CARE HOMES FOR OLDER PEOPLE
The Green Drump Road Redruth Cornwall TR15 1LU Lead Inspector
Lynda Kirtland Announced Inspection 29th September 2005 09:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information
Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address The Green DS0000009107.V251151.R01.S.doc Version 5.0 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. The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 3 SERVICE INFORMATION
Name of service The Green Address Drump Road Redruth Cornwall TR15 1LU 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) 01209 215250 01209 313375 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 DS0000009107.V251151.R01.S.doc Version 5.0 Page 4 SERVICE INFORMATION
Conditions of registration: 1. 2. 3. 4. 5. 6. 7. Service users to include up to 45 adults aged over 65 with dementia (DE[E]) Service users to include up to 45 adults aged over 65 with a mental illness (MD[E]) To accommodate one named service user outside the registered categories of the home. To accommodate one named service user outside the registered categories of the home. To accommodate one named service user outside the registered categories of the home To accommodate one named service user outside the registered categories of the home Total number of service users not to exceed a maximum of 45 Date of last inspection 14th April 2005 Brief Description of the Service: The Green is one of eighteen care 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 DS0000009107.V251151.R01.S.doc Version 5.0 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. The inspector visited the Green Residential Home on the 29 September 2005 and spent ten hours at the home. This was an announced visit. The purpose of the inspection was to gain an update on the progress of compliance to the requirements that were identified in the last inspection report dated 14 April 2005. In addition the inspector focused on the following key areas of care: choice of home, care planning, health care, leisure, complaints, staffing and some management areas. On the day of inspection 41 service users were resident in the home. The methods used to undertake the inspection are to meet with a number of residents, their representatives, staff and the interim manager to gain their views on the services that the Green offer. A pre inspection questionnaire was completed which is similar to a survey asking for information on what services/facilities the home provide. The Green records, policies and procedures were examined and the inspector toured the building. The registered manager has not been present at the home for the last few months and was absent for this inspection. Therefore an interim manager has been appointed, Sharon Colsten. It is acknowledged that due to her recent arrival and changes within the staffing structures of the home that The Green has undergone a period of instability, confirmed by staff, residents and relatives. This did affect the findings of the inspection process as detailed in this report and by the number of statutory requirements and recommendations that were identified on this visit. This report summarises the findings of this inspection. What the service does well:
Residents and their representatives stated that The Green provides good quality care and accommodation. Residents all commented positively about the quality and choice in the daily menus. Additional comments were made about staff such as; they are ‘kind’, ‘caring’ and ‘patient’. Family members commented that they felt that they were consulted about their relatives care needs which staff ‘met to the best of their abilities’. Residents and their representatives were complimentary about staff skill and attitude. Individual care plans are formulated with residents and their relatives. Assessments from referring agencies such as social services and health colleagues are received and are incorporated in the assessment process, which leads to an individualised care plan being produced. The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 6 Residents and their representatives commented that they have access to health care and felt that all their health needs were met to a ‘good’ standard. Health professionals spoken to also commented that The Green’s standard of health care has recently ‘improved’ and felt that referrals to them were appropriate and that the staff listened to their advice and put it into action. The home and local community provides a varied and stimulating programme of activities. These were observed during the inspection. Visitors felt they were welcomed to the home, as was the inspector during this inspection process. Cornwall Care prioritises staff training and is keen to continue to develop staff skills. Staff were complimentary about the training they receive. What has improved since the last inspection? What they could do better:
The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 7 The Greens Statement of purpose, which explains the services that the home provides, must be reviewed in order that it accurately reflects the services that the Green provides. From inspection of four residents files it was noted that the pre admission documentation was completed to differing standards. With new admissions, one was completed with sufficient detail to ensure that staff were aware of the individuals care needs and what intervention from staff was needed to meet this need in a consistent manner. However in two files this was lacking. The interim manager agreed to review the pre admission documentation. The interim manager agreed to review residents risk assessments, in particular around moving and handling issues to ensure that clear guidance is recorded as to how staff are to intervene with an individual following a fall. In addition it needs to specify what equipment, if any is to be used. Some fire doors were wedged open, this must not occur due to health and safety risks. From this inspection a recommendation was identified to expand the adult protection policy and procedure. Cornwall Care ltd has discussed the amendments needed and is in the process of complying with this. The interim manager agreed to review an incident of how a resident’s money has been distributed. The homes policy in respect of management of resident’s monies is satisfactory and all records inspected were satisfactory. The main concern that was highlighted from this inspection was in respect of staffing levels. Since the opening of the two new wings staff commented that there is additional pressures on their time to complete all their tasks. The inspector observed, confirmed by general assistance and relatives comments that the standard of cleanliness and the general appearance in the home has dropped. The reasons cited for this is the additional wings to clean, staff sickness and a handyperson post was vacant for some months. In respect of catering staff they commented that there were insufficient staff to be able to promote Cornwall Care