Care Home: Greenacres

What the care home does well All people wishing to move into the home are offered the chance to look around before they move in. At this time staff can look at their needs and see if Greenacres staff can meet them. People who cannot visit the home are visited by a staff member to discuss the home with them and to look at their individual needs. During the visit staff were seen to be respectful of the people living in the home. Comments included ""staff are lovely, very polite" and "best thing is the staff, very caring, always want to look after me". Another person said that staff always knocked on the door before they came into their bedrooms. Relatives are encouraged to come and see the people who live in the home. Those spoken with said "we are always welcome to visit" and "staff are very nice, happy to help they help make my visits here a pleasant experiences". The staff try to make sure that all complaints are dealt with correctly. People living in the home told us that "I have no problems it`s a nice place to live", "staff are good if I need something they sort it out" and "if I have any issues they are quickly fixed". This showed that people living in the home felt able to raise their concerns and believed that they would be listened to. People living in the home are able to make their bedrooms their own. All bedrooms had family pictures and ornaments available. Some had furniture that they had been brought from their previous home. People we spoke with said, "I really like my bedroom", "I have my own bits in here and when I shut the door, it`s my little world" and "it`s a lovely room". What has improved since the last inspection? The home has made an effort to make sure that medications are managed safely. When we looked at how they were dealing with medications we noticed that all people received their medications correctly and medications were dealt with safely. The home has had some areas redecorated and the corridors now included pictures that show the local area in the past. This makes the home feel much more welcoming and comfortable. All staff are properly checked before they are allowed to come and work in the home. The manager has also looked at all staff files and made sure that all staff have had the proper checks and that they are fit to work in the home. Staff development has also improved with staff doing a variety of training including health and safety, fire, moving and handling and the prevention of abuse. What the care home could do better: The home needs to make sure that all people moving there have had the chance to choose a local doctor. Without access to a doctor there can be delays in getting treatment. Information in the home needs to be in a form that meets individual needs and is easily understood by the people living in the home. A way to make sure that the home is aware of individual personal choices and preferences needs to be in place. There are no written records available to show what activities people would like to do. There is little discussion with people living in the home about how they want the service to run. The management of personal money belonging to people who live in the home is not enough to make sure that they are protected from possible harm. CARE HOMES FOR OLDER PEOPLE Greenacres Pighue Lane Wavertree Liverpool Merseyside L13 1DG Lead Inspector Julie Garrity Unannounced Inspection 9th September 2008 11:30 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenacres Address Pighue Lane Wavertree Liverpool Merseyside L13 1DG 0151 2597899 0151 2592802 wavertreenursing@btconnect.com Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) Mr Ilam Chaudhry Miss Lynn Williams Care Home 42 Category(ies) of Old age, not falling within any other category registration, with number (42) of places Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of 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 - Code OP The maximum number of service users who can be accommodated is: 42 Date of last inspection 26th July 2007 Brief Description of the Service: Greenacres is a purpose built care home providing 24-hour personal care for forty-two people with age related needs. The home is a single storey building, which was opened in 1996. There are two lounges, a seating area and a dining room. Bedroom accommodation is forty single bedrooms and one double bedroom all with en-suite toilets. There is also a central courtyard area that provides outdoor space for people living in the home. As Greenacres is a no smoking home this is the only area in which people are able to smoke. Parking is available to the front and the side of the building. The home is located in a residential neighbourhood of the Wavertree area of Liverpool. Next door to Greenacres is a sister home owned by the same people, which provides support to people who need nursing care. The two homes share some facilities such as administration staff and maintenance staff. Greenacres is within easy access to bus routes and train stations, which are about five to ten minutes, walk away. The home is near local churches, shops and other amenities in the Edge Hill and Old Swan shopping centres. The city of Liverpool is approximately twenty minutes away by car. There are also major motorway links within ten minutes drive. Fees for accommodation is £320 per week with additional charges for items Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 5 such as newspapers. Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 6 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes. The visit to the home started at 11:30 and finished at 19:20. We spoke with a total of nine people who live in the home, six members of staff, two relatives and the manager. The home completed a document known as an Annual Quality Assurance Assessment (AQAA). This documented is completed and sent to us by the home before we visit. The AQAA tells us what the home does well and what their plans are to improve the quality of the home. We sent ten surveys to people living in the home, four were returned and information from these are included in this report. When we visited the home we looked at many of their records, these included care records, staff records, menus and activities records. All of the Key standards were covered at this visit to the home; these are detailed in the report. Feedback was given to the manager during and at the end of the visit. Feedback covered all the areas detailed in this report. The arrangements for equality and diversity were discussed during the visit. We particularly looked at ways that the home used to find out peoples needs, promote their independence and support them to make choices. What the service does well: All people wishing to move into the home are offered the chance to look around before they move in. At this time staff can look at their needs and see if Greenacres staff can meet them. People who cannot visit the home are visited by a staff member to discuss the home with them