Care Home: Greenacres Care Home

What the care home does well The home provides a very friendly and relaxed atmosphere, the people that use the service also said that their families and friends could visit them `anytime` and that their rooms were `like home`. People said that that there was always a good choice of meals at the home and that they enjoyed their food. The staff receive lots of training and support to make sure that they have the skills and knowledge to be able to understand peoples individual needs and how they would like to be looked after.The health needs of the people living in the home are well met and staff the staff work well with doctors and nurses to make sure that their health care is well looked after. The people that live in the home say that they are `well looked after` and they are happy to be living there. They are also given the opportunity to decorate their rooms to their own likes and comforts. What has improved since the last inspection? The manager of the home or their deputies are available throughout the week now. This means that people that use the service, visitors or care staff can seek advice and support when they need to. Care staff have better relationships with the people living at the home and communicate with them more easily. They are also available for people that use the service whenever they need them. Training is provided for the staff that helps them to understand the needs of the people that use the service. The dining area in the dementia area of the home has been improved to create a more homely environment. The care plans in the home include better information. This means that it is easier for the care staff to see how individuals want to be looked after. CARE HOMES FOR OLDER PEOPLE Greenacres Care Home Fieldside Road Crowle Scunthorpe North Lincolnshire DN17 4HL Lead Inspector Stephen Robertshaw Key Unannounced Inspection 17th June 2008 09:00 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 Care Home DS0000070876.V366590.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 Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greenacres Care Home Address Fieldside Road Crowle Scunthorpe North Lincolnshire DN17 4HL 01724 711661 01724 711455 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) Worcester Garden Ltd Ms Sharon Kendell Care Home 39 Category(ies) of Dementia (39), Old age, not falling within any registration, with number other category (39), Physical disability (39) of places Greenacres Care Home DS0000070876.V366590.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; Dementia - Code DE; Physical disability code PD. The maximum number of service users who can be accommodated is: 39 21/05/07 2. Date of last inspection Brief Description of the Service: Greenacres is registered as a 39 bed care home for older people including those with dementia care needs. The home is situated in the small village of Crowle, which is approximately ten miles from the centre of Scunthorpe. It is not on the main road, but on a side street. The home generally serves the area of the Isle of Axholme, through the adjoining villages. The home is divided into two parts, the original building, and a newer purpose built area. There are large grounds, which provide safe areas for the service users to access. The home has good links with the local community. The weekly fees for the home range between £410 and £465. There are no third party top up fees at the home. Additional costs are made to individual service users for their newspapers, hairdressing, chiropody and optician services. Trial periods at the home can be arranged to make sure that it will meet the needs of the people wishing to use the service. A copy of the previous inspection report was available in the office in the entrance to the home. Since the last inspection the business was taken over by a new provider in December 2007. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is two star. This means the people that use the service experience good quality outcomes. The site visit to the service was unannounced and took place on the 17th June 2008. . We were in the home for approximately six and a half hours. This report has been written with the information gained on this day and from the Annual Quality Assurance Assessment that had been completed by the management of the service and had been sent in to us before the site visit. We also spoke with seven of the people that use the service, two professional visitor and two relatives. The information that they gave to us has also been used to help to write this report. The Commission also case tracked three of the people that use the service. This also included looking at all of the assessments and care plans that had been written about them. Before the site visit we sent out surveys to five people that use the home and twenty of the staff group. Four surveys were returned by people that use the service and six surveys were returned by the staff. The information included in these surveys has helped to determine the outcomes in this report. We would like to thank the management and staff working for the home and the people who we met at the site visit for their hospitality and friendly welcome. What the service does well: The home provides a very friendly and relaxed atmosphere, the people that use the service also said that their families and friends could visit them ‘anytime’ and that their rooms were ‘like home’. People said that that there was always a good choice of meals at the home and that they enjoyed their food. The staff receive lots of training and support to make sure that they have the skills and knowledge to be able to understand peoples individual needs and how they would like to be looked after. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 6 The health needs of the people living in the home are well met and staff the staff work well with doctors and nurses to make sure that their health care is well looked after. The people that live in the home say that they are ‘well looked after’ and they are happy to be living there. They are also given the opportunity to decorate their rooms to their own likes and comforts. What has improved since the last inspection? What they could do better: Some areas of the home need to be decorated to create a more homely environment for the people that live at the home. The staff need to be more careful when they are recording the prescribed medication in the home to make sure that everyone has the right medication and to make sure that any medication is returned to the chemist if it is no longer needed. The kitchen needs to be improved to make sure that the area does not cause health and safety problems to the people working in the kitchen and the people receiving food and drinks from the kitchen. The owners of the home need to make a plan to show any renewals or replacements that they intend to carry out to improve the conditions of the service for the people that live at the home. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 7 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 Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 8 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 Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 9 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): 1, 2, 3, 5 and 6 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the people that use the service are provided with an opportunity to visit the home before they make a decision that it will be right for them to move in on a more permanent basis. EVIDENCE: The Commission case tracked three of the people that were living at the home. This included looking at all of the information that had been recorded in their care files in relation to the assessment of their needs. All of the care files observed by us included the terms and conditions of their residency at the home. However one of the contracts had been signed by the person that uses the service and the front sheet including the fees payable and the room to be occupied had not been completed. The registered manager of Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 10 the service must make sure that the people signing documents clearly understand what they are signing and not just carry out this process to meet requirements. People are given the opportunity to visit the home before they make a decision that they would like to live there. One person said ‘I first came to the home for respite care, then when I needed to go somewhere permanently I thought that this would be the right home for me as I already knew it. The assessments that had been case tracked showed that an assessment had been completed before they had been admitted to the home, however much of the assessment remains basic and in some ways generic. The assessment process should be developed further to include a more person centred approach. The homes assessments included the views of families and outside professionals for people that use the service. This is particularly important when individuals have dementia care needs and may not be able to express their needs fully for themselves. Greenacres does not provide intermediate care to the people that use the service, and therefore National Minimum Standard 6 is not applicable to the service. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 11 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): 7, 8, 9 and 10 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the homes care plans have improved and are more likely to identify how the people that use the service would prefer to have their needs supported and met at the home. EVIDENCE: The care files observed by the Commission all included care plans that reflected the individual needs identified through the assessments of need for the people that use the service. The care plans had all been evaluated on a monthly basis to make sure that they were still appropriate to the people that they involved. The care plans had much improved since the last inspection and had become more person centred. This would help new staff to the service to be able to meet the individual needs of the people that use the service. Although the new format had not completed for all of the people that live at the home the manager stated that this was an ongoing process. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 12 There was clear evidence that when care needs had changed in between the monthly evaluations the care plans had been updated as and when necessary. Two outside professionals confirmed to the Commission that they believed that the staff working at the home had the knowledge and skills to be able to safely care for the people that live at the home. One said ‘the staff are very friendly and supportive of the people that live here’. Individual care files that were seen by the Commission supported the evidence that individual health care needs are supported through professional healthcare workers that are based in the local community. Discussions with two outside professionals, interviews with the care staff and direct observations supported the evidence that the working relationships between the two staff groups had much improved since the last inspection. Appropriate moving and handling aides and equipment were available for use at the home and a new hoist had been provided since the last inspection. Staff were observed transferring people from chairs to wheelchairs and all good practices and guidelines were followed. An outside professional stated that from their observation in the home ‘the care staff always safely transferred people’ using the appropriate equipment. The individual care files that were observed by us included contact sheets for when people that use the service had any involvement from outside professionals. These