Care Home: Evergreen House

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What the care home does well We have recognised the achievements made since the last key inspection, in that requirements and recommendations made at that inspection have been satisfactorily addressed. We have found that Evergreen House offers a satisfactory commitment to care with an open and personable approach, which reflects the homeliness of a confident relationship between carers and those people using the service. Comments received from surveys and talking with people during the inspection included: "Everyone who works there is so helpful and friendly, I couldn`t wish for a better place for my mother to be cared for, excellent". "They are excellent in everything they do, my mum is doing so well since going in the home. She loves her food, which is very good". "Mom has been living here for three years and she is happy in her own way. I would never consider moving her, they are all well qualified and very caring". From our examination of care records we established that there are effective pre admission assessments, and care planning of individual needs, which are meaningful in formulating a satisfactory standard of personal care. When we discussed the quality of care with those people using the service and visitors, it was clear that they appreciated this personable attitude and approach to care. The housekeeping, administrative and support services have all contribute to the team approach, and are recognised by the management for their efforts. Comments we received from relatives during the inspection include: "Evergreen is a really nice home, we have always been impressed with the comfortable living standards for mum. The recent bedroom redecoration has been very welcome, and has improved her lifestyle". "Everyone who works there is so helpful and friendly, I couldn`t wish for a better place for my mother to be cared for, excellent". We considered that the overall management style demonstrated a solid approach in maintaining an environment conducive to the care of the elderly. What has improved since the last inspection? Our inspection has identified a more positive `person centred` approach to care, especially for people with dementia. The arrangements for activities and socialisation have shown some improvement, although much still needs to be accomplished to offer people an inclusive quality of life, and a sound foundation to provide a good standard of care. Various comments we received through surveying from people in the home: From the Expert by experience: `One lady I spoke to said that she would like to be doing something because it would make the days go quicker. The visitor I spoke with said she was very happy with the quality of care for her Nan, but when discussing activities offered she felt that this could be improved`."Supports and assists service users to have a healthy, well balanced life, with respect and dignity. Service users are treated as individuals and are given a good, happy life". "When I`ve been not happy about something, I know I can tell the manager of the home, or any member of staff, they are always very helpful". "Evergreen is a really nice home, we have always been impressed with the comfortable living standards for mum. The recent bedroom redecoration has been very welcome, and has improved her lifestyle". We have acknowledged that there have been significant improvements in the furnishings and decor throughout the home, presenting a comfortable, safe environment, and to assist people, especially those with a higher dependency of care or dementia needs. Our discussions with staff confirmed an improvement in the standards of staff morale, motivation and training, through effective management. Information gathered from the AQAA, and discussed during our inspection found this to be true. What the care home could do better: We considered that much could be achieved by the support of a dedicated activity coordinator, to facilitate and promote stimulation and diversion for people living in the Home. More variety in indoor activities would be beneficial, especially for people with dementia and other cognitive impairments. From our inspection we advised that the Care Manager ensures that every person admitted to the Home has a full appraisal of lifestyle and social needs, to form the basis of a meaningful care plan, and that all assessments, care plans and ongoing monitoring is evidenced consistently through signature, and dating ownership. We also recommend that confirmation of agreement for admission be sent in writing to the person involved as soon as is appropriate. To review the state of maintenance of external facilities to enhance the surroundings for people to enjoy and use constructively. The conservatory and external woodwork are in need of renewal We consider that the Registered Provider should ensure adequate care staff on night duty in raising the nightly cover to three staff; and deploys adequate numbers of care staff to accommodate the needs of people with dementia, and offer more support for activity work. We also advised that the records of staff induction and mandatory training be kept up to date, and managed effectively. We feel that to promote transparency and achieve effective control that the Registered Provider conduct an audit of financial account related to resident`s monies as an established routine. The achievements have been recognised, attention to areas of further recommended detail will significantly enhance the provision of an honest, solid and homely service. Key inspection report Care homes for older people Name: Address: Evergreen House Lichfield Road Tamworth Staffordshire B79 7SF     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Keith Jones     Date: 1 4 0 4 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. 