and to look at their individual needs. During the visit staff were seen to be respectful of the people living in the home. Comments included ““staff are lovely, very polite” and “best thing is the staff, very caring, always want to look after me”. Another person said that staff always knocked on the door before they came into their bedrooms. Relatives are encouraged to come and see the people who live in the home. Those spoken with said “we are always welcome to visit” and “staff are very nice, happy to help they help make my visits here a pleasant experiences”. The staff try to make sure that all complaints are dealt with correctly. People living in the home told us that “I have no problems it’s a nice place to live”, Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 7 “staff are good if I need something they sort it out” and “if I have any issues they are quickly fixed”. This showed that people living in the home felt able to raise their concerns and believed that they would be listened to. People living in the home are able to make their bedrooms their own. All bedrooms had family pictures and ornaments available. Some had furniture that they had been brought from their previous home. People we spoke with said, “I really like my bedroom”, “I have my own bits in here and when I shut the door, it’s my little world” and “it’s a lovely room”. What has improved since the last inspection? What they could do better: The home needs to make sure that all people moving there have had the chance to choose a local doctor. Without access to a doctor there can be delays in getting treatment. Information in the home needs to be in a form that meets individual needs and is easily understood by the people living in the home. A way to make sure that the home is aware of individual personal choices and preferences needs to be in place. There are no written records available to show what activities people would like to do. There is little discussion with people living in the home about how they want the service to run. The management of personal money belonging to people who live in the home is not enough to make sure that they are protected from possible harm. Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 8 Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 9 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 10 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3 were reviewed. Standard 6 is not applicable to the home. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. All people wishing to move into the home are given the opportunity to look around and have their needs looked at before they move in. Information that would help people moving into the home needs to be in place in a form that helps meet individual needs. EVIDENCE: The AQAA from the home told us that they try to encourage people and their families to look around before they move in. We looked at records for people who have moved into the home. These showed that they had their individual needs look at (assessed) before they moved in. The home makes sure that they have other information about individual needs such as assessments from social services. This helps them decide if they can meet individual needs. We spoke with people who live in the home who told us, “I came to look around before I moved in. It’s not far from my family so useful for them to visit” and Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 11 “I liked the staff and the bedroom so it seemed like the right place for me”. The manager confirmed that she encourages people to come and look around the home; this helps people to decide if they like it, it also helps the staff make sure that they can meet the person’ needs. We looked at information available to people wanting to move in. This information is called a statement of purpose and should detail the services available in the home. We noticed that this did not have a clear description of the needs the home can meet. A clear description would inform both people moving into the home and those working there as to the needs the home could support. Other information known as a service users guide that details daily life in the home was not available. The AQAA told us that a copy of a service users guide was available in each person’s bedroom. When we looked around the home we did not see any in the four bedrooms we looked at. Surveys sent to people living in the home from us showed that three people thought that they had enough information when they moved. One person did not agree and did not think they had enough information. The information that the home had was written in one form only. No other forms such, as Braille or large print was available. Comments from talking to people who live in the home included, “ I was given a little brochure that had some information in it”, “was not given anything other than a brochure” and “Not seen anything other than a brochure”. Without full information in a form that they can access people moving into the home will not have the opportunity to easily decide if the home can meet their needs. Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 were reviewed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Health and personal care needs of people living in the home are met by the staff. Information for staff is not always clear and stops staff from being sure that they are meeting individual needs at all times. Medications management continues to improve and maintains the safety of people living in the home. EVIDENCE: Four care plans were looked at. The plans record each persons health and personal care needs. Of those looked at all had been checked by staff and kept up to date. The directions to staff that tell them how to support people living in the home has improved since the last inspection. The AQAA from the home told us that each persons needs are set out in an individual plan. Care plans looked at were of varying quality and did not always tell us how to properly support people living in the home. Staff spoken with said that they rarely read the care plans but did tell each other all information about the needs of people Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 13 living in the home. We received four surveys all said that they always had the care and support that they needed and that the staff listened to them. People living in the home or their representatives did not sign the care plans we looked at. There was no evidence to show that they had been involved in writing them. We spoke to individuals living in the home none could recall seeing a care plan. Comments included, “Not seen a care plan” and “no idea what they write about me didn’t know they did”. People living in the home need to be involved in the writing of a care plan to make sure that it meets their personal needs. Records for people living in the home showed that the service did contact external professionals when needed. This included doctors, district nurses and attending hospital