Care Home: Greengarth

What the care home does well The manager ensures that she has a copy of people’s individual assessed care needs before they come to live at Greengarth. This information helps to ensure that the home will be suitable and able to meet the needs and expectations of prospective residents. People living at Greengarth tell us that the home provides a friendly and warm environment. Some of the comments from people who use this service included the following: • ‘Greengarth provides a very homely place to live. I’m very happy living here and wouldn’t want to live anywhere else. I get help with anything I need and the staff are always about.’ • ‘The staff are friendly and happy and always ready to help me when I ask. I am well looked after and have everything I need it is home from home. If I had to make the same choice over again I would still choose Greengarth to live. My family are all happy with the way I am looked after here.’ • ‘the staff are very good and they are respectful. They don’t take over and they encourage me to maintain my independence; they make sure I am alright.’ • ‘Staff are very good and helpful if I need help with something I don’t have to wait very long for assistance; the staff come pretty quickly unless they are helping someone else.’ Some of the people we spoke to also said that the food is very good at the home. They told us that there is always ‘plenty of it’ and that they receive a ‘sufficient amount of what they want.’ There are a variety of dishes on offer at each mealtime but ‘if there is something I don’t like I can choose something else.’ Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 What has improved since the last inspection? The manager has made sure that the facilities available for people who wish to smoke, comply with the law. Most of the bathrooms and toilets have been redecorated to help create a more pleasant environment. The manager and staff have undertaken lots of work to improve people’s care plans including risk and nutritional assessments. Care plans have been written in consultation with the individual person and with help from their relatives where appropriate. The manager told us that staff have also been involved in the changes to care plans as they need to know how to use them. One member of staff commented, ‘we have new care plans in place, which are much more detailed and give us more information about the people we support.’ This means that people living at Greengarth should have their individual care and support needs met according to their wishes and choices. Another area where improvements have been made is around social and leisure activities. The home has been involved with Age Concern to help develop a programme of meaningful events and activities. In addition to this one of the supervisors has supported some care staff to help improve their confidence and skills with providing activities. Some of the people that use this service and some of the staff commented on the activities available and the improvements. What the care home could do better: Some areas of the home have been redecorated and new furniture and carpets have been purchased, but there are still some areas that require attention. The home has not yet had it’s annual survey from the organisation’s estates department. The manager has identified some areas for improvement and told us of the plans to improve the décor and general environment in the dementia unit in line with good practice guidance for people with dementia. We found some gaps in the medication administration system that would benefit from improvement, particularly where people are prescribed medication for administration ‘when required’. We did find some discrepancies between the medication administration record sheets and information recorded in care notes. We discussed this during our visit with the supervisor responsible for administering medicines. She did start to attend to the discrepancies straight away. There was also some confusion regarding the record keeping for the administering of creams and ointments and we have made a good practice recommendation. This should help to improve the way in which this type of medication is managed. During our audit of the staff records we did see that staff do receive some supervision in their work. The records show that there are some gaps in the system and that staff supervision is not always carried out as frequently as it should be. One member of staff commented ‘I would appreciate having supervision more regularly and to receive constructive feedback on how well I am doing my job.’ Supervision helps to ensure that staff are supported properly and work to the policies, procedures, aims and objectives of the organisation.GreengarthDS0000036484.V376052.R01.S.doc Version 5.2 Key inspection report CARE HOMES FOR OLDER PEOPLE Greengarth Bridge Lane Penrith Cumbria CA11 8HY Lead Inspector Diane Jinks Key Unannounced Inspection 20th May 2009 09:00 DS0000036484.V376052.R01.S.do c Version 5.2 Page 1 This report is a review of the 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. 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. Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 2 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 Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Greengarth Address Bridge Lane Penrith Cumbria CA11 8HY 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) 01768 242040 www.cumbriacare.org.uk Cumbria Care Mrs Susan Jane Tweddle Care Home 39 Category(ies) of Dementia - over 65 years of age (10), Old age, registration, with number not falling within any other category (39) of places Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home is registered for a maximum of 39 service users to include: up to 39 service users in the category of OP (Old age, not falling within any other category) up to 10 service users in category DE(E) (Dementia over 65 years of age) Date of last inspection Brief Description of the Service: Greengarth is registered to provide accommodation and care for up to 39 older people, of whom 10 have dementia. The home is operated by Cumbria Care, which is an internal business unit of Cumbria County Council. Greengarth is situated close to the centre of Penrith and is on a bus route. Accommodation is provided in four separate living units, each with a lounge/dining room and kitchen area, communal bathrooms and toilets. Bedrooms are close by. There is also a large communal lounge that is used for special events, and a pleasant conservatory/garden room. There is a small day centre in the home, which operates Monday to Friday for people who live locally. This is managed separately and therefore not included in this inspection. There is a passenger lift and a range of mobility equipment to assist people in their daily lives. Outside there are garden areas and two pleasant easily accessible internal courtyards. There is a small car park for staff and visitors. The home produces a guide to the services and facilities provided and this is available on request from the manager. The scale of charges are available from the manager of the home and are subject to an assessment. Greengarth DS0000036484.V376052.