Care Home: Evergreen

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What the care home does well Evergreen is a welcoming and homely home. Mr and Mrs Tope, the owners, their daughter, and the staff team pride themselves on providing an `extended family` to the people living there. The service was described as `you could not ask for anything better` with one person saying `I`d love to win the lottery so I could buy them all a gift to say thank you. They are wonderful, and I often think I am very lucky to have found a place like this` The admission procedure is good and shows that staff make sure they can meet the person`s needs before they are admitted. People tell us that the admission process is made easier by the staff at the home. People receive a very good standard of personal care, and communication with healthcare professionals in the community is very good. The care people receive is provided in a safe way and medicines are well-managed by the staff. Staff at the home make sure people see healthcare professionals when they need to. Care of the dying is also performed very well with the help of district nurses. One thank you card from a relative read `Many, many thanks for the love and care you gave to our mother whilst staying at Evergreen. She was happy staying here`. The improved care planning documentation at home are good and mean that staff know how to care for somebody in a safe and consistent way that meet their individual needs and preferences. People have access to a range of activities and are able to maintain contact with their family and friends. People enjoy the activities provided by the home particularly the opportunities for the external entertainers and 1:1 time with staff. People tell us that the food is `wonderful` and `gorgeous`. Any issues regarding dietary requirements, preferences or weight issues are sensitively managed. People say there is plenty of food and staff know what they like and don`t like. People who use the service and their relatives can be confident that if they complain, their concerns will be listened to and acted on. People feel able to complain and know how to do this, although people said they have never needed to complain. Induction and training for staff is good at the home and means that vulnerable adults are cared for by a stable group of staff who have had the necessary training in order to provide care in a safe and effective way. The staff group are popular with people who live in the home who describe the staff as `gorgeous` `very kind` and `wonderful`. Thank you cards described the care as `loving` and `devoted`. Evergreen is a safe and clean place to live and work. Maintenance systems are very well managed and a good level of decor and furnishings is provided at the home. The manager and staff group have suitable qualifications and experience to care forpeople who require personal care. The home is well-managed by the manager and supporting team. The providers are very responsive to suggestions and requirements made about their service and are keen to rectify any shortfalls immediately. What has improved since the last inspection? Care records and charts have improved. New turn and diet charts show what care is provided at the home and prompt staff into providing regular care for the more frail and vulnerable people at the home. Further personal care charts prompt staff to record the consent and checks that are performed when providing personal care and assistance with baths. Further work procedure charts are now used to remind staff about their roles. A district nurse communication book has also been introduce to help pass on messages to the community nursing teams. Continual review of records used at the home takes place with a review each time a record is printed from the computer. This means that charts, records and forms are up to date and include the necessary information. The routine maintenance programme had been carried out and has included re carpeting the dining room, conservatory and two bedrooms, repainting the conservatory and fitting a new roof and totally refurbishing six bedrooms. New items of equipment have been purchased; dry powder carpet cleaner, vacuum cleaner, washing machines, irons, microwave, water urn, two cookers, two electric bath chairs and free view boxes to enable televisions to work after the digital switchover. Since the last inspection, the laundry has been re fitted providing more space and newer equipment. What the care home could do better: Information provided to people before they move into the home should be improved to make sure they have written information before they move to the home. The Statement of purpose and Service User Guide should be update to ensure they contain accurate information. These documents should then be made available to people. Staff could also improve the information they obtain about people before a person is admitted to the home by adding a few minor prompts to the pre admission document. This will show staff have enough information to decide whether they can meet the persons needs. Although people are treated with kindness and respect at the home, the protection of people must improved by making sure the recruitment process is robust and meets guidelines set by the criminal records bureau. The Provider must be aware that CRB checks are not portable despite previous CRB`s only being issued in weeks before the interview and must ensure new CRB`s are performed. Further information such as obtaining a recent photograph would also improve this recruitment process.People could also be protected by ensuring the personal monies held are securely stored. Although receipts for individual items are produced, records for regular services should be clear to show what money has been spent and what date this occurred on. By providing this clear audit trail will help to protect people from abuse and will also protect the management. Staff should be provided with adequate training during their induction period. Although the majority of people in the home are mobile, information on the safe moving and handling practices should be provided to all staff. The manager must also consider their employment responsibilities by reviewing the length of time and work patterns that some staff work. Systems must be in place to ensure excessive hours do not have an impact on the health and safety of vulnerable people in the home. Inspecting for better lives Key inspection report Care homes for older people Name: Address: Evergreen 2 Brandreth Road Mannamead Plymouth Devon PL3 5HQ     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home, agency or scheme is meeting the needs of the people who use it. We give a quality rating following a full assessment of the service. We call this a ‘key’ inspection. Lead inspector: Clare Medlock     Date: 2 2 0 6 2 0 0 9 This is a report of an inspection where we looked at how well this care home is meeting the needs of people who use it. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop 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 Our duty to regulate social care services is set out in the Care Standards Act 2000. Care Homes for Older People Page 2 of 33 Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report CSCI General public 0870 240 7535 (telephone order line) Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CSCI copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 33 Information about the care home Name of care home: Address: Evergreen 2 Brandreth Road Mannamead Plymouth Devon PL3 5HQ 01752665042 NOFAX jdt@blueyonder.co.uk Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Conditions of registration: Category(ies) : Mr Roy Richard Tope,Mrs Jacqueline Denise Tope care home 16 Number of places (if applicable): Under 65 Over 65 16 old age, not falling within any other category Additional conditions: 0 The maximum number of service users who can be accommodated is 16 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: Old age, not falling within any other category (Code OP) Date of last inspection Brief description of the care home Evergreen is situated within walking distance of Mutley Plain shopping precinct in Plymouth. The establishment is formed from two terraced Victorian villas that have been internally combined. The home has a family atmosphere due to the efforts of the owners and the staff, and because the home can only accommodate sixteen residents at any one time this ensures a non-institutional atmosphere. The home has the category of OP (older person) and has neither of the specialist categories for the provision of dementia care or severe physical disability. Evergreen does not provide nursing care. The home specialises in creating a homely environment to meet the Care Homes for Older People Page 4 of 33 Brief description of the care home individual needs of each resident. Accommodation is provided on both the ground and first floors. The home offers a large lounge room that has 2 seating areas, a dining room and a large conservatory area that leads to a small garden. Currently the fees range from three hundred and fifty five punds and seventy six pence to four hundred and seventy pounds a week. Items not included in the fees include chiropody treatment, hairdressing, newspapers and magazines and toiletries. Information regarding the services provided at Evergreen can be obtained directly from the home. Care Homes for Older People Page 5 of 33 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. Prior to this inspection we sent surveys to people who use the service and staff who work at the home. We received seven surveys from people who live at the home and five surveys from staff. The findings of these surveys are incorporated into the report. This key inspection included a visit to the home on Monday the 22nd June 2009. During this time we spoke to the registered manager, registered provider and assistant manager. We spoke at length with three people who live in the home, and to three Care Homes for Older People Page 6 of 33 members of staff. We case tracked two people who use the service. This means we looked in detail at the care these people receive. We spoke to staff about their care, we looked records that related to them, and made observations if they were unable to speak to us or provide feedback. We looked at care plans, maintenance records, three staff recruitment records, training records, policies and procedures. We did this because we wanted to understand how well the recruitment and safeguarding systems work and what this means the people who use the service. During inspection we also watched interactions between staff and people living at the home. At the inspection the manager gave us the annual quality assurance assessment (within timescales). The AQAA is a self-assessment record that focuses on how well outcomes are being met for people using the service. It also gives us some numerical information about the service. All this information helps us to develop a picture of how the home is managed and what it is like to live at Evergreen. What the care home does well: Evergreen is a welcoming and homely home. Mr and Mrs Tope, the owners, their daughter, and the staff team pride themselves on providing an extended family to the people living there. The service was described as you could not ask for anything better with one person saying Id love to win the lottery so I could buy them all a gift to say thank you. They are wonderful, and I often think I am very lucky to have found a place like this The admission procedure is good and shows that staff make sure they can meet the persons needs before they are admitted. People tell us that the admission process is made easier by the staff at the home. People receive a very good standard of personal care, and communication with healthcare professionals in the community is very good. The care people receive is provided in a safe way and medicines are well-managed by the staff. Staff at the home make sure people see healthcare professionals when they need to. Care of the dying is also performed very well with the help of district nurses. One thank you card from a relative read Many, many thanks for the love and care you gave to our mother whilst staying at Evergreen. She was happy staying here. The improved care planning documentation at home are good and mean that staff know how to care for