Care Home: Evergreen

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What the care home does well People using the service are happy and settled and there is a good rapport with staff. The home supports people with complex needs and strives to promote peoples independence and encourages people to make decisions that affect their lifestyle. Peoples` preferences and views are listened to, respected and acted upon encouraging an open environment. Staff have a good knowledge and awareness of peoples needs that helps to contribute to their wellbeing and treat people with dignity and respect. What has improved since the last inspection? There have been improvements to the environment with a rolling programme of redecoration taking place. Fire drills are conducted within prescribed time limits.EvergreenDS0000026590.V339366.R01.S.docVersion 5.2 What the care home could do better: The Statement of Purpose and Service User Guide must be updated so that people are informed of all current and relevant information. Although the home has a new format for containing peoples care planning, the manager must ensure information is transferred to the new formats so that staff support people consistently. A risk assessment must be carried out in relation to the use of the key pad in the kitchen determining the frequency of this restriction. There are some areas of the garden that are in need of maintenance. CARE HOME ADULTS 18-65 Evergreen 290 Passage Road Brentry Bristol BS10 7HZ Lead Inspector Sarah Webb Key Unannounced Inspection 18 & 19th July 2007 08:45 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 Evergreen DS0000026590.V339366.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. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Evergreen Address 290 Passage Road Brentry Bristol BS10 7HZ 0117 9501791 0117 9501791 evergreen.house@craegmoor.co.uk 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) Treehome Ltd Ms Sue Thompson Care Home 6 Category(ies) of Learning disability (6) registration, with number of places Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of either gender whose primary care needs on admission to the home are within the following category: 2. Learning disability - (Code LD) The maximum number of service users who can be accommodated is 6. Date of last inspection 22nd June 2006 Brief Description of the Service: Evergreen is owned by Craegmoor Healthcare. It is registered to provide accommodation and personal care for up to six people with a learning disability aged 18 - 64 years. A number of people currently accommodated have complex needs, which can result in behaviour that challenges. The premises are situated in a quiet residential area. It is a large house that blends in well with the immediate surroundings. There are some shops and local amenities in the vicinity. The home also has two mini-vans which residents use frequently to go out. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced inspection with the purpose of the visit to review the progress made to meet the requirements from the inspection in June 2006 and monitor the care provided to the people living at Evergreen House. The inspection was conducted over 8 hours. The inspector had an opportunity to meet and talk with the majority of the people living at the home, the manager, and several members of staff. As part of the inspection process records were viewed including those in relation to care and support plans, risk management, the administration of medication, and staff training. Further information was also provided through the Annual Quality Assurance Assessment. A tour of the home was undertaken and interaction between staff and the people using the service was also observed during the visit. As part of the inspection process surveys were received by 4 relatives and also pictorial questionnaires were received by people using the service. Comments were very positive in the care and support offered to people living at Evergreen House. What the service does well: What has improved since the last inspection? There have been improvements to the environment with a rolling programme of redecoration taking place. Fire drills are conducted within prescribed time limits. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 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 summary of this inspection report can be made available in other formats on request. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 7 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 Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 8 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. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, & 5. Quality in this outcome area is good. Although there is good information about the range of services offered at Evergreen, there are areas that must be updated so that people are provided with current information. The home ensures people’s needs are assessed to ensure the home is suitable for them. The home gives people a contract explaining the terms of their stay. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The Statement of Purpose describes the range of people the home provides a service to including the aims and values of the home. However this document must be reviewed so that people have up to date information about the home. There has been a change in the management and staffing. The inspector explained that the Statement of Purpose will be a key document in future inspections and will need to be expanded in its content. Although there have been no new people admitted to the home, the manager demonstrated knowledge of the homes admissions processes and how people would be supported. All 6 people currently using the service have lived together for many years. Care files identified that assessments of peoples needs were carried out prior to living at the home. This is to ensure that the home can make a decision as Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 9 to whether the home can meet people’s needs. Care plans also indicated how people’s needs are met; this is discussed in more detail in Standard 6. Contracts setting out the terms and conditions of peoples stay were seen. The manager explained family involvement was important in this area as contracts are not in an accessible format for people to understand. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 10 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. JUDGEMENT – we looked at outcomes for the following standard(s): 6, 7 & 9 Quality in this outcome area is good. Peoples’ needs are clearly identified in care plans that contain up to date guidance to help staff to meet these needs. Staff demonstrated a good knowledge of peoples’ needs and how they are supported in making decisions about their daily routines and lifestyle. Risk assessments help to support people in taking risks safely. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three care files seen contained relevant information including personal profiles, and identified health, social and emotional needs. The home is in the process of transferring information into a new care planning format. One persons care plan had been updated in the new format improving information provided for staff. This has helped focus on the person’s involvement in the care planning process and in setting outcomes wanted. Discussion was had with the manager about the need for more detail in an individuals care plan in how they are supported with their communication. The Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 11 manager was confident that when the new format is used for everyone there will be more detailed information available. Observation of interaction between people using the service and staff demonstrated that they have built good relationships; staff spoken with had a good knowledge and understanding of peoples needs. The home consults with people in varying ways. Regular house meetings take place where different areas are discussed such as holidays, routines of the home and the menu. Minutes are taken so that actions can be followed up. It was evident that people have opportunities to make decisions and are listened to; a new dining room table has been bought by the home as requested by people showing that the home has acted positively. The organisation also provides forums for people to attend. One person goes to a residential conference which they enjoy. Risk assessments link into care planning setting out identified risks. These showed that people are supported in taking risks safely within their daily activities. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 12 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. JUDGEMENT – we looked at outcomes for the following standard(s): 11,12, 13, 14, 15, 16, & 17 Quality in this outcome area is good. People make choices about the activities they want and are supported in having active life styles. Staff support people with keeping in contact with their families and in the routines of the home. People benefit from a healthy, well balanced diet. This judgement has been made using available evidence including a visit to this service. EVIDENCE: People are supported in taking part in meaningful activities; these are documented through daily written records. During the inspection, one person was being supported to access a community venue whilst another two people spent the day out on a trip. The manager said three people have signed up to attend new college courses. Another person chooses not to be socially involved within the home but has good contact with their family and will go out in the homes mini bus supported by 2:1 staffing. Daily records also indicated that they had been on holiday on Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 13 their own with 2 staff. This further shows that people’s preferences are respected and their individual needs met. Discussion with staff and from observing people showed that visits to pubs, cafes and going for walks was a favourite activity. The manager said she allows for extra staff to be on duty to meet people’s social needs. This was also evidenced through the rota. The manager said staff have built good relationships with families and people are supported in keeping in contact with their relatives and friends. People do not have to pay for their transport and the home takes some people to visit their families. The home encourages people to be involved in the daily routines of the home. One person was happy to show me their room which they cleaned on their own whilst another person said staff help them. The manager said menus have been reviewed and rewritten with more choices on offer. Menus looked at identified there was a range of nutritional meals recorded as being available for each day. There was evidence seen that demonstrate people’s likes and dislikes are included when menus are planned. One person said the food was ‘nice’ and that staff help them to cook dinner. They said that they could have an alternative to the menu if this was disliked. It is evident that the home has plans to improve accessible information showing meals in a picture format. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 14 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. JUDGEMENT – we looked at outcomes for the following standard(s): 18, 19, & 20. Quality in this outcome area is good. Peoples healthcare needs are clearly identified in care plans and staff demonstrated a good knowledge of these. There are good systems to help monitor peoples health and staff are respectful when supporting people. People are supported safely with their medication. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care files contained information about peoples’ healthcare needs and preferences and demonstrated the involvement of health and social care professionals. New Health action plans now provide more detail so that staff can support people consistently. The organisation also provides support form the Clinical Governance Team. All people using the service are registered with the local surgery and health care records identified support from the Community Learning Difficulty Team with access to specialist services. Records also indicated that people’s health is monitored through support in attending appointments including those with optician, and dentist. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 15 People were observed getting up at different times during the morning, which helps to demonstrate how their choices and different preferences are respected. One person was going shopping for clothes supported by staff. Interactions observed during the inspection identified that staff are respectful of people’s privacy and dignity and the recording of how people are supported also demonstrated this. There is no one that self-medicates. Medication profiles contained a photograph with the drug records to ensure medication is dispensed safely and the medical administration charts were in order. There are arrangements for the disposal of unused medication. Staff receive training in the administration of medication with their competency monitored. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 16 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. JUDGEMENT – we looked at outcomes for the following standard(s): 22 & 23. Quality in this outcome area is good. People are encouraged to express their concerns; there are systems for dealing with complaints. There are procedures in place for the protection and safety of people. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Care files showed that people have been told how to make a complaint. Written records identified that the home has regular meetings and the manager said that these encourage people to say how they feel and if they are unhappy. A number of staff spoken with explained how people made their concerns known; this also demonstrated that staff had a good awareness of peoples’ communication needs and how they vocalise their views. A complaint from a neighbour has been resolved also resulting in a positive outcome for an individual using the service. Staff spoken with indicated that they had attended training in understanding abuse and protecting the vulnerable adult. They demonstrated an awareness of abuse and what action to take if a disclosure was made. The home has strategies in place for the management of peoples’ behaviour. There was well documented information available showing ways that staff deal with challenging situations. These included ‘triggers’ prior to an incident and diversionary tactics that could be used. People were observed being supported by staff on several occasions when they became anxious. It was evident that people felt relaxed and comfortable with staff and they responded to support offered. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 17 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. JUDGEMENT – we looked at outcomes for the following standard(s): 24, 26, & 30 Quality in this outcome area is good. People benefit from living in a homely and clean environment; both communal and personal space meets peoples’ needs and lifestyles. There are some areas of the garden that need maintaining. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Evergreen is a large house in a residential suburb of Bristol. Several requirements relating to improvements to the environment have been met. The home now has a maintenance schedule for this year indicating which areas are to be redecorated setting out dates for work to be carried out. It was evident that areas of the schedule are being followed. Five bedrooms were seen; some people were happy to show their rooms whilst others were shown by the manager. Peoples’ rooms were personalised and decorated to individuals’ choices. One person chooses to have minimal decoration and personal belongings; however both staff spoken with and the manager showed their enthusiasm in encouraging them with the redecoration of their bedroom. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 18 Two people have moved to different bedrooms that have been redecorated to their choice. The manager demonstrated that both families and individuals were involved in being consulted about the move and that the two people have benefited through this change. This move has also helped resolve a complaint from a neighbour. The dining area has been decorated and a new dining table has been bought so that everyone can sit at the table to eat meals if they want to. This was suggested by people living at the home. People have benefited from new sofas bought for the lounge. A keypad on the kitchen door dictates when people are able to access this area. The manager explained that there are times when people may be challenging and that restrictions are then made to this area; there was no risk assessment indicating risk levels and how this is managed. There is a large garden to the back of the house. The manager said a summer house is planned to be bought so that people can have some extra communal space for leisure activities such as art and craft. However the grass is very overgrown in one area with the grounds needing attention. The home employs a cleaner who also carries out care hours. The home was clean and tidy and free from offensive odours. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 19 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. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 32, 34, & 35 Quality in this outcome area is good. People benefit from an experienced and qualified staff team. The home follows good recruitment processes and staff have attended relevant training to meet peoples needs. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Three staff were spoken with; they demonstrated a good understanding of their roles and responsibilities. The rota indicated that there are normally 4 staff on duty during the day, while there are 3 staff on duty later in the day. The manager had made arrangements for a staff member to cover extra duties due to staff being unable to work during this visit. The Annual Quality Assurance Assessment returned highlighted that barriers to improvement are often staff shortages. However the home has tried to overcome these barriers by employing staff with different abilities. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 20 The home has 10 permanent staff; 7 staff have achieved a National Vocational Qualification level 2; this has ensured the home has 70 of the staff team who are now qualified and competent staff. The manager has not interviewed for new staff since she became the registered manager but was able to demonstrate good recruitment practice. Four staff files looked at identified that there was relevant documentation in place to indicate good recruitment processes have taken place. Files contained evidence of police checks by the Criminal Records Bureau, Protection of vulnerable adults checks, two references and application. The files also included induction records and certificates from recent training. Staff spoken with also explained their induction and how this was completed. Training records and discussion with staff identified that they have attended statutory training in first aid, health and safety, food hygiene, manual handling and food hygiene. The organisation also provide annual training for staff in relation to equality and diversity. The manager said that staff meetings also highlight specific areas regularly. The manager was very clear that the message for staff was that they should ‘embrace the differences in people using the service no matter what they are’. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 21 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. JUDGEMENT – we looked at outcomes for the following standard(s): 37,39 & 42 Quality in this outcome area is good. People benefit from leadership that promotes an open and inclusive style of management and in which peoples views are acted on. There are processes to monitor health and safety to ensure people are safe. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a new registered manager at the home since the last inspection. She has completed National Vocational Qualification level 4 and the Registered Managers Award. Staff spoken with expressed satisfaction with her leadership and through observation of both staff and people using the service it was identified that there is an open culture operating at the home. The manager demonstrated a commitment to staff and to the people using the service; requirements made at the previous visit have now been met. She also attended relevant training such as team leading and recruitment. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 22 There are monthly meetings for people, and participation is encouraged. The organisation also has processes in place for consulting with people through quality monitoring. Both annual Health and Safety and monthly in-house audits are carried out. A senior manager also visits monthly to monitor all aspects of the management of the home. The fire logbook record was checked and showed the required weekly and monthly tests of the fire alarms and the fire fighting equipment were being carried out and were up to date. Records identified that staff have attended fire training; fire drills had taken place. Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 23 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 2 2 3 3 3 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 x 26 3 27 x 28 2 29 x 30 3 STAFFING Standard No Score 31 3 32 3 33 x 34 3 35 3 36 x CONDUCT AND MANAGEMENT OF THE HOME Standard No 37 38 39 40 41 42 43 Score 2 3 x 3 x 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 x 3 x x 3 x Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 24 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 YA1 Regulation 4&5 Requirement The Statement of Purpose and Service User Guide must be reviewed to include changes to the home so that any prospective people are well informed about the home. Care plans must be completed in new format so that staff support people consistently. A risk assessment of the use of the keypad in the kitchen must be completed so that this restriction is monitored and understood when it is in use. All areas of the garden must be maintained to ensure the safety of both staff and people using the service. Timescale for action 31/10/07 2. 3. YA6 YA28 15 12 30/09/07 31/08/09 4. YA28 23 30/09/07 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. Refer to Standard Good Practice Recommendations Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 25 Evergreen DS0000026590.V339366.R01.S.doc Version 5.2 Page 26 Commission for Social Care Inspection Bristol North LO 300 Aztec West Almondsbury South Glos BS32 4RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI - 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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