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 2 star. This means the people who use this service experience good quality outcomes. The assessment of this service took place over several weeks and included a visit to the home. During our visit to the home we met with some of the staff, some of the people that live at Greengarth and the manager. We also sent surveys to a random selection of people that use this service and some of the staff. This helps us to gather a variety of views and opinions about the home and the services it provides. We also asked the manager to complete the Annual Quality Assurance Assessment (AQAA), which provided extra information for the inspection process. The manager ensured that this document was returned when we asked for it. What the service does well: The manager ensures that she has a copy of people’s individual assessed care needs before they come to live at Greengarth. This information helps to ensure that the home will be suitable and able to meet the needs and expectations of prospective residents. People living at Greengarth tell us that the home provides a friendly and warm environment. Some of the comments from people who use this service included the following: • ‘Greengarth provides a very homely place to live. I’m very happy living here and wouldn’t want to live anywhere else. I get help with anything I need and the staff are always about.’ • ‘The staff are friendly and happy and always ready to help me when I ask. I am well looked after and have everything I need it is home from home. If I had to make the same choice over again I would still choose Greengarth to live. My family are all happy with the way I am looked after here.’ • ‘the staff are very good and they are respectful. They don’t take over and they encourage me to maintain my independence; they make sure I am alright.’ • ‘Staff are very good and helpful if I need help with something I don’t have to wait very long for assistance; the staff come pretty quickly unless they are helping someone else.’ Some of the people we spoke to also said that the food is very good at the home. They told us that there is always ‘plenty of it’ and that they receive a ‘sufficient amount of what they want.’ There are a variety of dishes on offer at each mealtime but ‘if there is something I don’t like I can choose something else.’ Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: Some areas of the home have been redecorated and new furniture and carpets have been purchased, but there are still some areas that require attention. The home has not yet had it’s annual survey from the organisation’s estates department. The manager has identified some areas for improvement and told us of the plans to improve the décor and general environment in the dementia unit in line with good practice guidance for people with dementia. We found some gaps in the medication administration system that would benefit from improvement, particularly where people are prescribed medication for administration ‘when required’. We did find some discrepancies between the medication administration record sheets and information recorded in care notes. We discussed this during our visit with the supervisor responsible for administering medicines. She did start to attend to the discrepancies straight away. There was also some confusion regarding the record keeping for the administering of creams and ointments and we have made a good practice recommendation. This should help to improve the way in which this type of medication is managed. During our audit of the staff records we did see that staff do receive some supervision in their work. The records show that there are some gaps in the system and that staff supervision is not always carried out as frequently as it should be. One member of staff commented ‘I would appreciate having supervision more regularly and to receive constructive feedback on how well I am doing my job.’ Supervision helps to ensure that staff are supported properly and work to the policies, procedures, aims and objectives of the organisation. Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 7 If you want to know what action the person responsible for this care home is taking following this report, you can contact them using the details 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. Greengarth DS0000036484.V376052.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 Greengarth DS0000036484.V376052.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 1 and 3. Standard 6 is not applicable. People using the 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 using this service are not admitted to the home until an assessment of their care needs and requirements has been obtained. This helps the manager to make sure that the home will be suitable and able to meet their needs and expectations. EVIDENCE: Greengarth has a Statement of Purpose and service user guide which is updated regularly. These documents provide people with information about the home and the services it can provide. There is a very clear admissions procedure in place at the home. All prospective service users have a full pre admission needs assessment undertaken with the involvement of themselves, their social worker and the Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 10 home manager. People may also have support from their relatives or any other individual they may choose, before agreeing to their admission to Greengarth. People thinking of moving into the home are given the opportunity to visit and spend time at Greengarth. This helps them to decide whether the home will be suitable and able to meet their needs and expectations. Admissions to the home only take place if the service is confident that staff have the ability to meet the assessed needs of the individual. The manager has introduced a questionnaire for new service users and their families who have recently been admitted to the home to gain feedback on how the admission process experience was for them. This will allow for future changes and improvements to be made if necessary. Greengarth DS0000036484.V376052.