records also included the outcome form any of the visits. People that use the service said that when they are visited by outside professionals they are always seen in private to uphold their privacy, dignity and respect. One person said ‘we always go to my room to see the nurse’. On the day of the site visit community Nurses and a chiropodist were observed taking people to their own rooms for treatment. We observed the medication being administered in the home and all good practice and legislation guidelines were followed. All of the staff that administer prescribed medication to the people that use the service had received appropriate accredited medication training. The medication records in the home were up to date and had been accurately recorded. The only concern was within the recording of the controlled drugs register. Although the final records were accurate there had been a lots of alterations to the register were errors in the recording had been made. Also controlled drugs that had been identified in the drugs return booklet had not been included in the controlled drugs register. The manager of the service was told that a full audit of the controlled drugs must be undertaken to update the correct information and to identify if any staff in particular require refresher medication training to equip them to safely record the controlled drugs in the home. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 13 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): 12, 13, 14 and 15 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the people that use the service can determine what they would like to do for themselves with the support that they require. EVIDENCE: At the last inspection it was identified that the activities for people with dementia care needs were not very good. Since that time it has improved and direct observations showed good supportive relationships between the care staff and the people that use the service. The activity area for people with dementia has been opened up to allow freedom of movement around the unit. However the activity area was very poorly lit and this could make it difficult for some people to use this area. The lighting should be improved so that people can clearly see to become involved in the activities being held in the room. The manager of the service stated that the owners of the home are considering introducing a safe outside area for people with dementia care needs to access. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 14 One person was observed having her nails painted in the main lounge area. She said that this was because she was ‘going to the pub…for a couple of sherries’ in the afternoon. Soon after lunch several people were supported by the care staff to go to a local public house. Relationships between the home and the local community are good. The pub that they were visiting altered their doorway recently when one person that uses the service couldn’t gain access, as their wheelchair was too wide. A new wider door was fitted so that everyone who wanted could go for a meal or a drink there. The home employs an activity co-ordinator who speaks with the service users on an individual basis to identify their personal requirements. More planned activities are now available and one person told us ‘were going to Cleethorpes soon for the day’. Drink times and meal times were flexible and the people that use the service were encouraged eat and drink at their own pace. Direct observations showed individuals being offered appropriate levels of support to have their meals and drinks. We ate lunch with three of the people that use the service. There was a choice of hot meals and the individuals stated that they always had a choice of meal. The presentation of the meals was very good and everyone spoken to by us said that they enjoy their meals at the home. No special diets were required in the home except for low fat, low sugar and softened meals. The Commission also looked around the kitchen, in general it was clean and tidy however there was a large area of the kitchen that was affected by damp and the oven hood needed a deep clean. This had also been identified ion a recent environmental health inspection of the premises. Daily diary records support the individual care plans for all of the individuals that use the service. These records have much improved since the last inspection and are more person centred, detailing all of the activities that people are involved in on a daily basis at the home. We discussed this with the manager of the service and highlighted the good clear records completed by two of the individual care staff working at the home. We spoke with two family visitors to the home and they confirmed that they could visit the home at any reasonable time. One said that ‘they always make us welcome, and they look after X well’. The records in the home showed that the people that use the service get involved in meetings and this allows them to offer their views on the services that are offered to them, however these are not held on a very regular basis. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 15 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): 16 and 18 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the working practices in the home support the safeguarding of the people that use the service and the staff are aware of adult protection issues and how to report them. EVIDENCE: No formal complaints had been received directly by the home or the Commission since the last inspection. The home has a clear complaints procedure and the people spoken to by the Commission said that they knew how to make a complaint if they wished to. One person said ‘we can talk to any of the staff or the manager if we have any problems’. Staff training records show that they have received safeguarding adults training. This has been provided through national Vocational training, video training and through courses provided through a local college. The manager of the service also said that she has been in contact with the local authority for them to provide local training for the staff in relation to safeguarding adults. She said that this could possibly be carried out through the use of an Internet connection with the local authority on the homes computer. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 16 Since the last inspection there had been two referrals to the local safeguarding adults team. One was in relation to an entertainer that had visited the home. The local authority that stated that it was not a safeguarding issue did not follow up this case. The second referral was in relation to one specific person that uses the service. The concerns raised included the quality of furniture in their bedroom, clothes going missing; ants in the bedroom and poor care plans. All of these issues were upheld. The person involved was case tracked by us at this site visit. The care plans had been improved to show how the care and support that the person required should be provided. A contract was in position for the home to rid them of ants or any other ‘pests’. The furniture in the room had been replaced with new furniture and an improved system for marking peoples clothes was put in position. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 17 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): 19, 21, 23, 24 and 25 Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. This means that there have been some improvements in the environment of the home provided for the people that use the service, however there are some areas of the home that still require attention to create a homely environment. EVIDENCE: We made a tour of the premises as part of the site visit to the service and it was identified that there had been some improvements made to the environment since the last inspection. The toilets and bathrooms are situated around the room and were close to all of the communal and bedroom areas. One of the Bathrooms has had a shower Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 18 unit fitted in to it. This now allows the people that use the service to have an option of whether to have a bath or a shower. Generally there where were no bad odours in any of the bathrooms and toilets during the course of the day. However on entering the building in the morning there was a bad odour in the entrance to the home. The odour was coming from one of the toilet areas and was probably due to the problems with the sewage drainage system that the home has experienced in the past. The odours were not present for any sustained period of time. One of the bathrooms had numerous linen towels and a bottle of shampoo left in them. It was pointed out to the manager and care staff that this contravened infection control policies and procedures. The care staff immediately removed these items from the bathroom. The laundry area of the home is small, however the domestic staff stated that it was suitable to their needs. Since the last inspection a linen press has been supplied in the laundry. The washing machine is programmable to disinfection and sluicing standards. A new sluice has been provided in one of the sluice areas to provide a safe disposal of waste material. The dining room in the dementia care area has been improved through providing a new floor covering and painting the walls. There were also new tables and chairs included in the dining room making this a more homely environment. The home needs a lot of decoration to create a homely environment for the people that use the service. The management of the home have begun to decorate the corridors around the unit. The tour of the premises supported the evidence that this was an ongoing process. The heating and lighting at the home are domestic in character, however as stated earlier in this report the lighting in the dementia unit activity area is poor and needs to be improved. The doorjamb in the dementia care lounge also needs attention, as there are large gaps in it. This means that ants, flies and other garden creatures can easily access the room and this can have a negative effect on the health and safety of the people using this room. Four people that use the service invited the Commission to look around their personal rooms. These had all been decorated to their own personal tastes and preferences including pictures, ornaments and small pieces of furniture. Some of the bedrooms have not got window restrainers fitted to them, this should be carried out to minimise the risk of unauthorised people entering the building. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 19 There was a large area of damp on the wall in the kitchen as already identified earlier in this report. The homes management systems did not identify the routine maintenance and renewal in an effective way. The management of the service need to make a renewal and refurbishment plan open to inspection to show how the premises will be improved to create a homely and safe environment for the people that use the service. Greenacres Care Home DS0000070876.V366590.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): 27, 28, 29 and 30 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the care staff have the appropriate knowledge and skills to be able to safely care for the people that are living at the home. EVIDENCE: The Commission observed the staffing rotas in the home to make sure that the commitments required of the residential formula were met. This means that there are appropriate numbers of staff available at all times in the home. However due to the increasing levels of dementia care required in the home and the request for 1-1 staffing rations for certain individuals, then this will constantly have to be monitored. An example of this if in the dementia lounge if a person needs a bath with support of two staff this only leaves one staff available to all of the other people that use the service and if any of them require 1-1 staffing this would leave the unit extremely under manned. Due to the complexities of the needs of the individual service users and the difficulty with the shape of the building the home requires more than the minimum staff recommendation of the Residential Forum. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 21 At the last inspection it was identified that staff were not available in the dementia unit for long periods of time and their communication with the people that use the service was poor. This had completely turned around at the time of the site visit. The staff were constantly around and were communicating well with all of the people in the lounge. Interviews with staff supported the evidence that they have received training to work with service users with dementia. This was also recorded in their individual training logs. The home does not provide nursing care to the service users. Nursing care is provided through professionals that are based in the community and work in partnership with the home. This includes doctors, district nurses and chiropodists. Visiting professionals to the home stated that the staff were competent in their roles and were able to care for the needs of the people that they were looking after. One person said ‘the staff keep me in touch with what is happening with my patients and always seem to have time for everyone’. The management and staff are working positively towards their commitment towards National Vocational Qualifications training. The homes records show that 40.6 of the homes staff had completed the award, and a further 7 staff are working towards NVQ 2 in care. The home had over 50 of staff with the award however some have moved on to other work surroundings including nurse training. Most of the staff’s mandatory training was up to date and there was a regular programme of refresher training in position. The manager would benefit from developing a training matrix that highlighted when individual staff would require refresher training. Observation of staff personnel files supported the evidence that the home operates a thorough recruitment procedure that is based on equal opportunities. Staff interviews supported this process and the files also included information that the staff receive appropriate security vetting, however two of the three staff files seen by the inspector showed that the staff had started work at the home when the POVA 1st had been completed but before a full Criminal Records bureau check had been completed. This could place people that use the service at risk of abuse. The manager stated that she had spoken to an inspector for the Commission who had said that the people could be employed earlier as the home were short staffed and this could have put the people that use the service more at risk. The staff induction and foundation training is now provided through an outside training company and complies with the current training standards. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 22 Interviews with the staff group and direct observations supported the evidence that the care staff group are now much more positive in relation to their roles and responsibilities in the workplace. One person that uses the service said ’ the staff are lovely, they do what they can for you’. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 23 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): 31, 32, 33, 35, 36, 37 and 38 Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. This means that the management of the service understands and support the needs of the people that use the service and the staff that work for the home. EVIDENCE: The manager of the home has completed the Registered Managers Award and also the NVQ 4 in care. Deputy management responsibilities have changed since the last inspection following the previous deputies leaving the service. The home has also been taken over by new owners since the last inspection. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 24 Currently the manager’s office is on the first floor of the building and therefore it is difficult for some people to access her. Therefore in the near future the managers office is going to be moved in to the entrance of the home so that she is more visible and it is easier for people to access her when she is in the home. This would also support the evidence for the management approach to the home being open and approachable. There are clear lines of accountability and responsibility for the people working in the home and all of the staff that were interviewed were aware of their own roles and responsibilities and those of their colleagues. The proprietor of the home visits on a regular basis. The service uses spoken to by the inspector stated that they knew who the proprietor was and that he was also very approachable. The owner of the business needs to keep a record of their visits to the home in respect of regulation 26. A copy of these records must be made open to inspection. The home has a good quality assurance and monitoring system. Questionnaires are sent out to different people including service users, staff and families and the returns are analysed. The most recent surveys need an action plan to be developed to show how any changes will be made to the current service provision. The improvements to the dining room came about as a direct result form a survey. Staff and service user meetings would benefit from being held on a more regular basis at the home. This would allow them to be able to offer their opinions on the quality of the services being provided through Greenacres. This was also recognised at the last inspection. The home has a clear business and financial plan for the maintenance and