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. Care Homes for Older People Page 2 of 34 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. 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 mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 34 Information about the care home Name of care home: Address: Evergreen House Lichfield Road Tamworth Staffordshire B79 7SF 0182750675 0182750120 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Mr Jayantical James Bhikhashai Patel,Mrs Kailash Jayantical Patel Name of registered manager (if applicable) Type of registration: Number of places registered: care home 28 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category physical disability Additional conditions: Age: Dementia (DE) age 55 and above. Physical disability (PD) age 55 and above. The maximum number of service users who can be accommodated is: 28 The registered person may provide the following category of service only: Care Home Only (Code PC); To service users of the following gender: Either; Whose primary care needs on admission to the home are within the following categories: Dementia (DE) 9 Old age, not falling within any other category (OP) 28 Physical disability (PD) 10 Date of last inspection 1 2 0 6 2 0 0 9 9 0 10 Over 65 0 28 0 Care Homes for Older People Page 4 of 34 Brief description of the care home Evergreen House is located in a residential area of Tamworth, Staffordshire, and is accessible via public transport, close to local amenities. The service provides care to older people, some of whom may have a physical disability, or dementia care needs. The three storey, detached building provides accommodation for twenty eight people on the ground and first floor level, comprising of sixteen single and six shared bedrooms. Although en- suite facilities are not provided bathrooms and toilet areas are situated close to bedrooms and communal areas. The ground floor offers a separate dining area, compact lounge, and a large conservatory that is utilised as a lounge. All areas are equipped with essential furnishings and fitments to promote the comfort of people who use the service. A passenger lift enables people to access all floors. Ramped access is provided at the rear of the property only. Ample car parking is available at the front of the building, secure gardens to the rear. The full range of charges ar detailed in the services Statement of Purpose, or Service User Guide documents, the reader may wish to contact the service to obtain up to date information. Care Homes for Older People Page 5 of 34 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: We conducted this unannounced inspection with the acting Care Manager, Operations Manager, and senior care staff on duty, and an Expert by experience, whose input contributed to this report. An Expert by experience is a person who, because of their shared experience of using services and ways of communicating, visits a service with an inspector to help them get a picture of what it is like to live in, or use the service. The Registered Provider joined the inspection later in the morning, and remained for most of the day. Our inspection of the Home allowed us free access to all areas and open discussion with people who use the service, relatives and staff. There were 25 people in residence on the day of our inspection. We looked at how care is being arranged and supported for a range of people with personal care needs. To do this we looked at (case tracked) four peoples files from admission referral to the present time, and four staff files were examined. We also looked at other information such as complaints, incidents, events Care Homes for Older People Page 6 of 34 and other professional reports. We took the opportunity to speak with a number of people who are using this service, relatives and members of staff, who took an active role in our inspection process; their input contributed to the subsequent report. We acknowledged receipt of the Annual Quality Assurance Assessment (AQAA), nine survey forms returned that we sent out to people who use the service some weeks before the inspection, and six staff responses were received. We inspected a sample review of administrative procedures, practices and records, confirming satisfactory practice and management. There followed an inspection report feedback, involving the Registered Provider, acting Care Manager and Operations Manager, in which we offered an evaluation of the inspection, indicating those requirements and recommendations resulting from the inspection. Care Homes for Older People Page 7 of 34 What the care home does well: What has improved since the last inspection? Our inspection has identified a more positive person centred approach to care, especially for people with dementia. The arrangements for activities and socialisation have shown some improvement, although much still needs to be accomplished to offer people an inclusive quality of life, and a sound foundation to provide a good standard of care. Various comments we received through surveying from people in the home: From the Expert by experience: One lady I spoke to said that she would like to be doing something because it would make the days go quicker. The visitor I spoke with said she was very happy with the quality of care for her Nan, but when discussing activities offered she felt that this could be improved. Care Homes for Older People Page 8 of 34 Supports and assists service users to have a healthy, well balanced life, with respect and dignity. Service users are treated as individuals and are given a good, happy life. When Ive been not happy about something, I know I can tell the manager of the home, or any member of staff, they are always very helpful. Evergreen is a really nice home, we have always been impressed with the comfortable living standards for mum. The recent bedroom redecoration has