Care Home: Green Gables

What the care home does well Comments from people who use the service in relation to what the home does well included `look after me`, `dispense medication, food, cleanliness, kind and caring staff`, `look after residents well being and make family members welcome`, look after me and care about everything` and `friendly atmosphere`. There is an enthusiastic workforce that is well motivated and works positively with people to ensure that all their health and welfare needs are met. Staff training is ongoing at the home. People benefit from a range of activities organised by an activities coordinator, who spends two hours a day at the home during the week. Green Gables provides a homely environment for people and has a warm and friendly atmosphere. The home is pleasantly decorated and comfortably furnished with good quality items. The home has a thorough admission process that makes sure that the care needs of the person can be met at the time of their admission. The majority of written records seen that are required to be maintained by regulation were comprehensive and up to date. What has improved since the last inspection? The home has maintained the exemplary standard with regard to providing a homely environment for people. The new office building has been completed. The outside of the home has been repainted, and the garden areas have been landscaped. A number of new carpets have been laid. The management structure in the home is being increased providing additional care staffing hours from February 2010. The requirement made in the last inspection report has been met. What the care home could do better: The care planning system needs to be developed to provide a fully person centred care planning approach. Ensure that there are no gaps in the recording of the medication records. Update staff training matrix. Upgrade the laundry area. Key inspection report Care homes for older people Name: Address: Green Gables Green Gables 6 Northdown Avenue Cliftonville Margate Kent CT9 2NL     The quality rating for this care home is:   three star excellent 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: Sandra Crosby     Date: 0 9 1 2 2 0 0 9 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 27 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) Copyright © (2009) Care Quality Commission (CQC). 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 CQC 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 27 Information about the care home Name of care home: Address: Green Gables Green Gables 6 Northdown Avenue Cliftonville Margate Kent CT9 2NL 01843227770 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Mrs Annette Zammit,Carol Lewis care home 18 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 old age, not falling within any other category Additional conditions: The maximum number of service users who can be accommodated is: 18 The registered person may provide the following category/ies of service only: Care home only - PC to service users of the following gender: Either whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - OP Date of last inspection Brief description of the care home Green Gables is a detached three-storey property, providing 14 single bedrooms and 2 doubles. Five of the single bedrooms have en-suite facilities. There are stair lifts to the first and second floors. All bedrooms have a call bell point and television point. There are three lounge areas and a dining area, all of which are interlinked, plus a conservatory, where smoking is allowed. Green Gables is situated in a residential part of Cliftonville, close to shops and other Care Homes for Older People Page 4 of 27 Over 65 18 0 Brief description of the care home local amenities. There is unrestricted parking on street, with one off-street parking place. There is a well laid out back garden accessible to residents. According to its statement of purpose, Green Gables aims to provide a home from home environment to meet the needs of elderly service users within its care. Information recently received from the Registered Person states that the fees range from £294.00 to £340.00 per week. Care Homes for Older People Page 5 of 27 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: three star excellent 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 3 star. This means the people who use this service experience excellent quality outcomes. This report contains the findings of the homes key inspection and takes account of information obtained from various sources since the last Key Inspection of the 14 November 2006, an Annual Service Review dated 13 May 2008 and a visit to the home. The key inspection visit was unannounced and carried out on Tuesday 08th December 2009 between 10.00 and 12.30 and on Wednesday 09th December 2009 between 09.30 and 13.00. During the time at the home the inspector spoke with the two registered persons, care staff and people who use the service. Various records were seen, together with an accompanied tour of some areas of the premises being made. Care Homes for Older People Page 6 of 27 Information contained in the last completed Annual Quality Assurance Assessment (AQAA), completed by the registered persons was clear and informative. As the yearly AQAA documentation has recently been sent to the home for completion, the information contained in the previously completed AQAA has been considered together with information gained and observations made at the time of the inspection visit, all of which has been used when completing this report. Eight service user surveys were sent to the home for completion. Six service user surveys were returned at the time of writing this report. The aim of the visit was to carry out an inspection against the key standards of the National Minimum Standards for Older Persons in accordance with the Inspecting for Better Lives (IBL) process. Judgements have been made for each outcome area in this report and these have been made using the Key Lines of Regulatory Assessment (KLORA), which is guidance used to ensure that a fair and proportionate judgement is made in each outcome area. More information about KLORAs can be found on the Care Quality Commissions (CQC) website. The findings of this inspection were discussed with one of the registered persons at the end of the visit, and overall indicate that this home is providing sustained good quality outcomes provision for the residents and in line with CQC ratings agenda this service has achieved an excellent 3* rating. Care Homes for Older People Page 7 of 27 What the care home does well: What has improved since the last inspection? 