CARE HOMES FOR OLDER PEOPLE
The Green Home for Older People The Green Seacroft Leeds LS14 6JL Lead Inspector
Ann Stoner Announced 09.30: 6 September 2005
th 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 Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 Page 3 SERVICE INFORMATION
Name of service The Green Address Seacroft Green Leeds LS14 6JL 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) 0113 2144166 Leeds City Council Dept of Social Services Michaela Conoby Care Home Only 37 Category(ies) of Old Age (37) registration, with number of places The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 Page 4 SERVICE INFORMATION
Conditions of registration: None Date of last inspection 11th January 2005. Brief Description of the Service: The Green Home for Older People provides personal care, without nursing, for 37 residents in a purpose built two storey building in the heart of Seacroft, a suburb of Leeds. There is an adjoining day centre, which is independent of the home and is not regulated, therefore was not part of this inspection. Accommodation for residents is in single rooms on two floors. There is a lift for those unable to climb stairs. Bedrooms and bathrooms are arranged in small units with communal open-plan sitting and dining areas on both floors. Local facilities including shops, pubs and public transport are within easy reach of the home. The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 Page 5 SUMMARY
This is an overview of what the inspector found during the inspection. Over an inspection year from April until March, care homes have a minimum of two inspections a year; these may be announced or unannounced. The last inspection was unannounced and took place on the 11th January 2005. There have been no further visits until this announced inspection. The people who live in the home prefer the term resident; therefore this will be the term used throughout this report. During the inspection, I looked at records, I saw care staff carrying out their work and spoke with residents, visitors, staff and the manager. Comment cards/questionnaires are left for residents, visitors and other professionals at each inspection. These provide an opportunity for people to share their views of the home with the Commission for Social Care Inspection. Comments received in this way are shared with the provider without revealing the identity of those completing them. Since the last inspection three have been returned. What the service does well: What has improved since the last inspection?
Since the last inspection the manager has completed the registration process with the Commission for Social Care Inspection, and has worked hard to address most of the issues identified at the last inspection. This has included providing training events for staff and making sure that all staff responsible for giving out medication receive accredited training. Disposal bins for clinical waste are now in all toilets. Progress towards meeting the National Vocational Qualification targets for 2005 has been made and on an organisational level, monies held for safekeeping are no longer held in ‘pooled’ accounts. The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 Page 6 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 Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 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 Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 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) 1, 2, 3 & 5. People are able to make an informed decision before moving into the home, but the home’s pre-admission assessment should be more detailed to make sure that needs are not overlooked. EVIDENCE: Future residents and their relatives are invited to visit the home, and written information, such as the Statement of Purpose and Service User Guide are on view near to the entrance. The manager said she encourages people to read these. Four care plans were sampled, and in each case there was an Easy Care assessment along with the home’s introductory assessment. The home’s assessment does not show where the assessment took place, and who provided the information. For example one person was admitted from another home, but there was no evidence that staff from that home had been consulted as part of the assessment process. Those assessments seen were not always fully completed, did not provide enough information to form the basis of a care plan, show the outcome of the assessment, or justify how the home was able to meet assessed need. A recommendation has been made.
The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 Page 9 A licence agreement, which forms the statement of terms and conditions, was seen in all of the care plans sampled. The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 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) 7, 8, 9, 10 & 11. Care plans have improved but further work needs to take place to make sure that care is delivered according to assessed need and personal choices. Health care needs are met, the privacy and dignity of residents is respected and death is handled with sensitivity. EVIDENCE: The manager said that some work on care plans has taken place, but more work is still needed. From discussions with staff it is clear that care is provided based on the precise needs of the individuals, but this is not reflected within individual care plans. Terms such as ‘needs assistance when getting up’, and ‘needs assistance when dressing”, fail to give staff precise instructions on how to assist the person. There were no instructions for staff on how to communicate with a resident who has poor eyesight and hearing. One person’s plan showed that she can be aggressive, but there was no information about identified triggers, or information for staff on how to de-escalate or diffuse any aggression. One person had a history of falls, and although there was a risk assessment in place there was no care plan for the prevention of falls. The manager said that plans are in place to make sure that care plans are reviewed on a monthly basis. Terms such as, ‘very nasty,’ and ‘demanding
The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 Page 11 and fussy’, were seen in daily records. A requirement and recommendation has been made. During the inspection a GP, community nurses and an OT all visited the home, and evidence was seen in care plans of residents having chiropody, dental and optical treatment. Visitors said that they were always made aware of any concerns about their relative’s health. One visitor said, “If my mum has any pain, her GP is contacted immediately and then staff ring me.” This person said that she was aware of her mother’s care plan, and was able to see it after each GPs visit. Some medication practices were sampled. There was no risk assessment in place to show how a resident’s capacity to self medicate had been assessed, or how compliance would be monitored and by whom, for a person who held some of his medication. The manager however, did explain how compliance was monitored, despite the lack of recorded evidence. There is no system in place for the use of homely remedies. A requirement and recommendation has been made. Throughout the inspection staff