somebody in a safe and consistent way that meet their individual needs and preferences. People have access to a range of activities and are able to maintain contact with their family and friends. People enjoy the activities provided by the home particularly the opportunities for the external entertainers and 1:1 time with staff. People tell us that the food is wonderful and gorgeous. Any issues regarding dietary requirements, preferences or weight issues are sensitively managed. People say there is plenty of food and staff know what they like and dont like. People who use the service and their relatives can be confident that if they complain, their concerns will be listened to and acted on. People feel able to complain and know how to do this, although people said they have never needed to complain. Induction and training for staff is good at the home and means that vulnerable adults are cared for by a stable group of staff who have had the necessary training in order to provide care in a safe and effective way. The staff group are popular with people who live in the home who describe the staff as gorgeous very kind and wonderful. Thank you cards described the care as loving and devoted. Evergreen is a safe and clean place to live and work. Maintenance systems are very well managed and a good level of decor and furnishings is provided at the home. The manager and staff group have suitable qualifications and experience to care for Care Homes for Older People Page 8 of 33 people who require personal care. The home is well-managed by the manager and supporting team. The providers are very responsive to suggestions and requirements made about their service and are keen to rectify any shortfalls immediately. What has improved since the last inspection? What they could do better: Information provided to people before they move into the home should be improved to make sure they have written information before they move to the home. The Statement of purpose and Service User Guide should be update to ensure they contain accurate information. These documents should then be made available to people. Staff could also improve the information they obtain about people before a person is admitted to the home by adding a few minor prompts to the pre admission document. This will show staff have enough information to decide whether they can meet the persons needs. Although people are treated with kindness and respect at the home, the protection of people must improved by making sure the recruitment process is robust and meets guidelines set by the criminal records bureau. The Provider must be aware that CRB checks are not portable despite previous CRBs only being issued in weeks before the interview and must ensure new CRBs are performed. Further information such as obtaining a recent photograph would also improve this recruitment process. Care Homes for Older People Page 9 of 33 People could also be protected by ensuring the personal monies held are securely stored. Although receipts for individual items are produced, records for regular services should be clear to show what money has been spent and what date this occurred on. By providing this clear audit trail will help to protect people from abuse and will also protect the management. Staff should be provided with adequate training during their induction period. Although the majority of people in the home are mobile, information on the safe moving and handling practices should be provided to all staff. The manager must also consider their employment responsibilities by reviewing the length of time and work patterns that some staff work. Systems must be in place to ensure excessive hours do not have an impact on the health and safety of vulnerable people in the home. If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details set out on page 4. The report of this inspection is available from our website www.cqc.org.uk. You can get printed copies from enquiries@cqc.org.uk or by telephoning our order line –0870 240 7535. Care Homes for Older People Page 10 of 33 Details of our 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) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 33 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The admission procedure is good. Minor improvements to the pre admission document will show that staff have detailed information to decide whether they are able to meet the needs of the person. Improvements and updates to the information provided will mean that people have accurate information about Evergreen before they come to the home. Evidence: People told us either themselves or their family and friends had an input into deciding whether Evergreen was the right home for them to move into. One person said my family decided this was the best place to be, and it is whilst another person said I looked around about ten and knew this was the right place as soon as I arrived. We were told that most pre admission information is passed onto the peron verbally Care Homes for Older People Page 12 of 33 Evidence: and that there is an information booklet for people to read when they are admitted. This folder contains such information about the staff, local hairdresser, mealtimes and other useful information.The people we spoke with said they cant remember receiving any written information but knew the staff were very good at passing the necessary information to them. Survey response about information received before admission was mixed. Three responses were that not enough information was received, whilst the remaining responses were that people did get enough information. The Statement of purpose was printed from the computer and had not been updated since 2004. Minor details regarding the deputy manager and change of name of the care quality commission were highlighted for update. The manager informed us that these changes had taken place prior to writing this report. The service user guide was located within the residents information folder. The manager confirmed this was also due for review. This also had been updated at the time of writing this report. The manager told us either herself or her assisstant manager perform the pre admission assessment. This