appointments. In one instance the service had tried to get a doctor for an individual but had not arranged a new doctor before the person moved in. This had resulted in a delay before a doctor could be arranged to visit the home. We discussed this with the manager who said that in the future the home will make sure all new people are registered with a doctor before they move in. Daily records were written clearly and showed the support that people living in the home had been given. Good daily records help the staff to monitor individual conditions and get medical help as needed. All of the people spoken to during the visit confirmed that the staff treated them with respect and dignity at all times and particularly when carrying out personal care. Comments included ““staff are lovely, very polite”, “best thing is the staff very caring, always want to look after me”. Three people living in the home confirmed that staff always knock on the door before they come into their bedrooms. We noticed during the day that staff treated all of the people living in the home and their relatives with respect. Medications were checked the management of this has improved. All staff that give out medications have received training and audits (that check the medications) are being done monthly. The AQAA from the home showed us that policies and procedures on how to manage medications were available. Policies and procedures are in place to provide guidance and support staff to give out medications safely. The majority of medications checked were given correctly. All medicines were recorded properly when they arrived in the home. Other accurate records include the recording of medications when they were given to the people. Medicines are mostly managed in way that maintains the safety of the people living in the home. Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15 were reviewed. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The opportunity to find out and record each individual’s choices, preferences and daily routines has not been taken. This will mean the service may not always be aware of individual wishes and as such may not be able to meet the person’s cultural, diet or social needs. EVIDENCE: We looked at the activities provided by the home. During the visit no activities were seen to be happening. People living in the home spent the majority of the day in the lounge area. There were no records in place that showed what each individual’s choice, preferences and needs for activities were. Individuals living in the service told us, I’d like to get out more”, “we do have entertainment occasionally and its usually good fun”, “I like to sit in the courtyard its much nicer now” and “there really isn’t a lot to do. I can get a bit bored”. We received four surveys, of these three people said that they sometimes had activities that suited them and one person said there are always activities Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 15 available. Several people spoken with said that they generally organised their own routines and they were able to do as they pleased. This shows that the service does not always provide stimulating activities that meet individual equality and diversity needs. Relatives feel welcome to visit the home. Those spoken with said that “more activities would be good” and “we are always welcome to visit” and “staff are very nice, happy to help they help make my visits here a pleasant experiences”. The AQAA from the home showed us that relatives are encouraged to maintain contact with the people living in the home. Although information is available about the meal choices this is not always available in forms that meet the individual needs of people living in the home. Observations over the lunch showed that there were a variety of choices available. People who prefer to eat in their bedrooms did not have access to a menu that told them what choices were available. We spoke to people regarding their opinion of the food available. These varied, some people thought that the food was “very tasty”, others said, “I find it a little boring, more variety would be good”. The surveys that we received showed us that three individuals felt that the food was usually as they would like, with one person saying this happened sometimes. Staff do ask people living in the home on a daily basis what they want to eat. Several people spoken with said they “don’t remember” what the choices were. A menu-board is available in the dining room that showed people what choices were available. This is good practice as it helps people remember what food is on offer. Three people spoken with said “the writing is a little small” and “I don’t read it but I can if I want”. We discussed with staff their knowledge of dealing with special diets. We were informed that they had not had any training but would welcome this. They said that training in catering for diabetic diets would be of benefit. The cook said that the home did try to alter menus if they noticed items were not getting eaten. The home does not have records either in the kitchen or care records that show individual personal preferences, choices or cultural needs regarding food. The evidence indicates that choices are available to people living in the home but these are not taken from their expressed personal choices. Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 16 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18 were reviewed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. People living in the home feel confident that they can raise any issues and that will be taken seriously with action taken as needed. Staff have a good understanding of how to protect the people living in the home from possible abuse. EVIDENCE: The AQAA told us that there is an “open door” policy to make sure that people living in the home can feel comfortable in raising any concerns. A complaints procedure is in place in the home that gives guidance as to how complaints are to be dealt with by the staff. This also provides advice to people living in the service on how to raise their concerns. We received four surveys; these told us that people living in the home knew how to raise concerns and who to speak with if they had any complaints. People living in the home told us that, “I have no problems it’s a nice place to live”, “staff are good if I need something they sort it out” and “if I have any issues they are quickly fixed”. This showed that people living in the home were confident that they could tell staff what their concerns were and that they would be dealt with. There has been one concern sent to us. We discussed this with the manager who told us how the home had dealt with it. The correct actions were taken in line with the homes policies and procedures. There was no record within the Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 17 home that recorded the concern we had raised with the home. We spoke to staff about reporting concerns and they said that they dealt with small concerns but made sure that the manager was aware of major or serious concerns. We discussed with the manager how she recorded concerns. The manager told us that she would put into place a system for staff to report smaller concerns in order to make sure that they would be dealt with. We looked at the policies and procedures available for staff that tell them how to report any serious concerns such as claims of abuse. The policy was kept up to date and contained information about contacting external agencies such as social services and the police if needed. We spoke to the staff whom were able to clearly tell us how claims of abuse would be dealt with. All staff showed us that they had good knowledge and would deal with any claims of abuse correctly. Training records are available that show that staff are given training in this area. This helps staff keep their understanding up to date and take the correct action to keep the people they support safe. Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 18 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 23 and 26 were reviewed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Greenacres is a clean and comfortable place for people to live in. EVIDENCE: There are two large lounges, a dining area and a seating area on a main corridor. These are well used by the people living in the home and offers them a variety of places to spend their day. There is a central courtyard garden that has been developed in the last year and is now a comfortable place to sit. The majority of people who use the courtyard are people who smoke. The home has a no smoking policy and this is the only area that people can access to smoke in. The carpets in the main corridors and the largest lounge have been replaced this has improved the appearance of the home. Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 19 There have been a number of pictures put up in the main corridors that show the local area in the past. Additionally there is a notice board that provides some information. This is in the main entrance of the home and not in an area often used by the people who live in the home. All of the corridors, bedroom doors and bathroom doors are identical so there are no “signposts” that would help people with visual or memory impairment to find their way around. The homes own information says that it supports people with “confusion and dementia”, but has not changed the building to support them to be more independent. The AQAA from the home told us that the home tries to make peoples bedrooms meet their needs and that they are encouraged to have their own possessions around them. The four bedrooms we looked at had been personalised by the people living in the home. All had family pictures and ornaments available. Some had furniture that they had brought from their previous houses such as shelves or chairs. This helps the bedrooms look personal to the person living there. People we spoke with said, “I really like my bedroom”, “I have my own bits in here and when I shut the door its my little world” and “it’s a lovely room”. People living in the home are able to make their bedrooms their own. The four surveys returned to us showed that all the people thought that the home was clean and tidy. There are policies and procedures in place to prevent the spread of infection. A recent event in which several people in the home developed an infection was managed properly. The manager contacted the relevant experts for advice such as the district nurse, environmental health and the local doctors. The advice that they were given was put into place promptly and this helped to stop any further spread of infection. Staff training is in place that also helps them be aware of how to prevent the spread of infection. We looked in bathrooms and bedrooms and noticed that in all cases suitable hand washing and hand dying facilities were in place. Staff told us that they are told to wash their hands between supporting people who work in the home. They are also told to wear items such as plastic aprons when giving out meals to help prevent the spread of any infection. Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 20 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27,28, 29 and 30 were reviewed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Staff working in the home have been checked to make sure that they are suitable to work there. People living in the home and staff feel that there is enough staff available to meet the needs of individuals. EVIDENCE: The AQAA from the home told us that people living in the home are protected by good recruitment procedures. We looked at three staffing files, these were well organised. All staffing files looked at contained all of the checks that staff need to have before they start working in the home. Checks on staff are done to make sure that they are suitable to work with the people living in the home. The manager has also checked files for staff members that have worked in the home for a long time and were recruited by a previous manager. A number of these staff had missing recruitment checks. The manager obtained new police checks for two people in order to make sure that they are still suitable to work in the home. The home shares a member of staff with its sister home next door. We looked at this persons file and noticed that there were no recruitment checks available. The file had been checked but no action had taken place to update the checks and to make sure that the person was suitable to work in the home. The manager said that she intends to discuss Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 21 this with the manager of the sister home and that they will make sure that the checks are in place as soon as possible. We looked at staff training. Staff told us that they have had lots of training in the last year. This has included, the prevention of abuse, fire training and moving and handling. Training records in the home confirmed that staff have all received training in health and safety areas in the last year. The manager is monitoring staff training to make sure that they remain in date. There are also plans for more staff to do a qualification known as an NVQ. An NVQ is training designed for care staff and helps them increase their skills in supporting people they look after. The AQAA from the home told us that all staff have on-going training and are encouraged to develop their skills. Staff observed during the day showed a genuine enthusiasm for the job that they do. Most staff have worked in the home for several years. All of the staff spoken with were keen to be more involved in care planning for the people who live in the home. In general staff would welcome more training and they all said that they would like to increase their skills and understand their job much more. Surveys we received showed that people living in the home all thought that there was enough staff available. They also said that staff were “lovely”, “could not ask for a nicer bunch”, “very kind” and “although they are busy they always have time for you”. The manager told us that if someone living in the home needs to go to a hospital appointment extra staff are available to make sure that good staff levels are still available for the people in the home. Staff said that the home could be busy in the mornings. They also said that there are enough staff available to make sure that they can do their jobs without rushing. Staffing levels have not been looked at for sometime. The manager explained that the number of staff is determined by how many people are living in the home. The manager also said that she intends to look at the staffing levels again taking into account the needs of the people living in the home. Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 22 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 33, 35 and 38 were reviewed. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The people living in the home are happy and settled. The opportunity to develop the quality of the service in the home is in place although this would benefit from including more of the points of view of the people living in the home. The management of people’s money is not sufficient to always safeguard their interests. EVIDENCE: People living in the home told us “the manager is great, she listens and tries hard” and “I really like her, she is lovely, she has made such a difference”. Staff spoken with commented that they had “lots” of confidence in the Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 23 manager and found her “supportive”. The service has had a stable management team for over 3 years. This includes the senior care staff that have also worked in the home for several years. A stable staff and management team has meant that the home has been able to increase the quality of the service. The manager is registered with us as fit to manage a care home. The AQAA from the home told us that the home is run in the best interests of the people who live there. We spoke to people who live in the home who could not recall if they had had any meetings. Records showed that the last meeting the home held was in July and minutes were not on display for people to read. Staff meetings had not been held for sometime and staff could not recall when the last meeting was held. Other than the surveys sent from to us the home did not have any copies of surveys that they sent to the people who lived in the home, their relatives or staff. The manager explained that this would be sent out in the next few months and the information would be used to increase the quality of the home. Taking the time to find out the points of view of the people living in the home means that the service is more likely to be run in a manner that meets the needs of those people who live there. The home did not have any formal quality assurance in place. Quality assurance is when the home looks at the quality of the services it provides and makes sure that it puts into place a plan as to how it will make the service better. The manager looked at the medicines monthly and has made sure that the staff recruitment and training files have been checked. This informal quality check has increased the quality in these areas. We looked at how the home managed the personal funds of people who live in the home. Records were unclear as to the kind of account that the money was kept in. We received information after we visited the home that confirmed that there is no interest earned on the account that holds peoples personal funds. There is no information for the people in the home that tells them how their money will be managed. People living in the home have limited access to their own money as they can only get their money when the relevant members of staff are available. We also noticed that there are no policies and procedures in place that would guide the staff as to how to manage people’s money safely. There are receipts available for money spent by the people living in the home that makes sure that any spending can be accounted for. Records showed that a relative was given an amount of money belonging to an individual in the home. The home was unable to account for what this money had been spent on and had given it to the family member without the permission of the person whose money it was. The manager told us a few days after this visit that they have been given the receipts to account for the money and that in future they will make sure that get permission from people before they give their money to family members. Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 24 We looked at the homes management of risks to the people living in the home. Certificates of gas and electricity were up to date and showed that these areas had been checked to maintain safely. A fire risk assessment for the home was available but was in need of updating to make sure that the safety of the people living in the home was being maintained. Risk assessments for individual people living in the home were looked at the. The majority of these were reviewed and updated each month. In two instances this had not occurred for several months. The manager told us that this would done within the next week. Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 X 3 X X X HEALTH AND PERSONAL CARE Standard No Score 7 2 8 2 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 2 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X 3 X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 2 X 2 X X 3 Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2. 3. Refer to Standard OP1 OP7 OP14 Good Practice Recommendations It would benefit the people living in the home and people thinking of moving in if the information in the home was easily available in forms that meet their needs. Care plans would be more use if they all included detailed information that described exactly how staff were to meet the individual needs of the people who live in the home. Individual personal preferences and choices need to be determined and recorded so all staff can be aware of what peoples choices are. Their opinions need to be used to influence individual daily activities and the running of the home. The management of individuals living in the homes’ personal allowances needs to be looked at. Policies and procedures that safeguard individuals’ funds need to be in place. Information to people who live in the home as to how the home will manage their money will help them make a decision as to what is best for them. DS0000025108.V371669.R01.S.doc Version 5.2 Page 27 4. OP35 Greenacres Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Merseyside Area Office 2nd Floor South Wing Burlington House Crosby Road North Waterloo, Liverpool L22 OLG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI Greenacres DS0000025108.V371669.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. 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