were seen to respect the privacy and dignity of residents, and a new member of staff said that privacy was included as part of her induction. This person was seen encouraging people to retain some independence, and when asked she was aware of why this was important. The manager described how a recent death at the home had been dealt with in a sensitive way. It was clear from care plans that residents are asked about any wishes or arrangements after death, with one person’s plan showing that she would like her ashes scattered in a rose garden at Lawnswood. The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 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. Residents are encouraged to make decisions and take control over their lives wherever possible. Leisure activities are provided, and contact with friends and family is encouraged. EVIDENCE: Residents spoke of the choices they can make, such as times for getting up and going to bed at night, choice of meals and whether to join in an activity or not. The manager described how the religious needs of residents are met. Throughout the inspection a flexible approach to care was evident. Some people were sitting outside, one person was watching TV, one was knitting, some preferred to remain in their rooms, others were listening to music and some were reading. The range of activities on offer was displayed, and staff said that wherever possible they spend time with residents either on a one-toone basis or organising a group activity such as bingo. One visitor said. “Staff ‘put themselves out’ for the social side of things”, she went on to describe the planning and effort that staff had made to make sure a recent outing was a success. One resident has developed a passion for gardening, and staff have been creative in nurturing this interest by giving him responsibility for the gardens at the front and rear of the building. He spoke of winning a second prize in a gardening competition, but not satisfied with this he is working towards a first prize next year. Other residents are also reaping the benefits of his
The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 Page 13 achievements; one person said she enjoyed watching him at work, and that it was a delight to look out of the window at the beautiful garden. The manager said that she is looking at ways of maintaining his interest over the winter months. Visitors spoke highly of the home, said that they were welcome at any time, and are offered refreshments. One person said she has been offered lunch with her mother. The Service User Guide suggests ways in which relatives and friends can continue to have an active role in the resident’s life. This is good practice. The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 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 & 18. Complaints are dealt with properly, and residents are protected from abuse. EVIDENCE: The manager records all complaints and an investigation is always carried out. Residents and visitors all said that they would have no hesitation in making a complaint if the need arose. The home has a copy of the Multi Agency Adult Protection Procedures. One member of staff was aware of the different types of abuse, including the more subtle types of institutional abuse. Both experienced and inexperienced staff were able to explain how they would react to any suspicion of adult abuse, even if the abuser was the manager. The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 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) None These standards were not assessed at this visit. EVIDENCE: The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 Page 16 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 Night time staffing levels are inappropriate for the number of residents. EVIDENCE: Bedrooms are in small units over two floors. With the layout of the building, and the number of residents, the night time staffing levels of two staff is unacceptable. The manager said that if a resident’s needs change or condition deteriorates, as a short-term measure, she has in the past been allowed three night care staff. A requirement has been made. The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 Page 17 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) 36 & 38. Staff are supervised and health, safety and maintenance checks are carried out. EVIDENCE: There is a planned programme of supervision in place and staff said that supervision is effective. Health & safety issues will be looked at in more detail at the next inspection, however the manager completed a pre-inspection questionnaire that confirmed all the required health, safety and maintenance checks have been carried out. The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 Page 18 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 ENVIRONMENT Standard No 1 2 3 4 5 6 Score Standard No 19 20 21 22 23 24 25 26 Score 3 3 2 x 3 x HEALTH AND PERSONAL CARE Standard No Score 7 2 8 3 9 2 10 3 11 3 DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 4 13 3 14 3 15 x
COMPLAINTS AND PROTECTION x x x x x x x x STAFFING Standard No Score 27 2 28 x 29 x 30 x MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score Standard No 16 17 18 Score 3 x 3 x x x x x 3 x 3 The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 Page 19 Yes 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 7 Regulation 15 (1) Requirement Care plans must set out in detail the action which needs to be taken by staff to make sure that all aspects of the health, personal and social care needs of the resident are met This is outstanding from the previous inspection. All residents who self medicate must have a risk assessment that shows: The factors taken into account to assess the residents cognitive ability to hold medication. The measures taken to monitor compliance. A review of the monitoring process. Evidence that the resident understands that the medicines must be locked away. The home must make sure that at all times there are staff in such numbers as are appropriate for the layout of the building and the number of residents. Timescale for action 31.12.05. 2. 9 13 (2) 31.12.05. 3. 27 18 (1) (c) 31.12.05. The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 Page 20 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 3 Good Practice Recommendations The homes pre-admission assessment should form the basis of the care plan, demonstrate how the home can meet assessed need, and show the outcome of the assessment. A record should be kept on the pre-assessment form as to where the assessment was carried out, and who provided the information. Terms such as nasty and demanding should be replaced with descriptions of actual behaviours. Policies and procedures should be revised and updated in line with guidelines from the Royal Pharmaceutical Society. This should include a policy and procedure relating to homely remedies. 2. 3. 7 9 The Green Home for Older People J52 J03 S33270 The Green V212923 160805 Stage 4.doc Version 1.30 Page 21 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP National Enquiry Line: 0845 015 0120 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk
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