assessment is recorded in depth on a tailor made document. This was well completed and contained sufficient information to decide whether the home would be able to care for the person. Information is also obtained from the person, their family, social services and healthcare professionals. Discussions were held about including information on issues such as footcare, eye care, hearing and dietry information on the pre admission document. These had been added by the time this report had ben written. The majority of people in the home were mobile, with the use of walking aids. The pre admission assessment was detailed in assessing mobility to ensure people could manage the stairs or stair lift. Each person is provided with a contract from either the home or social services. The manager confirmed the contracts issued by the home are under review at present. Care Homes for Older People Page 13 of 33 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The personal care people receive is provided in a respectful way. The care planning systems at the home are good and mean people have their health needs identified and met in a safe and consistent way. The management of medicines is generally good and helps protect people from risk. Minor improvements to medication records would help minimise any risk. Evidence: People living at Evergreen have access to a range of health care services both at the home and in the community. Each person has a GP who attends when staff request. One person told us she felt very reassured that the doctors surgery was next door. This person said you only have to ask and staff will contact the doctor for you. During the inspection people looked cared with the finer details such as eye care, nail Care Homes for Older People Page 14 of 33 Evidence: care and appropriate foot wear present. People who were being cared for in bed looked comfortable, pain free and clean. People told us they thought the standard of personal care was good at the home. One person said I really appreciate that they dont take over but that they are there in an instant if I need my buttons fastening Another person said I really like bath days as this is a time when I have a good old natter with the girls. Without exception people told us they thought that the care was very good. One person said Id love to win the lottery so I could buy them all a gift to say thank you. They are wonderful, and I often think I am very lucky to have found a place like this. Thank you cards were on display in the residents folder. One care read Many, many thanks for the love and care you gave to our mother whilst staying at Evergreen. She was happy staying here. Health care needs are communicated both verablly betwen staff and within care plans. Care Plans have improved since the last inspection. Each person has a plan, which sets out his or her needs. Each plan contains personal information, social information, medical information, medicine information, routines and preferences, and assessments for continence, skin care and moving and handling assessments. Risk assessmnets are performed on issues which are considered relevent for that person. One person had a risk assessment for family involvemnet in personal care, whilst another had a risk assessment for self medication and another for having tea and coffee making facilities in their room. Care charts are also used for people. Examples were newly introduced hygeine and bath charts which record what personal care was performed. New turn charts have been introduced for people with poor skin condition. Care charts to record what a person has consented to for mental health monitoring and diet charts are also used. Care charts were all completed to a high standard and kept under review. All surveys said that people always receive the care and support people need. All respondednts said the home makes sure people get the medical care needed. Specialist health care professionals are sought for advice and guidance. This input is recorded in the persons notes. Examples included chiropodist, physiotherapist, dentist, district nurse, specialist nurses, and GP. Staff told us the local NHS dental service had been very responsive in recent months. The management of medications is generally performed well at the home. Medications are supplied in individual weekly blister packs and stored in a locked box within a Care Homes for Older People Page 15 of 33 Evidence: locked cupboard. Controlled drugs are stored within a locked box attatched to the wall within the locked cupboard, although the manager and AQAA confirmed that no one is in receiept of controlled drugs at present. The manager informed us that any medicines needing to be stored within the fridge are kept in the kitchen fridge within a designated container. The manager said there were no refridgerated medicines stored at the home at present. Patient information leaflets are stored within a medication folder along with the mediciene administartion records and homely remedy policies and medication administration guidance. The records of administration were clear. A discussion was held about the benefit of obtaining two signatures to show that two staff have checked any hand written entries on the administration record. This will minimise any errors when copying a prescription. The manager told us that resident photographs had been taken for the medicine administration records. We were told that four of the twelve care staff have attended indepth 12 week medication training course whilst eight have attended the supplying pharmacist half day training. We were also told that an audit had been performed by the supplying pharmacist on the medication system. The manager told us people are able to end their life at the home where possible and that the district nurse team support the home with specialist equipment, pain relief and support for staff. Staff at the home find out the wishes and preferences of people in resepct of terminal illness when they are admitted to the home. People were encouraged to move freely around areas of the home if they are able to do so. Walking aids were present for those that required them. Grab rails, ramps, and stair lifts were present