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10 People using the 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 using this service have clear and detailed plans of their care. This helps to make sure that their care and support needs are met appropriately. EVIDENCE: The manager told us that each person living at the home has a care plan that sets out in detail the action which needs to be taken by staff to ensure that people receive the care and support they need. She also told us that people using this service have access to a variety of health care professionals such as a GP, district nurses, opticians, dentist and chiropody services. Daily records and discussion with people that live at Greengarth confirm this to be the case. Staff assist people to access these services both within the home and in the community. All of the people that live at the home are allocated a staff member to be a link worker. Their role is to provide support and a personal link between the service provided, the people living at Greengarth and their families and friends. Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 12 Some of the people that live at Greengarth made the following comments about their care and support, ‘I’m very happy living at Greengarth and the staff take very good care of me.’ Someone else said, ‘My family are all happy with the way I am looked after here’ and another told us, ‘I get help with anything I need, the staff are always about.’ The manager and staff at the home have reviewed and updated care records with the person receiving care and support or with the involvement of their relative where appropriate. This helps to ensure that people using this service receive the support and care they need, when they need it. Staff are aware of the new care plans and one person told us, ‘We have new care plans in place which are much more detailed and give us more information about the people we care for.’ Another member of staff said, ‘We are encouraged to read care plans and to refer to them so that we know the needs of our residents.’ One member of staff that returned a survey to us indicated that there are occasions when communication is not as good as it could be. We discussed this with the manager. The manager told us that there are handover sessions for staff at the beginning and end of each shift. This helps to make sure that any changes in people’s needs are passed on for the attention of the next staff coming on duty. We looked at a sample of three care records. All of them include personal details such as people’s next of kin, their doctor and of their religious preferences. The care plans are developed from care needs assessments and are personalised to meet the needs of each individual. They contain information about people’s preferred routines for dressing, grooming and bathing, for example. They identify areas where people like or are able to be independent and there are clear instructions so that staff know when and where help may be needed. The plans include an element of nutritional assessment and monitoring to help ensure people using this service receive a suitable diet to maintain their health. They also include a variety of risk assessments to help make sure people are supported safely particularly around the areas of moving, handling, use of equipment and where people may have behaviours that can at times be challenging. There are policies and procedures in place at the home with regard to helping people with their medication. Staff are provided with training to help ensure that medication is managed and administered safely. People who have the capacity and choose to keep and administer their own medication are encouraged to do so and this is managed by risk assessments. The details of individual’s medication requirements are recorded in their care plan and the administration of medications are generally recorded accurately on separate charts. We did see some gaps in the recording of medications that could lead to confusion or mistakes being made. This was particularly evident Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 13 in medicines that have been prescribed as ‘when required’. We discussed this with the manager and the supervisor. They started to take action to rectify this whilst we were still at the home. Where people may have difficulties swallowing, the manager has obtained medicines in liquid form to alleviate this problem. We looked at a sample of medications that are liable to misuse and the ways in which the home stores and manages this type of medication. The records had been completed properly and the medicine had been administered as prescribed. The home did not store this type of medicine in the recommended manner, but it was safe and secure. A new medicine cupboard was at the home waiting to be fitted. Topical ointments and creams are kept in the rooms of people using this service. Instructions for their applications are kept with the creams and details of their application are recorded in individual daily records but not on the medication administration record sheets. This is something that should be reviewed, dependent on the type of creams being applied. Greengarth DS0000036484.V376052.