been very welcome, and has improved her lifestyle. We have acknowledged that there have been significant improvements in the furnishings and decor throughout the home, presenting a comfortable, safe environment, and to assist people, especially those with a higher dependency of care or dementia needs. Our discussions with staff confirmed an improvement in the standards of staff morale, motivation and training, through effective management. Information gathered from the AQAA, and discussed during our inspection found this to be true. What they could do better: If you want to know what action the person responsible for this care home is taking Care Homes for Older People Page 9 of 34 following this report, you can contact them using the details 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 34 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 34 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 process to ensure that the needs of people are appropriately assessed before they are offered a place, are in place. They and their relatives can be confident that the service will be able to meet their needs. Evidence: We looked at the Homes recently revised Statement of Purpose and Service User Guide, and found them to provide an informative description of the homes aims, objectives, and the way it operated. We were informed that the information was presented to all enquirers, and that information concerning fees payable are included in the Service User Guide. We found that there were several elements that needed updating, although presented in a large print and DVD/audio version to help people to make an informed choice. It is stated in the AQAA, and we recognised that the Statement of Purpose represents the basis on which the home operates upon, offering those people who may use the service, and their relatives, the opportunity to make an informed choice about where to live. Care Homes for Older People Page 12 of 34 Evidence: Through our case tracking of three peoples care records we clearly identified that the Care Manager, or her Deputy, at the point of reference, had conducted the preadmission assessment. We found that the established process identified a clearly dependency assessment, but lacked information of life style and social life. There remains an inconsistency in taking ownership of responsibility with several documents not signed or dated. Nevertheless the process does form a foundation for care planning to meet needs, which included a copy of the care plan from social services, prior to admission. There is evidence that the assessment is produced with the full involvement of people who may use the service and their family, allowing them to influence the direction of care. Those files we examined showed this to be true, with each individual having a plan of care, which included a daily care programme, risk assessments with goals and outcomes. Any special needs of the individual are discussed and documented, although a life history or account of lifestyle would help to meet their personal needs. We saw evidence during the day to confirm that a number of people who have dementia or confusion, are receiving the appropriate level of care to ensure that their needs, health and well being are being met. During the course of our inspection we had opportunities to sit and talk with people who use the service, staff and a number of visitors. We found evidence that care had been taken in involving people, and their families in the admission process. I tell people my mum is in Evergreen, and I would recommend the home to anyone who are looking for a home for their relatives. Makes my family feel at home, takes care of me. Mom has been living here for three years and she is happy in her own way. I would never consider moving her, they are all well qualified and very caring. From our discussions it was evident that people are able to visit and assess the facilities and suitability of the Home at any reasonable time to meet with staff and management. Staff are aware of the special period of personal anxiety that people have under those conditions, a point well illustrated when talking to people, and examining records on case tracking. No intermediate care took place in the home. Care Homes for Older People Page 13 of 34 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 health and personal care, which people receive, is based on meeting personal needs, with clear principles of respect, dignity and privacy put into practice. Medicine administration systems are safe and secure. Evidence: Care records we examined, and case tracking provided evidence to show that the pre admission assessment formed a basis for an improved, revised care planning process. We acknowledge that Social Services reports and assessments are taken into consideration. We found that the profile of each persons social, physical and psychological status offered an individual plan of care, increasingly based upon a more person centred process of dependency assessment and activities of daily living. We advised that the assessment be confirmed in writing with the family and person involved immediately. There was indication of an inconsistency with signing and dating assessments, needed to authenticate the quality of assessment. We saw that the assessment of need is reconsidered within an individual plan of care that is reviewed monthly, to reflect their Care Homes for Older People Page 14 of 34 Evidence: changing needs and adapting care profiles. There is an informative daily progress report and separate night reports which would be more appropriately combined to provide an accurate chronicle of stay and events. Established monitoring systems following a process of goals, care and evaluation of satisfactory care plans, which was shared and appreciated by those people and relatives alike. Risk assessments are carried