throughout the home and ramps were available to reduce risk. We were told no one in the home required transfer using a hoist. People who use the service were treated with respect during the inspection. They were offered choice regarding meals and activities and addressed using their chosen term of address. People were full of praise for the staff saying, Staff are wonderful, they are gorgeous, and you only have to ask and they they give you if they can People said response to call bells was very quick. One person even described staff as running up to check I am ok. Care Homes for Older People Page 16 of 33 Care Homes for Older People Page 17 of 33 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The routines of daily living are provided in accordance with the wishes and feelings of people in the home. The satisfactory activities programme helps to provide people with stimulation and entertainment. Evidence: All but one survey showed us that people think the home always arrange activities that people can take part in. The remaining respondent said sometimes People we spoke with said they were able to come and go as they pleased and sometimes joined in the activities. People we spoke with particularly enjoyed the musical entertainers, Plymouth museum and slide shows which were arranged monthly. People told us there were also library books, board games and films to watch if they wanted. However, the majority of people we spoke with preferred to continue with their own hobbies and interests. One person said she was an avid reader and appreciated the large print books, whilst another person preferred to sit quietly to do Care Homes for Older People Page 18 of 33 Evidence: needlework. Staff told us people chose whether to listen to music or watch TV in the communal areas. Staff also showed us the monthly activities print out displaying what activity was organised for each day. We were told people still enjoy going out with friends and family. One person told us he had loved going out with his family at the weekend to celebrate fathers day. Staff also told us some people still attend community therapy sessions whilst some people go for walks to the local park or shops. One person was overheard saying Ive met some wonderful people since I have been here Staff told us that all the people at the home had declared they had no religious beliefs or were of various Christian faiths. The manager explained that she had tried to get religious ministers to visit the home on a Sunday but had been unsuccessful and no one in the home had wanted to attend any local churches. The manager confirmed this could be arranged if people wanted. The interactions between staff and people in the home were positive, affectionate and very professional. The staff were seen to display a genuine caring attitude with suitable laughter and light banter. Staff providing care behind closed doors were heard to continue with positive interactions speaking to people in a respectful way. People told us they appreciated the fact that staff do not take over, but encourage them to do as much as they like to do. One person said I like to change my bottom sheet myself but staff come and help me with my duvet. Feedback at the inspection regarding food was overwhelmingly positive. Comments such as gorgeous marvellous and lovely were received. People told us staff always offer a choice of meals and bend over back wards to find an alternative. We were told that the meals were always served on time and were always hot. On the day of inspection people were being offered fish in parsley sauce or beef casserole and dumplings. Home made rice pudding was also being prepared. People told us the meal was lovely as usual. Mealtimes appeared to be a sociable affair with people sitting at their preferred table. We were told that a four weekly menu was in place. The manager told us alternatives would always be found because the home is small enough to know what people like and accommodate preferences. Care Homes for Older People Page 19 of 33 Evidence: The feedback regarding meals in the surveys was also good with five people saying they always liked the food and the remaining two saying they usually liked the food. People told us the portion sizes were good and extra food out of meal times was available but not needed. The kitchen, food cupboard and freezers were well stocked despite a supermarket delivery being made. The kitchen areas were very small but used effectively. Mobile work surfaces were used. An environmental health office inspection had been performed in march and had identified fridge temperatures as an action point. These were now being done. The kitchen was well managed with the use of the recommended safer food better business programme. Care Homes for Older People Page 20 of 33 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People can be confident that complaints will be well managed at the home. The training, and staff knowledge helps to protect people from abuse. Evidence: The manager told us they had not received any complaints since the last inspection. The AQAA confirmed this and read that the Providers at the home listen to people by being at the home on a daily basis and by looking and listening to see issues before they become complaints. The AQAA also read We provide a homely atmosphere where our clients feel safe and secure. This response was confirmed when speaking to people in the home. The complaints process is clearly displayed within the home, on notice boards and within the resident information folder. People at the inspection all said they knew how to complain with comments given such as I know how to, but why would I need to, everthing is perfect. Survey responses confirmed that people knew who to speak to if they were unhappy and knew how to make a complaint. Everyone we spoke with felt confident that their complaints would be dealt with appropriately. Care Homes for Older People Page 21 of 33 Evidence: Everyone we spoke with said they felt safe living at home. People told us the staff were very kind and very caring. Several people told us the staff felt more like family rather than carers. All staff we spoke with knew how to report any allegations