development of the service. This was not available at the site visit but was essential for the registration off the service. Staff interviews and observation of their personnel files supported the evidence that they generally receive the recommended minimum of six formal recorded supervision periods per year. This makes sure that they understand their roles and responsibilities and have a clear understanding of the needs of the people that they are looking after. The manager of the home does not receive any formal recorded supervision, however she has regular contact with the proprietor of the home and discusses any important issues with them. These sessions must be formally recorded in a similar pattern to that of the other staff working at the home. This was formally identified through the homes last two inspections. The health and safety of the people that use the service and the staff working at the home are protected. All of the appropriate certificates for the Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 25 maintenance and servicing of the equipment used in the home were observed to be in place and were up to date. This included up to date safety certificates for the gas and electrical systems and the insurance for the home. Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 26 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 2 3 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 2 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 2 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X 3 2 2 2 STAFFING Standard No Score 27 3 28 3 29 2 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 3 2 X 3 2 2 3 Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 27 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP2 Regulation 17 (2) and schedule 4 Requirement The registered person must make sure that people that use the service understand any of the paperwork that they sign agreement to in particular their contracts with the home. The registered person must make sure that a full audit of the controlled drugs register is carried out to ensure the health and safety of the people that use the service. Emphasis should be made on accurate recording and not multiple changes being made to the register due to miscalculations. The registered person must improve the lighting in the activity area of the dementia lounge to encourage people to use this area and become involved in the activities taking place. Timescale for action 30/06/08 2. OP9 13 (2) 30/06/08 3. OP12 OP25 16 (2) (n) 23 (2) (p) 30/08/08 4. OP19 23 (2) (b) The registered person must 30/08/08 repair the damp damage to the kitchen to support the health and DS0000070876.V366590.R01.S.doc Version 5.2 Page 28 Greenacres Care Home safety of the people living at the home and the people that are working in the kitchen area. 5. OP19 23 (2) (d) The registered person must make sure that the redecoration of the home has been completed until a homely and safe environment is provided for the people that use the service. The registered person must make sure that the doorjamb in the dementia lounge is repaired to prevent drafts and garden creatures entering the home. The registered person must make sure that the hood above the cooker in the kitchen has a deep clean to support health and safety in the home. 30/10/08 6. OP24 23 (2) (b) 30/07/08 7. OP26 23 (2) (c) 07/07/08 8. OP29 19 (1) (a), (4) (b), (5) The registered person must 30/06/08 make sure that new staff to the home are not appointed to work with the people that use the service until after they have received full Criminal Records bureau clearance to safeguard the everyone that they may have contact with. The registered person must provide the manager of the home with formal recorded supervision a minimum of six times a year. This is also an outstanding requirement from the last inspection when the home was under different ownership. The registered person must complete regulation 26 reports when they visit the service. A copy of these reports must be made available to inspection. DS0000070876.V366590.R01.S.doc 9. OP36 9 (1,2) 30/11/08 10. OP37 17 (2) Schedule 4 (5) 30/07/08 Greenacres Care Home Version 5.2 Page 29 This will help to identify how the proprietors are supporting the needs of the people that use the service. 11. OP37 23 (2) (b) The registered person must make a renewal and maintenance plan open to inspection to show how the environment of the home will be improved for the people that use the service. 30/07/08 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. Refer to Standard OP3 Good Practice Recommendations The registered person should make sure that the assessments that are carried out by the home are comprehensive and person centred to make sure that the people that they involve receive the right level of care to support their needs. The registered person should make sure that linen towels are not left in bathrooms to support the home policies and procedures for infection control. The registered person should continually re-assess the staffing levels of the home in particular in the dementia lounge as peoples needs increase. The registered person should continue with the homes progression towards having 50 of the staff having achieved NVQ 2 or equivalent in care. The registered person should make sure that regular meetings are held with the people that use the service and their families to allow them to be able to comment on how they see services being delivered at the home. This could also be used to support the homes Quality Assurance and Monitoring System. 2. 3. 4. 5. OP26 OP27 OP28 OP33 Greenacres Care Home DS0000070876.V366590.R01.S.doc Version 5.2 Page 30 Commission for Social Care Inspection North Eastern Region St Nicholas Building St Nicholas Street Newcastle Upon Tyne NE1 1NB 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. 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