out on an individual basis and reviewed as required, these include tissue viability, continence and nutrition. The strength of purposeful planned care lies within the frequency of the review process in monitoring and adapting care profiles. The reviewed care planning process is established with a good understanding of dementia care needs, was found to be well maintained and accurate. Case tracking of four people living in the home confirmed to us that specialist support and advice are sought as needed, with each person having access to a local Doctor, Dentist, Optician, Chiropodist, and Occupational Therapist as required. Through case tracking, our discussions and inspection of records, it was recognised that the Home arranges for health professionals should special health care needs be recognised. Our observations showed that generally people using the service appeared to be content, comfortable and happy with their lifestyle, complimentary regarding the quality of their lives and the care they were receiving. Comments we received during the course of inspection from people using the service, visitors and professionals: Everyone who works there is so helpful and friendly, I couldnt wish for a better place for my mother to be cared for, excellent. Makes my family feel at home, takes care of me. My mother is very well looked after, I have no complaints, only praise. Everything has changed here, the care is better, and I can say that the clients are more happier now and full of life. There was a clear appreciation of the openness and opportunity to contribute. Carers were seen to generally interact with people who use the service with understanding and friendly compassion. People were seen to be supervised in the lounge areas. In the progress of meeting people who use the service it was acknowledged that their general appearance indicated that their health and personal care was attentive and effective. Care Homes for Older People Page 15 of 34 Evidence: We confirmed that the administration of medicines adhered to procedures to maximise protection for people who use the service. We found that the acting Care Manager is responsible for overseeing all matters relating to medicines. She has effected a well developed, and smooth process of ordering, receiving, storing, administering and disposing of medicines. The poorly designed MAR records were seen to be incomplete in respect of audit trail, although there were no observed breaches in the system. Controlled Drug management was comprehensive. In our examination of care records, we established that a policy and procedure on care of the dying and death had been introduced to meet individual needs, and were in place with the full knowledge of those who use the service and relatives. Individual spiritual persuasions were seen to be documented and respected. It is stated in the services Statement of Purpose and the AQAA, that independence, privacy and dignity are encouraged, with the full involvement of family in all matters concerning the well being of people. This was confirmed in our discussions with people who use the service. visitors and staff. Relatives and friends have freedom of visiting, which emphasised the importance of maintaining social contact. We looked at bedrooms presented to facilitate privacy for the individual, which included medical examinations and personal care procedures being performed in private. Our discussions with people confirmed that individual spiritual persuasions, and individual diversity was seen to be respected. We were impressed with the confidence and closeness within the Home and the mutual respect that prevailed. Care Homes for Older People Page 16 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The care team promote the health, safety and welfare of people using the service, and working practices are satisfactory. There remains a need to promote social stimulation and activities to enhance daily living and quality of life. People who use the service can be assured that the home is run in their interests, based on openness and respect. People are offered a healthy, well balanced diet. Evidence: We found during our inspection that the daily routine was flexible to meet peoples expectations in a relaxed and informal atmosphere, with the security that there are familiar events to the day they could recognise. People were able to get up when they wanted, and were able to spend time in their rooms, or in the communal areas if they wished to. We found choices for meal times, and personal and social activities, including recognition of varied religious needs. We recognise the principle that activities are a key element in the socialisation approach to care, with visitors encouraged to be involved in a partnership style with care staff. The home engages a part time activity coordinator, who was on maternity leave at present, and on talking with the acting care manager it was apparent that Care Homes for Older People Page 17 of 34 Evidence: although socialisation is recognised as important, the resources applied are meagre, and too fragmented to have a sustained effect. An observation by the Expert by experience indicated: I was informed that the Activity Coordinator was on maternity leave at present and so the care staff would be doing some activities instead. A timetable showing the weeks activities were on the notice board by the front door. I spoke to a number of residents about activities at the home and received comments such as: We do not do much here. They do bingo sometimes but that is not my thing, I dont know about any activities here, we can have a newspaper if we request one but that is about it. One lady I spoke to said that she would like to be doing something because it would make the days go quicker. The visitor I spoke with said she was very happy with the quality of care for her Nan, but when