of abuse to the manager but also how to report outside of the home. Staff said they had received training in safeguardng adults. The manager confirmed she had attended a deprivation of liberties and safeguarding adults training events in recent months. We did not find any evidence where people were being restrained or deprived of their liberties. The manager was able to explain where courts of protection were in place to protect people from financial abuse. Policies were in place regarding whistleblowing for staff, and how to recognise and report abuse. Care Homes for Older People Page 22 of 33 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is a pleasant, clean, and safe place to live and work. Evidence: Evergreen is situated within walking distance of Mutley Plain shopping precinct in Plymouth. The establishment is formed from two terraced Victorian villas that have been internally combined. Accommodation is provided on both the ground and first floors. The home offers a large lounge room that has 2 seating areas, a dining room and a large conservatory area that leads to a small garden. All communal rooms and bedrooms were pleasantly decorated and furnished, reflecting the period of the building. The home was found to be very clean and tidy. Five of the surveys we received confirmed that people thought the home was clean and tidy with the remining survey reading usually. People told us that the home was always clean. Staff told us there was no designated cleaner at present but people told us a new cleaner starts in August. People told us they had been provided with a small safe in which they were able to Care Homes for Older People Page 23 of 33 Evidence: store their mediciens or valuables. Three people said they had been offered a chance to have a door lock but had declined this facility. The manager confirmed that door locks woud be fitted if a person wanted this. All areas of the home were clean tidy and free from obvious risks. Furnishings throughout the home were of a good standard. All bedrooms visited were clean, tidy and contained varying amounts of personal memorabilia and furniture. Radiators have been covered to prevent the risk of burn injuries should someone come into contact with them when on. The manager told us the routine maintenence programme had been carried out. We were told this has included re carpeting the dining room, conservatory and two bedrooms, repainting the conservatory and fitting a new roof and totally refurbishing six bedrooms. The manager also informed us the following items of equipment had been purchased; dry powder carpet cleaner, vacum cleaner, washing machines, irons, microwave, water urn, two cookers, two electric bath chairs and freeview boxes to enable televisions to work after the digital switchover. The majority of bedrooms were ensuite with the remaining bedrooms having bathing and toilet facilities close by. The laundry has been re fitted, this has provided slightly more space, although the manager told us that further changes were being considered. The manager told us the majority of laundry at the home is domestic in style and the small number of people who have incontinence issues do not result in foul laundry being produced. The laundry is equipped with personal protective equipment and goggles if staff need to sluice any item. Care Homes for Older People Page 24 of 33 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff are well-trained and motivated and employed in sufficient numbers to meet the needs of those currently living in the home. Recruitment and staff deployment practices must be improved to protect vulnerable people. Evidence: Everyone we spoke with were very complimentary about the staff at the home. Comments we received included the girls are friendly and we enjoy the odd joke and they are more like family, they are gorgeous, you only have to ask and they they give you if they can and you could not ask for anything better. Surveys reflected this view with all respondents saying staff always listen and act on what people say. People said there were always staff to meet needs. People said call bells were answered instantly with another person describing staff running up to check I am ok. Staff spoken to said they thought there were enough staff on duty but that more cleaning had to be done with the absence of a cleaner. We were told there were usually at least two managers and three care staff on in the morning, with two care staff in the afternoon and two at night. Care Homes for Older People Page 25 of 33 Evidence: Staff duty records confirmed these levels however some staff were seen to be working excessively long hours. One example showed that a member of staff had worked 78 hours one week and in the month had worked fourteen days with no day off. The member of staff had signed an opt out agreement for the working time directive. Discussion was held about the imprortance of considering the effectivness of staff when fatigued and safety impact of these excessive working hours. It was also suggested to check regarding insurance implications and staff hours. By the time of writing the report the manager had checked with employment law and health and safety and was in the process of reducing some hours of staff who were working excessive hours. The manager also infomed us new staff had been recruited and were due to start work once recruitment checks had taken place. Staff recruitment records were consistant. All staff are asked to complete an application form which contains details of employment history and health declaration. Two forms of identification are checked and two written references are sought. Whilst all staff files contained a photograph some of these were photocopies of passports which were not always recent. The manager informed us prior to writing this report that the application form has been changed to include a five year employment history, staff photos have been taken and emergency contact details for staff have been taken. Whilst all staff files contained a CRB (police check) and POVA (protection of vulnerable adults pre employment check) two of the three staff files inspected contained examples performed by the previous