Ltd ‘Appetite for Life’ project as this has created more demands on their time. In respect of care staff examples were brought to the inspectors attention from relatives that there is insufficient staffing levels at the home. Two incidents were reported where allegations were made that residents were left for long periods of time with no staff monitoring. This led to relatives caring for their own relatives plus other residents in the home i.e. assisting at mealtimes. The inspector also observed a near accident by a resident when a staff member had to leave a lounge area to collect items from the kitchen. In discussion with the interim manager she agreed that staffing levels need to be reviewed urgently and is in the process of doing this with her group manager. The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 8 The Green has experienced staff changes in the home, particularly in the management team. Due to this staff commented that this has had an impact on the home and on staff morale. Staff are requesting that a meeting with the management team would be beneficial to gain a understanding of the current situation and any future plans. The interim manager agreed to arrange this. Staff and relatives do not currently know the interim manager and relations with her are developing. Due to the changes in the staff team, supervision has not occurred this needs to recommence and will assist in building staff morale and venues for staff to express their views. This inspection identified eight requirements and three recommendations. Due to the concerns highlighted, in particular around staffing levels CSCI will be monitoring this closely and will incur further unannounced visits to the home. The inspector would like to thank the residents, staff and management team for their assistance during this inspection process. 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 DS0000009107.V251151.R01.S.doc Version 5.0 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 The Green DS0000009107.V251151.R01.S.doc Version 5.0 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 at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 1,3,4 The Green has a statement of purpose that is provided to future residents of the home, this needs to be reviewed to ensure that it accurately reflects the services that The Green provides. Prior to admission, service users and their representatives participate in a pre admission assessment with members from the management team. This needs to be developed further to clearly identify individual residents needs. The Green has a competent staff team who are able to meet individual care needs. EVIDENCE: The Greens statement of purpose must be reviewed to ensure that it accurately reflects the services that The Green provides. This was discussed with the interim manager who agreed to review this document. From inspection of four residents files there was documented evidenced that a pre admission assessment by The Green with the resident or their representative had taken place in three files (one had been at the home for a number of years). The pre admission document is a corporate document and
The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 11 covers an assessment of all individual care needs. However the pre admission documents inspected were completed to differing standards. One had detailed information about the residents individual care needs and specified staff interventions to ensure care was provided in a consistent manner. Two were not completed in this manner and left staff with little guidance as to what interventions was needed. The interim manager agreed to review how the pre admission document was completed. Referral information from other agencies such as Social Services, health and previous care homes had been gained to assist in the admission process. From observations of staff, plus inspection of training records it was evident that the staff team are experienced in the area of older peoples care and receive training to update their knowledge in this area. It is planned that staff will attend some health training to expand their skills further i.e. in the areas of tissue viability, pressure sore care and diabetes. Throughout the inspection the inspector observed staff that displayed great skill in communicating and providing personal and emotional care to residents. The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 12 Health and Personal Care
The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,10 Care plans are being reviewed to ensure that they accurately reflect the individuals care needs and guide staff in how to intervene in their care. Health care needs are met to a good standard and relationships with health colleagues are positive. Staff at the home builds positive relationships with residents that are based upon the residents dignity and privacy. EVIDENCE: From discussion with the interim manager, she stated that the current care plans are being revised in the home. From the care plans a ‘care profile’ is compiled that specifies more clearly what actions care staff need to undertake to ensure that their interventions promote consistent care to each individual resident. The interim manager agreed that wording on this document must be specific so that staff are aware of what for example ‘assistance’ or ‘encouragement’ means and how this is then put into practice. A Care profile this was inspected and demonstrated clearer guidance in what and how care is to be provided to an individual. The care plans are reviewed on a regular bases. The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 13 Residents and relatives commented that health needs are met by the staff at the home and by external professionals to a good standard. Detailed records of all health professional visits to individual residents further evidenced this i.e. CPN, speech and language therapist, chiropodist, dentist and optician. In discussion with a district nurse, she commented that The Green make appropriate referrals to them and the GP service. The district nurse commented that she felt the level of care had ‘improved’ and that they are encouraging staff to attend some of their health care training to expand their knowledge and skills in the area of older peoples health care further. Medication was inspected on the last visit to the home and met the required guidance. The interim manager stated that The Green would be transferring to a new medication system in the near future. Therefore this was not assessed on this occasion. There is a monitoring system regarding the number of falls in the home. The number of falls is low and risk assessments to minimise falls for the individual are undertaken. The interim manager agreed risk assessments need to be expanded further so that it is clear how the risk was assessed and why a specific course of action needs to be taken. All residents and their relatives spoken with stated that staffs display a high standard of respect in their daily interactions. Residents representatives stated that staff ensure that the individuals privacy and dignity is maintained and could not see how this area of care could be improved. The inspector noted that the atmosphere of the home and residents appeared to be relaxed. Residents and relatives commented staff ‘were ‘kind’. In addition the inspector observed staff interacting with residents in a professional manner at all times, alongside a sense of humour when appropriate. The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 14 Daily Life and Social Activities
