. The Registered Manager said that there are plans to update the care plans in line with review decisions. Staff are very familiar with the changing needs of the residents they work with and are aware of the content of the reviews, so there was no evidence that this issue had caused any problems in practice. Residents are encouraged to take part in the everyday running of the home; they help with keeping their own flats clean The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 9 and tidy and with cooking. One of them prepares most of his own meals. Some of the residents go shopping with staff. Residents are encouraged to take appropriate risks and risk assessments are on file which also set out any restrictions which may need to be placed on residents – very few of them go out on their own, for instance. Staff organise residents’ meetings where they can discuss any issues about the running of the home. Detailed files and individual diaries for each resident are kept in the flats as are hard backed communication/handover books. Much of the information contained in the handover books is confidential in nature and should be recorded either in the individual diaries or on loose leaf sheets which can be filed on the individual’s personal file. The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 10 Lifestyle The intended outcomes for Standards 11 - 17 are: 11. 12. 13. 14. 15. 16. 17. Service users have opportunities for personal development. Service users are able to take part in age, peer and culturally appropriate activities. Service users are part of the local community. Service users engage in appropriate leisure activities. Service users have appropriate personal, family and sexual relationships. Service users’ rights are respected and responsibilities recognised in their daily lives. Service users are offered a healthy diet and enjoy their meals and mealtimes. The Commission considers Standards 12, 13, 15, 16 and 17 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 11, 12, 13, 14, 15, 16, 17. Quality in this outcome area was good. Residents are able to take part in appropriate activities that provide opportunities for their educational, social and personal development. There are good links with the local community and family and personal relationships are appropriately supported. Residents have varied and well-balanced meals in homely surroundings. EVIDENCE: Residents attend day services or other activities on weekdays. They have a range of opportunities to promote their personal development. Each resident has a schedule of activities, which is kept in the individual flats for daily reference. These are designed to meet their needs, skills and individual preferences. In some cases there is a highly detailed timetable to help to make sure that the resident does not spend too long on a particular activity, to the detriment of their overall well being. The opportunities available include horticulture, craftwork, work experience and physical education. Wirral Autistic Society itself provides a wide range of day services, both in the adjoining garden centre and in other local centres, and some residents also attend activities provided by other organisations such as local colleges. The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 11 Residents have the chance to get involved in the local community. For example, they visit local shops, go to the gym or pictures and join in community life through attending college courses. The home has its own transport – a minibus - and there is easy access to train and bus services. Several staff are trained to drive the bus. There was evidence from the files that residents’ sexual needs are taken seriously and are accounted for in the care planning process. Family and carer involvement is highly valued by the Wirral Autistic Society and there was considerable evidence on files of the involvement of families in the support provided to the residents. Relatives are invited to reviews and many of them attend. Relatives and friends are encouraged to visit The Green at any time that the residents so choose. Care plans indicate the dietary requirements of each resident are met and staff obtain advice from a dietician if necessary. A record is kept of food provided to service users but these were still not very detailed and were in some cases not complete. In one diary the record of food served had actually been partly completed in advance, which, of course, subverts the whole point of the exercise. One resident told the inspector that he chose his own meals and it was evident from observation and discussion with staff that the residents could choose what to eat, with guidance from staff on issues such as healthy eating. The residents help with cooking and on the day of the second site visit one had made scones at her day service. The residents eat in their own domestic style kitchen diners in the individual flats. The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 12 Personal and Healthcare Support The intended outcomes for Standards 18 - 21 are: 18. 19. 20. 21. Service users receive personal support in the way they prefer and require. Service users’ physical and emotional health needs are met. Service users retain, administer and control their own medication where appropriate, and are protected by the home’s policies and procedures for dealing with medicines. The ageing, illness and death of a service user are handled with respect and as the individual would wish. The Commission considers Standards 18, 19, and 20 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, 20. Quality in this outcome group is good. The home meets the personal care and health needs of its residents. Residents’ interests are safeguarded by the home’s practices for the administration of medication but attention does need to be paid to the detail of recording. EVIDENCE: Records set out any support residents need with their personal care. The Green operates a key worker system, which provides continuity of support for residents. The inspector spoke to two key workers who had in depth knowledge and understanding of the residents. Induction training includes sessions on promoting privacy and dignity. Records indicate that residents have access to community and specialist health care services as needed and they are supported in attending health care appointments. Accidents are properly recorded. Medication is stored securely and staff are trained in the administration of medication. A selection of medication administration record (MAR) sheets and corresponding medication was inspected and found to be in order though some medication had been taken away for a weekend visit and its return had not yet been recorded. It is important that staff continue to pay attention to this sort of detail. Any service users who administer their own medication do so in accordance with a recorded risk assessment. The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 13 Concerns, Complaints and Protection The intended outcomes for Standards 22 – 23 are: 22. 