employer. New CRB checks had not been applied for by the home. A discussion was held about CRB guidance that states that CRB checks are not portable, despite them being issued by previous employers in weeks before the interview. At the time of writing this report the manager informed us that a new CRB had been applied for. All staff had either completed a recognised induction programme or were doing this. All staff had received fire and emergency procedures training prior to work. Staff surveys all stated that they considered this information prepared them for working at the home. Staff said the manager encouraged and supported staff to do NVQ training. Care Homes for Older People Page 26 of 33 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Evergreen is a well managed home. The owners and their staff team strive to provide a homely, stimulating and safe environment that respects and protects the rights of people. Evidence: People said they thought the home was very well managed. One person said they are here everyday which helps. The AQAA was clear in showing how the home listen to the views of people. The AQAA aid they are confident they are providing a good service which is value for money because We get a good response from the service user questionnaires people return for holiday stays and fees are the same as other homes in this area The AQAA stated that quality assurance is performed in various ways. These were Care Homes for Older People Page 27 of 33 Evidence: listed and included meeting on a daily basis, being avilaible to the clients, quality control questionnaires, use of suggestion box, looking and listening and talking to families. The assistant manager showed the last quality assurance survey that had been performed and showed what action had been taken after collating the result. The AQAA stated The service is constantly evolving to incorporate the views of the people using it. Surveys sent to people who use the service asked what does the service do well? Comments included Everything everything, I have no complaints at all and Provide you with clean and pleasant surroundings. The staff will fetch you things you need inside your room or outside if you cant get to the shop. They also provde carers if you visit the doctors or hospital. Staff surveys were asked the same question. Response from staff included The cleaning The communication between staff and management all care is given very well excellent care and communication and discussions on how to improve any care issues that arise. Staff told us the Providers were supportive and encouraged further training. Staff were asked what the home could do better. One comment read more paperwork such as turn charts and hygeine charts At the time of inspection, these had been introduced. Another comment from staff surveys included we need a better understanding of moving and handling and how to care for bed ridden clients. At the time of inspection people being cared for in bed were well cared for with the use of skin care charts and involvemnt of district nurse teams. However, moving and handling training was not up to date for all staff. Training dates had been booked for July 2009. All but one person was mobile and able to transfer with minimal assistance. Discussion was held about ensuring all staff are provided with information on moving and handling before they work in the home. Training programmes were organised to ensure staff were up to date or had been booked onto mandatory training sessions. New staff had been booked on mandatory courses or were scheduled to do these sessions as part of NVQ 2 training. People at the home told us their families managed their finances and a small amount of cash was availiable for hairdressing, newspapers and chiropody charges. The managr told us two people in the home were subject to court of protection to Care Homes for Older People Page 28 of 33 Evidence: safeguard their finances. The manager told us the system works well and small amounts of money can be obtained. A balance of one of these was checked and found to be correct. Discussion confirmed that these personal monies are stored within the office but not within a locked cupboard. The managr said when they are not at the home the office is locked. It was pointed out that access to the office was possible when providers and managers were in the home. It was suggested that these monies were securely stored. Reciepts for individual items were present. However a clear audit trail was not possible for the services of the chiropodist because of lack of date and confirmation from the chiropodist. The manager infored us that a signature and details of the amount paid are now recorded on the receipt page. Care Homes for Older People Page 29 of 33 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 30 of 33 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 19 13 The Manager must demonstrate that considerations have been made regarding the excessive hours worked by staff. This will mean that any risks associated with long working hours do not have an impact on the health and safety of the people in the home. 13/08/2009 2 19 19 Staff must not work at the 13/08/2009 home unless satisfactory checks have been performed. These must include performing CRB checks and obtaining a recent photograph. This will show that the home have performed full pre employment checks on staff before they care for vulnerable adults. Recommendations Care Homes for Older People Page 31 of 33 These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No. Refer to Standard Good Practice Recommendations 1 2 35 35 Secure facilities should be provided for the safekeeping of money Written records of financial transactions should always be clear to protect people from financial abuse and to show staff have robust ways to protect peoples money. New staff should be provided with moving and handling training 3 38 Care Homes for Older People Page 32 of 33 Helpline: Telephone: 03000 616161 or Textphone: or Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Commission for Social Care Inspection (CSCI). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. 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