The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): EVIDENCE: Not inspected as assessed on last visit and all standards met. The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 15 Complaints and Protection
The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 16,18 Cornwall care Ltd has an appropriate complaints and whistle blowing policy. Some resident’s relatives are confident to raise any concerns with staff. The policy and procedure for protecting resident against abuse needs to be improved. EVIDENCE: Cornwall Care Ltd has completed corporate policies in respect of the complaints procedures. The Green has received a recent complaint that is in the process of being investigated. CSCI have received a complaint in respect of staffing issues, of which the regional manager has acknowledged that staffing levels need to be reviewed. From the inspector’s discussions with residents and relatives, in the main all stated they were satisfied with the services that the Green provides. Due to recent staff changes in the home some relatives were unsure if they could approach the new management team to raise any issues, citing the reason for this as they did not know them well enough so were unsure as to how any concerns they have may be received. Staff were also mixed in their views as to how a concern they had would be responded too due to recent staffing changes and some stated that they would not raise concerns as they are fearful of the repercussions of this. In discussion with the interim manager she was aware that staff morale needs to be raised and would be addressing how concerns would be managed with the staff team. The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 16 The Green has received four compliments in respect of the service that they provide. Cornwall Care Ltd has an adult protection procedure. This procedure has needed to be implemented and from this it is acknowledged that further clarity in the policy and procedure is needed. CSCI have met with Cornwall Care Ltd management team to discuss this and have agreed that more detailed information is needed so that when an allegation of abuse is made the registered manager of the home has clear guidance as to what actions to follow to ensure protection for residents and staff. Therefore this is in the process of being revised in line with guidance from CSCI. A recommendation in this respect has been identified. The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 17 Environment
The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 22,26 Residents have the facilities to be able to call for assistance when needed. Sufficient staffing levels to ensure the cleanliness and upkeep of the home must be reviewed to enable The Green to be maintained to a good standard for all those who live, work and visit the home. EVIDENCE: This section of standards was assessed at the last inspection and in the main met the national minimum standards. The one recommendation identified at the last visit was inspected. This was to ensure that call bells were within reach of residents – this has been addressed. In addition the interim manager stated she has ordered some pressure mats to alert staff when residents rise from bed, which will promote further monitoring. The inspector would comment that the homes general appearance was not too its usual standard of cleanliness i.e. some rooms had an odour; a bath was not clean, carpets stained and general appearance observed to be unkempt. Some relatives also commented on this. In discussion with the general assistant’s
The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 18 they agreed that the standard of cleanliness had dropped and cited the reason for this being staff sickness, on some weekends no domestic cover and also due to the opening of the additional 16 rooms that this has increased the workload. The interim manager also confirmed this and stated that a handyperson had not been in post since August and this has had an impact on the home. A handy person was appointed in the week of this inspection. The inspector observed some doors were wedged open, this could cause a health and safety risk and must be closed. The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 19 Staffing
The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,30 Staffing levels must be reviewed urgently to ensure that sufficient staff are on duty at all times to provide satisfactory care and accommodation to residents. The recruitment process must be robust to ensure that staff are employed to protect residents. EVIDENCE: On the day of inspection seven care staff plus a general assistant, handyperson, cook, laundress, administrator and managers were on duty. At night there are three waking night staff plus a manager sleeping in. Since the opening of two new wings it is evident that staffing levels are not sufficient. Throughout the inspection examples were provided of a lack of staff being present i.e. relatives told the inspector on separate occasions of two incidents were residents were left unsupervised for long periods of time, which resulted in the relatives providing care for not only their relatives but other service users in the home. In addition the care staff felt that the morning shift was ‘too busy for what we need to do’ and that the afternoon shift was quieter and so more manageable. General assistances felt there were insufficient staff, and at times no weekend cover, which could account for the deterioration on the usual standard of the homes cleanliness. The cook felt that more assistance was needed in the kitchen as they cater for 70 meals a day and are struggling to do this in the hours set. In addition staff commented that their morale is low. Some said that it has improved ‘a bit’. They have been some staff changes in the home including the