23. Service users feel their views are listened to and acted on. Service users are protected from abuse, neglect and self-harm. The Commission considers Standards 22, and 23 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22, 23. Quality in this outcome area is good. Policies and procedures are in place to ensure that residents’ views are heard and appropriate action taken. EVIDENCE: There is information available to enable a resident to make a complaint, or for an advocate/relative to do so on their behalf. The complaints procedure includes the timescales for dealing with each stage of a complaint and is displayed on the residents’ notice boards. The procedure is available in different formats to reflect the abilities of service users. The copy of the procedure shown to the inspector still referred to the National Care Standards Commission, which was abolished in 2005; all such references must be replaced by the Commission for Social Care Inspection. A record is kept of any complaints made. One complaint had been made (by a relative) since the last inspection and its investigation was fully recorded The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 14 Environment The intended outcomes for Standards 24 – 30 are: 24. 25. 26. 27. 28. 29. 30. Service users live in a homely, comfortable and safe environment. Service users’ bedrooms suit their needs and lifestyles. Service users’ bedrooms promote their independence. Service users’ toilets and bathrooms provide sufficient privacy and meet their individual needs. Shared spaces complement and supplement service users’ individual rooms. Service users have the specialist equipment they require to maximise their independence. The home is clean and hygienic. The Commission considers Standards 24, and 30 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 25, 26, 27, 28, 30. Quality in this outcome area is good. The Green provides comfortable, well decorated and spacious accommodation for its residents, though sleeping in arrangements impinge on the residents access to a lounge. EVIDENCE: The Green is a large building originally consisting of two houses. It is fully accessible to all of the residents. It is in Bromborough Pool village, facing the open space of The Green from which the house takes its name, and is close to local services and public transport links. The Wirral Autistic Society’s garden centre is next door. The premises are well maintained and the owners have their own maintenance section which responds to written requests from the Registered Manager or other members of staff. It was not entirely evident that all repairs are dealt with as quickly as they might, though the Registered Person said that emergencies are always responded to promptly. It would be helpful if maintenance staff left a completion note or similar document to avoid any confusion (though strictly speaking that may beyond the remit of this report). The individual flats are well furnished and staff said that the owners respond to requests for replacements, though there may be a wait until the budget is available. Residents are able to choose the colour schemes when rooms are redecorated and this was evident from an inspection of some residents’ rooms. Walls are painted rather than papered. The one area of the The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 15 building which does need serious attention is the office, which needs to be redecorated. The filing space in the office should also be reviewed. Although this does not directly affect the care and support of the residents it provides a poor working environment for the staff. Each flat has its own lounge, bathroom, kitchen and dining area. The exact layout is different in each flat; some often have separate lounges, others have a through lounge connected to the kitchen/diner. All of the residents have single bedrooms which are spacious, well decorated and personalised. The inspector toured the home and looked at most rooms though he did not visit any rooms where the resident had requested otherwise. The house was clean and odour free on this unannounced site visit. Sleep in staff still use one of the residents’ lounges as sleeping accommodation. This is entirely unsatisfactory as the lounge is not then available for the use of the residents. The Registered Manager said that in practice this had not caused any problems – and this is accepted - but the Registered Person needs to address the situation to ensure that staff sleeping in facilities do not impinge on the residents’ space. The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 16 Staffing The intended outcomes for Standards 31 – 36 are: 31. 32. 33. 34. 35. 36. Service users benefit from clarity of staff roles and responsibilities. Service users are supported by competent and qualified staff. Service users are supported by an effective staff team. Service users are supported and protected by the home’s recruitment policy and practices. Service users’ individual and joint needs are met by appropriately trained staff. Service users benefit from well supported and supervised staff. The Commission considers Standards 32, 34 and 35 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32, 33, 34, 35. Quality in this outcome area is good. The number of staff available and the training provided to staff meets the needs of the residents. Recruitment practices protect the interests of the residents. EVIDENCE: There are normally four or five support staff on duty plus the Registered Manager during office hours. If any resident decides for whatever reason to stay at home rather than attend a day service then staffing is provided even if there is nobody originally scheduled for duty. It is however considered to be important that residents maintain a regular and full schedule of activities. Two staff sleep in at night and the Registered Manager feels, on the basis of a risk assessment, that this is an appropriate arrangement. Wirral Autistic Society has an extensive training programme that includes comprehensive induction for all new staff. Recent training has included ‘Nonviolent Crisis Intervention’ which is being provided to all staff via an outside specialist training provider. Other training, in addition to required training such as Moving and Handling, has included ‘Learning disability and mental health awareness’, Managing Stress, and Team