discussing activities offered she felt that this could be improved. She went on to give some suggestions such as trips out, film nights and looking through old photographs. Maybe Rummage boxes could always be available and more pictures/memorabilia to touch and see would add to the lived experience of those who have Dementia. We were informed that the Home is planning extended activities to add to those already in place, and our discussion with the operations director identified a clear vision of care for people with dementia, and to participate in the process of change in environmental and social facilities. Staff were seen to be involved in attempting to stimulate activity, and generally chatting with people throughout the inspection. It remains our recommendation that creative ways of providing activities such as adapted equipment for those with disabilities; life story work and seeking individual interests would enhance life for people living in Evergreen House. This would be consistent with a Person Centred Care approach as stated in the Statement of Purpose. We also recognised that people would like the opportunity to enjoy outside activities in an attractive garden and patio area, well suited for the task. Some comments we received in the course of inspection included: Some residents have their seats facing away from the TV in the lounge, not a big problem. Perhaps the front lounge room on the right hand side could be more accessible for visitors. Supports and assists service users to have a healthy, well balanced life, with respect and dignity. Service users are treated as individuals and are given a good, happy life. Plenty of 1-2-1 chats with keyworkers, plenty of activities organised within the home, and organised events and entertainments are also regularly coming in to the home. Care Homes for Older People Page 18 of 34 Evidence: Make the garden more accessible for the service users. It is stated in the Statement of Purpose and AQAA, that personal choice, dignity and self determination are respected in policy and action, which we found to be true. Those individuals rooms we inspected showed a positive influence of personalisation in the inclusion of belongings, some furniture and general decor, demonstrated a degree of expressed individuality. An Anglican service is provided on a monthly basis, and a local Baptist minister has sessions. A Roman Catholic priest attends on request, and a Church of England communion is given every fourth Tuesday. We found a continuing good standard of catering, offering a service, to which all those people we spoke with, were complimentary on all aspects of quality and quantity. A four weekly menu cycle offered a wholesome, varied and excellent choice. We confirmed that the cook knew each person using the service, and some of the relatives. We discussed diversity with the cook, who indicated an awareness in meeting individual needs; there were no special cultural needs at the time. Individual preferences were conveyed to the catering staff, who met with, and discussed their requirements. A very pleasant lunch, and meals of choice were served during inspection, in a pleasantly furnished and clean dining room. Staff were seen to offer discreet assistance to those who required it. The choice of dining room, lounge or bedroom was at the discretion of people in the home. The Expert by experience commented: At lunch all residents who were able to attend the dining area did so. The process of assisting all residents to their seats took quite a time and there was little room to manoeuvre. One resident needed assistance throughout his meal, some were given bibs and I felt that the room lacked any social atmosphere. Two members of staff attended to the residents as they ate. People interviewed confirmed that that the quantity and quality food provided was good: They are excellent in everything they do, my mum is doing so well since going in the home. She loves her food, which is very good. Care Homes for Older People Page 19 of 34 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 are given opportunities to freely express any concerns, and these are quickly responded to. People are protected from abuse, and their human rights are promoted. Evidence: Through the course of inspection we confirmed that peoples legal rights are protected by the systems in place in the home to safeguard them, including the continual review and assessment of care planning, and policies in place, including the complaints procedure. The complaints policy and records of complaints dealt with were examined, which evidenced handling of peoples and families concerns in a meaningful and effective manner. From our discussions with people who used the service it was evident that issues were handled immediately, discretely and to the satisfaction of all concerned. There have been several complaints dealt with by addressing peoples, and their families concerns, in a meaningful and effective manner. Comments received from visitors, and people who live in Evergreen, in the course of inspection: In the three years I have lived here, I have no complaints to talk about. When Ive been not happy about something, I know I can tell the manager of the home, or any member of staff, they are always very helpful. Care Homes for Older People Page 20 of 34 Evidence: I would make sure that any problems are relayed back to the staff. I know the manager is very sensitive to her residents concerns, a good system. No complaints had been received by us since our last inspection, and the overall policy of openness and transparency was acknowledged. We were informed that all the people who used the service had received information on the procedure to complain, including reference to us. This process was evidenced on examination, and case tracking, as previously reported upon. Discussion with the acting care manager confirmed that there continues to be a satisfactory protocol, and response to anyone who may report any form of abuse, to ensure effective handling of such an incident. We have received one allegation since the last inspection, resulting in a direct and immediate response, dealt with to our satisfaction. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms all staff employed in the last 12 months have undertaken a satisfactory Criminal Records Bureau (CRB) check, confirmed by examining three staff files. Care Homes for Older People Page 21 of 34 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 provides a safe, well-maintained, clean and comfortable environment for the people who use the service, which encourages independence. Evidence: Evergreen House is located in a residential area of Tamworth, and is accessible via public transport and is close to local amenities. The service provides care to older people, some of whom may have a physical disability or dementia care needs. The three storey, detached building provides accommodation for twenty eight people, comprising of sixteen single and six shared bedrooms. External access is satisfactory for visitors, with adequate parking available on the homes forecourt. We found the gardens rarely use by people living in the home, although providing a pleasant outlook, and having had effective maintenance. We acknowledge the efforts being made to improve access to the garden area, and plans to involve people with a herb garden to spend some time in. We found the general state of exterior repair and maintenance to be in need of renewal, especially the conservatory and external window frames. There is adequate exterior security lighting, and all external doorways are secure. Comments received from people we met through inspection indicated: We find the home clean and tidy, my father seems to be comfortable with his situation. Care Homes for Older People Page 22 of 34 Evidence: Evergreen is a really nice home, we have always been impressed with the comfortable living standards for mum. The recent bedroom redecoration has been very welcome, and has improved her lifestyle. I have only been here for a few months, but it is almost as good as home, Im very comfortable. On admission the Care Manager or her deputy assesses each individual persons needs for equipment and necessary adaptations. Internal access was equipped with ample fittings of hand and grab rails, facilitating wheelchair access throughout most areas of the home. We found sufficient hoists and a range of aids and adaptations to assist people who are dependent. It was noted that there has been a programme of redecoration and fitting out to meet dementia care needs, especially in pathway recognition, reminiscence and familiar recognition, including personalisation of bedroom doors. The Care Manager confirmed to us a willingness on the part of management to meet any reasonable demand for special needs. The home provides two lounge areas and a conservatory, that were pleasantly decorated, providing essential furnishings and items to provide comfortable areas where people were able to interact, or to entertain their guests. A compact, homely dining area was clean and conducive to enjoy a good meal. The carer call alarm system was satisfactorily tested, with a good response from staff on duty. Our inspection of bedrooms found them well equipped and maintained to provide for peoples individual needs and preferences, personalised, with most displaying the personal furniture and belongings. There is a positive move to consider the individuality of personal space, especially in recognizing the needs of people with dementia. We found the overall quality to be an improving good standard, presenting a homely and comfortable environment. Several people we spoke to expressed a sense of belonging and satisfaction in the quality and presentation of their living areas. Bathrooms and toilets are located on both floors, near to bedrooms and communal areas, and fitted with appropriate aids and adaptations to meet the needs of people who use the service. We found them to be of a good quality, clean, uncluttered and odour free, visible with appropriate recognizable features. Sluice facilities have suitable arrangements to assist in control of infection. Notices regarding chemical handling in the areas that store chemicals are displayed. The housekeeping services in the Home were seen by us to be of a good standard. The people spoken to generally remarked that they find the environment always very clean and fresh. Comments from a survey we sent out: Care Homes for Older People Page 23 of 34 Evidence: Cares for emotional as well as physical wellbeing, always clean and tidy. Evergreen has always been clean and smells nice, bedrooms and bathrooms always clean and tidy. The home achieves a high standard of cleanliness. Heating and ventilation were found to be satisfactory, and lighting was domestic in style. Fire equipment was inspected and seen to be serviced and up to date. The laundry was well organised and equipped to a good standard. The kitchen presentation showed good standards of cleanliness and evidence of sound food hygiene practices, with a recent environmental health report offering a three star award. All fridges and freezers were seen to be used in the appropriate manner, and were checked daily by the kitchen staff. A cleaning schedule was in place, although requires updating to evidence the good quality of cleanliness observed. We spoke with the cook who confirmed to us that she actively engages with people who use the service to determine their needs and likes and dislikes. She was aware of the issues of culture, ethnicity and age diversity, having had experience in dealing with a diverse population. The Annual Quality Assurance Assessment completed by the service prior to the inspection