The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 20 registered manager not being present for sometime. The majority of staff commented that there has been a lack of leadership and that staff are not satisfied with the atmosphere of the home. Some added that staff meetings would be beneficial to gain an overview of what is occurring at the home and this may relieve some anxiety that the staff are currently feeling. Relatives also voiced disappointment that the registered manager has not been available and felt that his recent absence has had an impact on how the home has been organised. Relatives hope that they will get to know the interim manager so that they can express their views to her, as they felt able to with the registered manager of the home. The interim manager stated she is currently reviewing staffing levels in the home and is proposing to change the management structure of the home in the aim that more direct working and support is provided by the management team to residents and staff working in the home. In discussion it was noted that the ‘float’ care staff post had disappeared and CSCI agreed to confirm the minimal staffing levels of the home when the new units opened with the interim manager. The inspector stated that the level of care staff to ensure monitoring of residents must increase as two examples were provided when some residents were left for long periods of time (one alleged over 3 hours) before staff were present. In addition the inspector observed a near accident with a resident when residents were left in a lounge with no staff present as a staff member went to collect the tea for that wing. There are health and safety risks present to the residents left without close monitoring. This is unacceptable. The inspector observed staffs that were competent in their work. Relatives 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. CSCI are aware that a member of the management team has audited staff files and all necessary documentation was present on the files. Staff commented to the inspector that they had completed an induction programme and some were due to attend Cornwall Care Ltd Introduction course. Cornwall Care Ltd prioritises staff training and from discussion with staff and inspection of staff files this demonstrated a commitment to staff updating their training The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 21 Management and Administration
The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected at least once during a 12 month period. JUDGEMENT – we looked at outcomes for the following standard(s): 32,35,36,37 Due to the new management team being established a the home, work on developing positive relationships with residents, relatives and staff must occur. Policies regarding the management of resident’s money are satisfactory. The distribution of monies must be reviewed. Supervision of staff must recommence to allow a venue for staff to express their views and focus on care practice issues. EVIDENCE: Relatives were pleased that a relatives meeting had recently occurred and felt this was beneficial. Staff commented that with the changes in the management team that they would like to meet with the interim manager to gain her views on any proposed changes for the home so that they can air their views. The interim manager agreed to arrange this. The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 22 Cornwall care Ltd have cooperate policies in the management of residents monies. Residents or their representatives are encouraged to manage their own monies and hold their own accounts. However they can sign an agreement to request that Cornwall Care assist them in the management of a small amount of their monies. From inspection of service users monies records were accurate and tallied. The inspector was concerned to note a particular example of how monies was being distributed and raised this with the interim manager who agreed to investigate this. The inspector also recommended that the interim manager or regional manager audit the residents account on a regular bases to ensure that records are accurate. The interim manager, confirmed by records and discussion with some staff stated that supervision has not occurred at such regular intervals, due to the changes in staffing at the home. The interim manager is aware that it is recommended that all staff receive at least six supervision sessions per year. Records held by the home are stored in a confidential manner and in the main are in line with the Data protection Act. Cornwall Care Ltd is currently in the process of reviewing the quality assurance system and therefore it was not inspected on this occasion. The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 23 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 x 2 3 X X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 X 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 X 13 X 14 X 15 X COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 2 X X X 3 X X X 2 STAFFING Standard No Score 27 1 28 X 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score X 2 X X 2 2 3 X The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 24 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 OP1 Regulation Sch 1 Requirement The Greens statement of purpose must be reviewed to accurately reflect the services that it provides. Pre admission document must identify service users individual needs and specify what staff interventions are needed to address the care need in a consistent manner. Service uses risk assessments must be reviewed to ensure that the health and safety of all residents is promoted and specific instructions to staff in the moving and handling of service users are clear. Staffing levels for general assistants must be reviewed urgently in line with the observations of the homes cleanliness deteriorating. This is with immediate effect and is ongoing. An action plan in how this will be addressed must be sent to the Commission. Care staffing levels must be urgently reviewed in light of service users dependency needs
DS0000009107.V251151.R01.S.doc Timescale for action 30/12/05 2 OP3 14 30/12/05 3 OP8 23 30/12/05 4 OP26OP27 23,18 30/11/05 5 OP27 18 30/11/05 The Green Version 5.0 Page 25 6 OP15OP27 18 7 8 OP35 OP38 20 13 and the two allegations made by relatives in this inspection. This requirement is made with from immediate effect and is ongoing. An action plan in how this will be addressed must be sent to the Commission The catering staff levels must be reviewed urgently in light of promoting the ‘Appetite for Life’ project. An action plan in how this will be addressed must be sent to the Commission The distribution of service users monies must be reviewed. Fire doors must not be wedged open. 30/11/05 30/12/05 30/11/05 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 3 Refer to Standard OP18 OP36 OP32 Good Practice Recommendations The adult protection policy should be expanded to include a timetable of initiating an adult protection referral and explain what procedure should be followed. Staff supervision should recommence, a minimum of six supervision sessions per year should be provided. A staff meeting should be arranged to discuss current and future changes to the Green. The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 26 Commission for Social Care Inspection St Austell Office 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. Extracts may not be used or reproduced without the express permission of CSCI The Green DS0000009107.V251151.R01.S.doc Version 5.0 Page 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!