Building. Two Team Leaders have NVQ3 and two support workers have NVQ2. One member of staff is studying for NVQ2 and this leaves The Green short of the target for 50 of care staff to have the qualification as set out in National Minimum Standard 32. The owners need to take steps towards meeting this standard. The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 17 Three new staff have started since the last inspection and the recruitment records for all of them were checked. Copies of Criminal Records Bureau certificates were provided from the Registered Person’s head office, where they are normally stored. All applicants are now asked to provide a medical questionnaire and if appropriate a medical report. Records are kept of the interviews and staff do not start work until a CRB certificate is received, or, it that is delayed, confirmation is received that the applicant is not on the POVA (Protection Of Vulnerable Adults) register. Staff are appropriately supervised by the Registered Manager though these records were not examined on this occasion. The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 18 Conduct and Management of the Home The intended outcomes for Standards 37 – 43 are: 37. 38. 39. 40. 41. 42. 43. Service users benefit from a well run home. Service users benefit from the ethos, leadership and management approach of the home. Service users are confident their views underpin all self-monitoring, review and development by the home. Service users’ rights and best interests are safeguarded by the home’s policies and procedures. 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 are promoted and protected. Service users benefit from competent and accountable management of the service. The Commission considers Standards 37, 39, and 42 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 37, 38, 39, 42. Quality in this outcome area is good. There are systems in place to ensure that the health and safety of residents is protected though some improvements need to be made in respect of the recording of food safety precautions. The Green’s various quality assurance measures underpin the home’s development plans. EVIDENCE: The Registered Manager has several years experience in management in a care setting and has nearly completed an NVQ Level 4 in the management of care. Training around safe working practices such as manual handling, fire safety, infection control and first aid is made available to staff as part of their induction. There is a rolling programme of training opportunities provided which staff can access when required. There is a range of policies and procedures to promote safe working practices. The owners, Wirral Autistic Society, have a health and safety advisor who provides advice and is responsible for promoting a safe environment within the Society’s homes. A sample of safety check records and tests were inspected and were found to be in order. A five year gas safety certificate had been issued on 20 June 2006 The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 19 and the electrical wiring safety certificate is valid until October 2009. Fire safety checks and training were found to be in order. Fridge and freezer temperatures are checked and recorded but there was not a complete record of these and they were not recorded every day. The Registered Manager should contact the local Environmental Health Officer with a view to exploring the use of the Food Standard Agency’s ‘Safer Food, Better Business’ pack to monitor the home’s food safety and hygiene. In the meantime fridge and freezer temperatures should be checked and recorded every day. The Wirral Autistic Society is accredited by the National Autistic Society and this involves scrutiny of all its services, including The Green, each year. The Registered Manager sends quality assurance surveys to parents and carers of residents every year and occasionally to the residents themselves. The residents themselves provide feedback to staff on a daily basis. There is no formal annual review of the quality assurance returns. The Society’s Chief Executive visits The Green regularly to conduct montioring visits to comply with regulation 26 of the Care Homes Regulations 2001. The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 20 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Adults 18-65 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 3 2 3 3 x 4 x 5 3 INDIVIDUAL NEEDS AND CHOICES Standard No 6 7 8 9 10 Score CONCERNS AND COMPLAINTS Standard No Score 22 3 23 3 ENVIRONMENT Standard No Score 24 3 25 3 26 3 27 3 28 3 29 x 30 3 STAFFING Standard No Score 31 x 32 3 33 3 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 3 3 3 3 2 LIFESTYLES Standard No Score 11 3 12 3 13 3 14 3 15 3 16 3 17 3 PERSONAL AND HEALTHCARE SUPPORT Standard No 18 19 20 21 Score 3 3 3 x 3 3 3 x x 2 3 The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 21 Are there any outstanding requirements from the last inspection? No 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 YA42 Regulation 16(j) Requirement The Registered Person must ensure that satisfactory standards of hygiene are maintained and must therefore ensure that fridge and freezer temperatures are monitored and recorded every day. Timescale for action 01/11/06 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. Refer to Standard YA1 Good Practice Recommendations The Registered Person should review the service user guide and complaints procedure to ensure they contain all of the information set out in the regulations, including the name and address of the Commission for Social Care Inspection. Care plans should be promptly amended to reflect changes agreed during reviews. Daily reports containing confidential or sensitive information should be made on the individual service user’s file or diary, not in a communications book. The office should be redecorated and supplied with DS0000019008.V305903.R01.S.doc Version 5.2 Page 22 1. 2. 3. YA6 YA10 YA24 The Green sufficient office furniture to store all of the home’s documentation. 2. 3. 4. YA28 YA32 YA42 Alternative sleeping-in accommodation for staff should be provided. The home should continue to take steps to ensure that at least 50 of care staff have NVQ2. The Registered Manager should consult the Environmental Health Officer with a view to using ‘Safer Food, Better Business’. The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Liverpool Satellite Office 3rd Floor Campbell Square 10 Duke Street Liverpool L1 5AS National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI The Green DS0000019008.V305903.R01.S.doc Version 5.2 Page 24 - 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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