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 8 of 27 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 9 of 27 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 10 of 27 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. People are provided with the information they need to make an informed choice about moving into the home. The assessment process is very thorough and makes sure that the needs of the person can be met at the home. Management can demonstrate through the homes records, practices and staff competency that it can meet peoples needs. It is not the general policy of the home to admit people for intermediate care so Standard 6 was judged as not applicable. Evidence: The Statement of Purpose and Service User Guide for the home were seen at the last inspection visit and it was reported that both documents were well presented and contained comprehensive and clear information about the service provided by the home as required by regulation. Care Homes for Older People Page 11 of 27 Evidence: It was evidenced that the home has a thorough admission process that makes sure that the care needs of people can be met at the time of their admission. This involves one of the registered persons visiting prospective service users prior to admission, to meet them, assess their needs, give them information about Green Gables and let them know what to expect upon moving in. People can therefore be assured that the home is right for them at the start of their stay. Pre-assessment documentation was seen as part of the two care plans viewed. One of the people that have recently been admitted to the home was case tracked. There was much evidence to show that the Registered Providers had ensured that a comprehensive needs assessment had been completed. Care Homes for Older People Page 12 of 27 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. People benefit from care planning that is informative and mainly provides staff with the information they need to meet peoples needs. Peoples health care needs are met, and medication arrangements in the home mainly protect people. People can feel confident that they will be treated with respect and their right to privacy is upheld. Evidence: Two care plans were seen, and these contained all components as required by regulation. The plans were informative and up to date. The information contained in separate parts of the care plan indicates that peoples health care needs are closely monitored and action is taken to access health care services as appropriate. This was supported by comments from people who use the service, one person saying they called the Doctor and he came in to see me. Discussion took place with the registered person in relation to the implementation of person centred care plans that contain all information about the person in one place. The inspector was told that changes in management structure will allow for one of the duty managers to have six hours Care Homes for Older People Page 13 of 27 Evidence: allocated each week to be responsible for maintaining the care planning system. The medication records were seen, and on the whole were well recorded and up to date. A number of gaps were discussed with the senior and the registered person, and assurances given that action would be taken to address this issue. The storage of medications will be changed next year when the new office is operational. The registered person confirmed that an appropriate medication trolley would be acquired and that storage of this would no longer be in the quiet room. These changes are needed to ensure safe administration of medicines. It was observed that staff spend time with residents, talking to them and offering discreet assistance that respects dignity. People feel their rights as citizens are recognised and promoted, including fairness, equality, dignity, respect, and autonomy over their chosen way of life. This service is consistently providing good outcomes enabling this to be viewed as an excellent service in line with Inspecting for Better Lives. Care Homes for Older People Page 14 of 27 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. People are supported to participate in a variety of activities and maintain contact with family and friends. People have an active voice, expressing their personal preferences and this is respected and acted upon. People enjoy a good, balanced and wholesome diet with special diets being catered for. Evidence: People were spoken with individually in private, and several people were chatted to during the course of the inspection visit. All had positive things to say about the home, for example the staff were kind, people are well cared for and the food is good and alternatives are always available. It has been previously stated that people call the registered persons and staff by their first names and said that this is a very friendly place. An activities co-ordinator is employed to spend two hours a day at the home on weekdays. It has been previously stated that people are asked each day what they would like to do and activities are tailored to suit their mood at the time. A record is kept of the activities and who participates. Entries were also seen in residents daily Care Homes for Older People Page 15 of 27 Evidence: records. The meals seen served were well presented and there are alternatives choices at each mealtime. The menus show that a varied and nutritious diet is offered at the home. Fresh fruit was seen to be available. People spoken with and surveys returned confirmed on the whole that the food is good. Care Homes for Older People Page 16 of 27 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 confident that their opinions and concerns are taken seriously and responded to appropriately. People are protected from abuse and feel safe living in the home. Evidence: The home has policies and procedures in place in relation to the action to be taken if and when a complaint is made. The six surveys returned at the time of writing the report by people who live at the home confirmed that there was someone they could speak to informally if they were not happy and they all confirmed that they knew how to make a formal complaint. The registered person confirmed that there had been no complaints made in the last twelve months, and the Commission has not received any complaints about the service during that time. It was seen at the last inspection visit that the policies and procedures file contains detailed guidance on abuse and what to do if abuse is suspected. The abuse policy is regularly discussed with staff in their supervision meetings, and