confirms that the building complies with the requirements of the local fire service and environmental health department, and records are kept accordingly. Care Homes for Older People Page 24 of 34 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 adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. There is a need to review the staffing levels to maintain standards of care. Staff in the Home are trained to fulfill the aims of the unit and meet the changing needs of people using the service. Evidence: We confirmed that there were 25 people living in the Home on the day of the inspection. Three weeks of staffing rotas showed to us an adequate balance between skills, experience and numbers to provide a good standard of care. Discussions with staff also confirmed their commitment to providing a quality service and their awareness of the principles of good practice. At the time of the inspection the average care staff coverage was seen to be: Morning - 1 Senior 4 carers Evening - 1 Senior 3 carers Nights - 1 Senior 1 carer It is recognised that these levels are border line appropriate for the care of 25 people, to meet the demands of more dependant people, and a significant element of Care Homes for Older People Page 25 of 34 Evidence: dementia care. We consider it appropriate to require that staffing levels would be reviewed accordingly, especially on night duty. There remains a growing recognition that the arrangements for activities are inadequate, with people getting little in the way of effective supervision, and motivation to socialize and engage, especially in addressing dementia care needs. These issues were identified at the last inspection, and now requires an appropriate response to meet these demands. The catering, maintenance and domestic hours were determined and found to be appropriate for the size of the home and the needs of people. There are now sufficient hours given over to providing administration support to the care manager. We sampled four staff files, and found them to be consistent and up to date, although needing organising. Staff are employed in accordance with the Code of Conduct and Practice set by the General Social Care Council. We recognise that the management have established a procedure for interview, selection and appointment of staff, reinforcing the policy that the thoroughness of staff selection has a significant effect upon the provision of care to ensure protection of people. We consider that the formalisation of an interview record, and follow up letter of appointment would enhance the system and reinforce the agreements made on employment of staff. We saw little written evidence that all new team members receive a thorough induction programme, or an ongoing training and development plan for all staff. We asked staff about training, all of whom were complimentary of the improved facilities and opportunities offered. There is a need for the manager to upgrade the written record of induction and training to meet standards expected, and to involve staff more in the management of training, especially in keeping abreast of mandatory subjects, such as fire, movement and handling. The records we examined showed that 13 care staff are in receipt of National Vocational Qualification (NVQ) level II or level III, and that we recognise that a further three staff are undertaking, or planning to commence NVQ training at the time of inspection. A staff photograph in each file would be helpful. Some comments we have received in the course of inspection were: Everyone there is so friendly and nice, nothing is too much trouble. Everyone who works there is so helpful and friendly, I couldnt wish for a better place for my mother to be cared for, excellent. The young carers usually listen, are very helpful and try to meet our needs. The care of the clients is excellent. We are all up to date with course work and knowledge of our role, and of the clients. We all work as a team and our manager is Care Homes for Older People Page 26 of 34 Evidence: always there if you need her A little short staffed at times. Need even more training for care planning, risk assessment, challenging behaviour. More NVQ 3 available, any more training that would improve all service users quality of life. Records were available to demonstrate an on-going process of regular, practical supervision and supervised practice, showing training sessions and appraisals to be a routine feature of staff development. Care Homes for Older People Page 27 of 34 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. People can be assured that the home is run in their best interests. The ethos of the service is based on openness and respect. The care team, through good working practices, promote the health, safety and welfare of people who use this service. Evidence: We acknowledge that the acting Care Manager Norrie Pritchard has stepped in due to the sudden departure of the Registered Manager the week previously. Throughout the inspection she was helped by the Operations Director Joli Patel, offering effective support throughout the inspection. We however recognise the achievements made since that last inspection, demonstrating a management competence in re-establishing a solid management style that has been implemented, achieving good standards of set aims, objectives and care, supporting a developing Person Centred planning process. We have recognised the significant improvements across a wide spectrum of care and services since the last inspection, and the much improved atmosphere and staff Care Homes for Older People Page 28 of 34 Evidence: morale in the Home. The Registered Provider and the Operations Director have demonstrated a high profile and involvement in the effective running of the home, and are prepared to delegate a wide range of management responsibility to good effect. We acknowledged the