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. People using the 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 using this service are provided with opportunities to take part in a variety of social and leisure activities. EVIDENCE: The home provides a range of activities to help ensure that the people living there are offered a wide range of social and leisure activities. As part of the pre-admission assessment and care planning process, people are asked about their interests and hobbies. Records are kept of the activities that people take part in and include games, outings, armchair aerobics, bar meals, singing and arts and crafts. The travelling library visits the home and offers books in large print, compact disc or tape formats. People also have access to weekly church services at the home and religious leaders of various faiths make visits. Residents meetings take place and minutes are kept of the topics discussed. Recently these have included healthy eating, menus, activities, trips out, the Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 15 homes amenity fund and suggestions for expenditure or redecoration of the home. The manager and some of the staff told us about a project that the home has been involved with - ‘Enriching our Lives’ project with Age Concern and Age2Age programme. An activities workshop has been held with staff at the home and they have had the opportunity to work with volunteers from Age Concern. The project has now come to an end but the home is trying to maintain the links made with community organisations. The Princes Trust has also been involved with the home and organised a day out on the Ullswater Steamers with lunch included. There are plans for this organisation to re-visit Greengarth. They are going to do some work on improving the garden and create a sensory garden area. The organisers will be attending the next residents meeting to seek ideas and suggestions from the people that live at the home. Young people from the local grammar school have been visiting the home on a regular basis to help with activities at the home. Some of the people we spoke to told us that they come in and play games such as cards and dominoes with them or just have a chat. Some of the people we spoke to or received surveys from, told us of the activities available in the home. One of the supervisors told us of the work that has been done with staff to help improve their confidence and skills in providing activities. She said; ‘the Age Concern project followed on at the right time to further encourage and motivate staff, I think we are getting there now. Also we have bought craft boxes and games boxes for every unit so that things can be done without much planning.’ The manager told us that some people like to do things in the evening too as it can be a ‘long night’ and games such as cards or dominoes have introduced. We spoke to some of the staff about the activities available at the home. They all commented on the ‘great improvements with regard activities.’ One person said ‘I don’t think we do too badly with these now.’ The staff showed us examples of craft and art items that had been made by some of the residents. They explained about the difficulties at times, ‘to get some of the residents to join in things.’ Staff do remind people of the activities taking place and try to get people to at least be in the area where the activity is, one member of staff said ‘because sometimes they will just start to join in.’ There are details of planned activities on display throughout the home. Information is available about the residents meetings and minutes are available so that people can read what has been discussed and decided. We spoke to some of the people that live at Greengarth during our visit. Some of the ladies were looking forward the bingo game later in the day. They also told us about the previous day when they had played dominoes with some school children. They confirmed that they are able to make choices about their daily life such as when to go to bed or get up. One person in particular likes to stay up late and their daily notes show that they are often still up at midnight. Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 16 They told us that ‘staff are very good and helpful. If we need help with something we don’t have to wait very long for assistance. They come pretty quickly unless they are helping someone else.’ One person we spoke to has not been at the home very long but said that they were ‘settling in well.’ They liked their room and liked to spend time there with their own things. This person told us that ‘the staff are very good and they are respectful. They don’t take over and they encourage me to be independent, they make sure I am alright.’ The people we spoke to during our visit to the home told us that the ‘food is very good and there is plenty of it.’ One person said, ‘the breakfast is nice and sufficient for what I want’. Another person said ‘the food is good and there are choices. If there is something I don’t like I am able to choose something else.’ We observed staff serving the lunchtime meal on one of the units. The situation was calm and well managed. Staff gently helped people to the table and explained what was happening, the TV was turned off over the meal time and this greatly improved the chances of effective communication and understanding. Some of the staff sat with people to help them with their meal where needed, they chatted to them throughout and treated them with care and sensitivity. Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 17 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. People using the 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 using this service know about the comments and complaints process and are confident that staff will listen. This helps to make sure that any concerns they may have are taken seriously and acted upon quickly. EVIDENCE: There have been not been any complaints received or any safeguarding referrals made by the home and we have not been told of any issues that may place people at risk from harm. There is a complaints procedure in place at the home and copies are available and displayed on the resident’s notice board. It is made available in a variety of formats such as large print and tape. This procedure has recently been updated and this has helped to ensure that people have up to date details of who they may contact if they have a concern or complaint. Some of the people who use this service told us that they know about the process and that they know who to speak to if they do have concerns or problems. They also told us that the staff always listen and act on what they say. Residents meetings are held at the home every three months and these provide further opportunities for people to raise and discuss any issues or concerns they may have. The manager spoke briefly of some situations that have occurred in other Cumbria Care Homes recently. These events together with information Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 18 gathered during staff supervision sessions have highlighted a need for staff to have further training regarding safeguarding and protection (abuse). The manager has arranged for all staff to attend refresher training within the next few weeks. The home has copies of the local authority safeguarding process. Staff told us that they know about safeguarding procedures and who to report any concerns or suspicions to for further action if necessary. Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 19 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19, 21 and 26 People using the service experience adequate quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home generally provides a clean and warm environment that meets the needs of the people that use this service. EVIDENCE: Greengarth comprises of four ‘units’ each with its own sitting room, dining area and kitchenette. One unit provides care solely for people who have dementia type illnesses. People using this service have access to a variety of communal facilities including bathrooms, shower rooms and toilets. All of the bedrooms are for single occupancy and are fitted with the call bell system to enable people to summon assistance from staff when required. Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 20 Most of the bathrooms and bedrooms have been redecorated, together with some other areas of the home. Some areas have been recarpeted and dining furniture and chairs have been purchased. In one of the bathrooms, the bath has been damaged by the use of the hoist and needs some attention to repair or replace it. Each year the home has a survey carried out by the organisations estates department to help identify areas that need attention and refurbishment. There are some areas of the home that do need redecorating and updating. The manager has identified some areas where she would like to see improvements to the décor, for example the dark corridor near the laundry. The manager told us that there are also plans to improve the décor and general environment in the unit that provides care for people with dementia illness. These improvements are said to be in line with good practice guidance for people with dementia. We did not see the up to date maintenance and renewal plan for the home as Greengarth had not had the annual survey from the estates department, at the time of our visit. We looked around the home during this visit and many areas have been repainted and brightened up. There are new curtains waiting to be put up in the bathrooms to help them keep warm and look more cosy. Lounges were clean and tidy, with the dining areas laid ready for lunch with tablecloths. The home has two conservatory areas, one in the main part of the building and a smaller one on the dementia unit that leads out into a garden area. The paved patio area and the gardens are earmarked for development by the Princes Trust group this summer and the people that live at Greengarth are to be consulted on what they would like in their garden. We also visited the laundry, it was kept in a clean and tidy condition. The home has had a new washing machine and dryer recently. The extractor fan in the laundry needs some attention as it was very noisy. Protective clothing such as aprons and gloves were available for staff throughout the home and most staff have completed some training in infection control. People living at Greengarth are able to personalise their own rooms with small items of furniture, televisions, radios, pictures, ornaments and photographs. Where people need special mattresses or moving equipment these are obtained. Some of the people who returned surveys or who we spoke to during our visit told us that ‘Greengarth provides a very homely place to live. I’m very happy living here and wouldn’t want to live anywhere else.’ Most of the people participating in this assessment of the service said that their rooms were always clean, tidy and fresh. One person said, ‘I am well looked after and have everything I need it is home from home. If I had to make the same choice over again I would still choose Greengarth.’ Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 21 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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30 People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Staff receive relevant training. This helps to make sure that they understand and are confident and capable of meeting the needs and expectations of the people they support at Greengarth. EVIDENCE: The manager told us that she feels the home provides a sufficient number of care staff to help meet the needs of the people that use this service. There is a staffing rota, copies of which are available in various parts of the home. On the day of our visit to the home there were a sufficient number of care staff and ancillary staff on duty. The home has previously struggled to fill staff vacancies, but the manager tells us that she has recently recruited five new members of staff. Staff and residents told us that there are always or usually enough staff on duty. Some staff commented on the recently recruited staff. Other staff indicate that they are given sufficient time to read care plans and to help people participate in activities if they want to. This helps to make sure that the people they support are cared for appropriately and have access to stimulating and interesting events which help to enrich their lives. Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 22 We looked at some of the recruitment practices in place at the home. We found that staff must complete application forms giving detailed information about their previous experience and employment history. The organisation ensures that prospective staff attend in person for interviews. They also make sure that staff are properly checked out and references, criminal record bureau (CRB) and the protection of vulnerable adults list (POVA) checks are made before a person commences work at the home. These checks help to make sure that the people living at Greengarth are supported by appropriate people and are protected from the risks of harm or abuse. One member of staff told us, ‘I was offered my job in May and it took till September for my CRB check results’, and another said ‘I wasn’t allowed to start work until all the checks had been done.’ The manager told us that staff are encouraged to participate in a variety of training, including National Vocational Qualifications (NVQ’s) and over two thirds of the staff have gained this award. New staff are required to undertake induction training to help ensure they understand the nature of the work and are able to work safely. Induction training covers a variety of topics including, the principles of care, report writing, health and safety, manual handling, food hygiene, dementia, emergency action, safeguarding and communication. Other training is provided by the organisation to help make sure that staff keep up to date with current good practices. The manager told us that every member of staff at the home achieved their training targets for the last year. A lot of training has taken place in house with some specialist input from the community nurses regarding diabetes, care of the ageing skin and continence awareness. Many staff have undertaken dementia awareness training and some staff are to commence further training in dementia care, which is accredited by the Alzheimer’s Society. This specialised training helps to make sure that staff are able to appropriately support and understand people who may have this type of illness. We spoke to some of the staff that work at the home and some others returned their comments via surveys. They told us that communication in the home is ‘usually very good.’ They confirmed that there is a staff handover at the start of every shift and changes to people’s needs or visits by doctors are communicated. The staff told us that they have access to a variety of training and that this is usually relevant to their work. One person said, ‘some training is better than other sessions’ and another said ‘I prefer small group training sessions.’ All the staff we spoke to or surveyed felt that they are kept up to date with their training and development. There is an organisational training plan for the year, but because of the size of the organisation places can be limited at times. Supervisors at the home have started to provide some in house training based on suggestions made by staff at supervisions, appraisals or staff meetings. The manager has undertaken an audit and identified a need for all staff to have adult protection (abuse) training. Greengarth DS0000036484.V376052.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. This is what people staying in this care home experience: JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31, 35, 36 and 38. People using the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is run in the best interests of the people that use this service. EVIDENCE: The home is managed by a competent and qualified manager. She has many years of experience of working in and managing care services. The manager is supported in her role by an operations manager from within the organisation and by supervisors working at Greengarth. We checked that the manager has complied with any requirements that we made at the last inspection. We found that these have been implemented, Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 24 together with the good practice recommendations that we made. The home has recently undergone an internal audit to help monitor compliance with standards and a report of the internal audit findings has been produced. People using this service, their families and the local community are encouraged to be involved in the running of the home and with the development of the service. Contributions and comments are received by the manager via questionnaire’s, direct discussions and through the regular residents meetings. This helps to ensure that the home is run in the best interests of the people that use this service. Facilities are provided for the safe keeping of money and valuables for the service user. Written records for all personal monies, transactions and receipts are kept relating to this. We looked at a sample of three financial records during our visit to the home. Detailed records are kept and the manager carries out random audits at regular intervals to help ensure staff follow procedures regarding people’s personal finances keeping them secure and protected. We looked at a sample of staff supervision records. We found that supervision does take place but records do not demonstrate that this is carried out as frequently as it should be. We also looked at a sample of the health and safety records kept at the home, particularly relating to staff training and accident records. There are systems in place at the home to help ensure staff use safe working practices and complete training in key areas such as fire, manual handling, infection control, emergency action and medication. The accident records have been maintained accurately and we tracked some of the incidents and their outcomes through a variety of records including daily notes, risk assessments, safety procedures and the accident book. Greengarth DS0000036484.V376052.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 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 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 2 X 3 X X 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 3 X 3 2 X 3 Greengarth DS0000036484.V376052.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. Refer to Standard OP9 Good Practice Recommendations You should ensure that where topical creams and ointments are prescribed by the doctor, that clear and accurate records are maintained of their application. This will help ensure that medicines are administered as the doctor intended. You should ensure that there are care plans and clear instructions in place to help manage medications that are prescribed for ‘when required’ or ‘up to so many times per day.’ This will help ensure that medicines are administered as the doctor intended. You should ensure that a programme for the routine maintenance and renewal of furniture/décor at the home is produced and implemented. This will help to make sure that the home provides a warm, comfortable, safe and homely environment for the people that live there. DS0000036484.V376052.R01.S.doc Version 5.2 Page 27 2. OP9 3. OP19 Greengarth 4. OP36 You should review and update the system in place for staff supervisions. All staff should have their practice monitored on a consistent and continuous basis to help ensure they work safely and to the aims and objectives of the organisation. Greengarth DS0000036484.V376052.R01.S.doc Version 5.2 Page 28 Care Quality Commission National Enquiry Line: 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. Greengarth DS0000036484.V376052.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. 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