the procedures are covered in the staff induction programme. Staff also confirmed that they had received training in this area. It also forms part of the NVQ training that staff have undertaken. The registered persons have undertaken training in relation to the Mental Capacity Act Care Homes for Older People Page 17 of 27 Evidence: and Deprivation of Liberty and are currently looking to book staff on training. It was discussed that person centred care plans would need to incorporate the appropriate forms in relation to assessing a persons capacity, and the registered person was aware of the documentation and said that this would be done. Care Homes for Older People Page 18 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People benefit from living in a pleasant, homely environment that is well maintained. People are encouraged to maximise their independence by having access to the range of specialist equipment supplied by the home. People live in a clean and hygienic environment. Evidence: The Registered Providers have continued with their programme of improvements to the home. Since the last inspection the kitchen has been refurbished, the outside of the home has been repainted and the gardens have been landscaped. Re-decoration is ongoing with some bedrooms recently having new carpet laid. It was seen that the bedrooms are furnished to good standard, and that people have individualised their rooms with their own personal possessions. The building of the new office has been completed, and the registered persons said that they are hoping to have this area operational from 1 February 2010. This will mean that further improvements can then be made to other areas of the home. The home was pleasant, clean and hygienic at the time of the inspection visit. A ground floor bathroom was viewed and it was seen that due to the furniture in this room people would find it difficult to access the wash hand basin for washing their hands. Following discussion with the registered person immediate action was taken to Care Homes for Older People Page 19 of 27 Evidence: clear this area. The laundry area is small and is in need of improvement. The registered person said that this area has been discussed and is included in the ongoing business plan for the home. Care Homes for Older People Page 20 of 27 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. People benefit from a well-trained, enthusiastic and supportive staff team. People are protected by the homes recruitment procedures. Evidence: On the first day of the visit, due to staff shortages the registered persons were able to assist with the provision of care. At the second visit the staffing at the home was at the normal level of three carers, the cook, a person undertaking domestic duties, the maintenance person and one of the registered persons. One of the completed surveys stated I am very happy particularly with the staff. Changes in the management structure will provide extra care staffing hours from February 2010. The new system includes a duty manager on shift at all times during the day, and three carers in the morning, and two carers in the afternoon together with the activity person in the afternoon. Ancillary staff of cook, domestic person, and maintenance person make up the staff team. The two registered persons are in day to day control of running the home. Three staff files were checked, and showed that a thorough recruitment procedure is in operation at the home that meets the requirements of regulation. A person recently employed to work at the home confirmed that they undertook a thorough induction process. The registered person confirmed that a six week induction programme is Care Homes for Older People Page 21 of 27 Evidence: used that is linked with Skills for Care. The registered person said that nine members of staff have NVQ Level 2 or above, and that it was anticipated that five members of staff would be starting to undertake NVQ Level 2 in January 2010. Staff training is ongoing at the home, however the staff training matrix needs to be updated to clearly indicate the current position, and to ensure that staff have undertaken or updated mandatory training. Newly appointed staff awaiting a start date, have already undertaken moving and handling training. People are well supported by a staff team that recognises and responds appropriately to their diverse needs and human rights. This service is consistently providing good outcomes enabling this to be viewed as an excellent service in line with Inspecting for Better Lives. Care Homes for Older People Page 22 of 27 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 excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The management of the home provides leadership, guidance and direction to staff to ensure that people receive consistent quality care. Sound financial procedures protect people. Peoples health, safety and welfare are promoted. Evidence: The registered persons are experienced in running a home, and have achieved an open, positive and inclusive atmosphere. A comment from one of the quality assurance surveys stated in my opinion Green Gables is very well run by the two owners. The system of recording residents personal allowance monies remains the same and a sound system of recording is in place as previously reported. The registered person said that staff appraisals and regular supervision with written records maintained will be back on track once the office move is completed. Care Homes for Older People Page 23 of 27 Evidence: The home has a quality assurance system in place. Comments from December 2008 surveys included Green Gables is a very warm and friendly home with good staff, it is home from home and the food is always good. The registered person said that once the office move is completed and the new management structure is in place, the quality assurance system will be expanded. This service is consistently providing good outcomes enabling this to be viewed as an excellent service in line with Inspecting for Better Lives. Care Homes for Older People Page 24 of 27 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 25 of 27 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 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 Care Homes for Older People Page 26 of 27 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. Copyright © (2009) Care Quality Commission (CQC). 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 CQC copyright, with the title and date of publication of the document specified. Care Homes for Older People Page 27 of 27 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!