openness and confidence in the observed interactions of staff, relatives and people who live in the home. The relationships were seen to be of mutual trust and respect. Several comments made by people who live at Evergreen House, and visitors we spoke with, reinforced the improved foundation of confidence they had in the management leadership. I tell people my mum is in Evergreen, and I would recommend the home to anyone who are looking for a home for their relatives. Makes my family feel at home, takes care of me. The home meets all the needs of the service users, the carers work very hard to achieve this. Our manager is now doing a very good job, and is really making a difference to the home. The home runs efficiently now, and the service users are happy and content. At the present the home is improving and getting better, under the new management. We have established that there is an increasingly number of dependant people with dementia, who have over that past few months been identified, and accommodated with improved facilities, activities, and environment, made available to assist them in daily living. Supported with a higher state of training and awareness from staff, and in the planning of care to promote inclusion and the overall quality of life. Our examination of records showed appropriate risk assessments are in place for people, through care planning and recording, staff selection and of the general environment, these are up to date and accurate. The services completed AQAA states that the Home has quality monitoring systems in place, and they also consult the people who use the service and their relatives about the service. We recognise that the Provider, with the acting Care Manager have developed a formal approach to monitoring quality across a wide range of activities, although an examination of administrative, monitoring, planning and care records showed an inconsistency in regularity and attitude to effective record keeping, especially in maintaining peoples observations, and staff training records. We identified that small amounts of cash were efficiently handled by the acting Care Manager through the Providers office and regularly audited. We advised that the Administrator take a more Care Homes for Older People Page 29 of 34 Evidence: active role in financial management, and that the Provider instigate an annual audit of accounts. We made a random sample examination of the procedures manual, and found it to offer a very comprehensive reference. Policies on missing person, confidentiality and Movement and Handling were examined, and found to be accurate and informative. Equality and diversity issues were also discussed covering a wide range of issues, including food, religion and staffing. We found that the health and safety of people who use the service and staff, are promoted, including safe storage of hazardous substances, regular servicing of hoists, and regulation of the water system, including Legionella screening. The accident book was seen and found to be in order for staff and people using the service, with a three monthly analysis of trends and frequency undertaken by the acting care manger. We confirmed that completed records are held in peoples care plans, to facilitate audit of accidents and effectiveness of action taken. Care Homes for Older People Page 30 of 34 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 31 of 34 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 27 18 That the Registered Provider 31/05/2010 ensures adequate care staff on night duty, in raising the nightly cover to three staff. This will ensure a safe provision of staff in meeting the needs of people 2 27 18 That the Registered Provider 31/05/2010 deploys adequate numbers of care staff to accommodate the needs of people with dementia, and offer more support for activity work. This is to provide adequate resources to engender an appropriate level of supervision and support for socialised activities. Care Homes for Older People Page 32 of 34 Recommendations 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 3 That the Care Manager ensures that every person admitted to the Home has a full appraisal of lifestyle and social needs, to form the basis of a meaningful care plan. That the Care Manager ensures that all assessments, care plans and ongoing monitoring is evidenced consistently through signature and dating ownership. The Registered Provider will ensure that all records are authenticated with a signature and dated appropriately. The Registered Provider will ensure that confirmation of agreement for admission be sent in writing to the person involved as soon as is appropriate. Review and develop the range of activities and facilities for recreation available to people using the service through the provision of an activity co-ordinator, having regard to the needs of people to recreation and fitness. That a more detailed profiling of peoples lives be obtained at admission assessment, as a basis for individualised social care, offering choice and upport. That the Registered Provider take action to renewal of exterior facilities and fabric of building. That the catering officer undertake a consistent recording of cleaning work undertaken. That staff recruitment procedures are consistent and thorough, in ensuring that an interview record and letter of appointment is sent on to successful applicants. That the records of staff induction and mandatory training be kept up to date, and managed effectively. 2 3 3 4 7 10 5 12 6 12 7 8 9 19 26 29 10 30 Care Homes for Older People Page 33 of 34 Helpline: Telephone: 03000 616161 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. © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. Care Homes for Older People Page 34 of 34 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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