Care Home: Greenways

What the care home does well The majority of people we consulted both in writing and during our visit, expressed satisfaction with the home and made some very positive comments. These included; `All the staff are very friendly and do their utmost to help. Even the smallest task is always done at the time of asking.` `The home gives the best care possible to residents and tries to meet their needs.` `I think the home does well in all aspects of the care and well being of residents.` `The home is small and friendly, staff are caring.` Throughout our visit we observed carers going about their duties in a cheerful and pleasant manner. There was a relaxed, friendly atmosphere in the home and residents and carers appeared to get along very well. We noted that carers addressed residents in a courteous and respectful manner. We found care needs assessments had been carried out for all residents prior to their admission. This is important because it helps ensure that the prospective resident`s needs can be met at the home and that it is the right place for them. Robust assessment procedures also help ensure that carers have a good understanding of people`s needs and can plan their care effectively. In general, people`s care plans provided comprehensive information about their preferred daily routines and other things that were important to them. In all cases we found that people`s health care needs were very clearly stated and clear guidance was in place for staff in relation to how to meet those needs. We found improvement in arrangements for activities and noted that the home now try to provide activities that meet people`s individual needs. This means that there are now activities provided on a one to one basis as well as group activities that may not suit everyone. The majority of people we consulted expressed satisfaction with the quality and variety of meals provided at the home. Menus showed that people are provided with a varied diet and residents` individual needs and preferences in relation to food were recorded in their care plans. People are enabled to raise concerns and if they do so, the home take them seriously and respond appropriately. People who live at the home told us they knew how to raise any issues and that they would be comfortable in approaching the manager or the owner of the home. The home follows careful procedures when recruiting new staff members. This ensures that all the necessary background checks are carried out prior to any new person being appointed which helps protect the safety and wellbeing of residents. The home has a good approach to training and the manager carefully monitors this area. All carers are provided with training in the key health and safety areas such as moving and handling at the start of their employment and other areas such as caring for people with dementia are covered as part of each carer`s personal development plan. Over half the carers employed at the home hold National Vocational Qualifications in care at level 2 or above. What has improved since the last inspection? We found that the home had addressed all the requirements and the majority of recommendations made following their last inspection and a number of improvements had been made to improve outcomes for people using the service. Improvements to assessment and care planning processes were noted and we found that in general, people`s individual needs are well detailed in their care plans as is guidance for carers on how to meet people`s needs. We did identify some further improvements that could be made in relation to care planning and these are detailed later in this report. The provision of activities is now more person centred so as to meet people`s individual needs. More one to one activities are provided which is of particular benefit for those residents who do not want to take part in group activities. People are provided with choices of meals at each mealtime and work is being undertaken to develop menus that are accessible to people who live at the home. The dining area has been improved and now provides a much more pleasant dining experience for residents. There have been a number of improvements to the environment including the provision of an additional lounge and improved dining area. An additional assisted bathing facility has also been provided. Issues with the hot water supply at the home have now been resolved and all residents have access to hot water when they require it. The training programme has continued to develop and over half the carers employed at the home hold National Vocational Qualifications in care at level 2 or above. The manager now has systems in place to monitor training so as to identify when a staff member requires training or refresher training in a particular area. All staff are currently undergoing training in working with people with dementia. What the care home could do better: Whilst we found some improvements in assessment and care planning processes we noted that some people`s care plans still lacked detail in certain areas, for example support some people required in relation to more complex behavioural needs. It is important that carers have detailed guidance in relation to individual residents so that they can approach situations consistently and confidently. Residents and their relatives who responded to our written survey told us that they were able to get involved with their care planning and contribute towards the development of their care plans. However, there was no documentary evidence of such involvement in the home. We advised the manager to ensure that evidence is maintained so that the home can demonstrate that people are provided with this opportunity. We found significant improvements in the way residents` medicines were managed resulting in safer practice and better protection for residents. We made two recommendations to further support development in this area. We found some examples of missing information in relation to `as and when required` medication. This information is very important to ensure that people receive their medicines when they need them and as such we made a recommendation that details guidance be included in the care plans of all residents prescribed medication on this basis. We also made recommendation regarding the recording of medicines belonging to people staying at the home on a short term basis. The person centred approach now adopted by the home when arranging activities should continue. Records of people`s engagement in activities should be regularly analysed to ensure that their individual needs and preferences are being met. We found that the home follow careful procedures when recruiting new staff and suitable background checks including a Criminal Records Bureau check are carried out for all prospective staff members. However, some of these disclosures are now several years old and in discussion we found that there is no policy for updating such checks. We have made a recommendation that this be addressed and procedures introduced to ensure that these checks are updated within specified timescales. The manager needs to ensure that the Commission is made aware of any incident which occurs in the home and is notifiable under regulation 37 of the Care Homes Regulations, 2001. A requirement has been made in relation to this matter. Key inspection report Care homes for older people Name: Address: Greenways 720 Preston Road Bamber Bridge Preston Lancashire PR5 8JP     The quality rating for this care home is:   two star good service A quality rating is our assessment of how well a care home is meeting the needs of the people who use it. We give a quality rating following a full review of the service. We call this full review a ‘key’ inspection. Lead inspector: Marie Cordingley     Date: 1 4 0 1 2 0 1 0 This is a review of quality of outcomes that people experience in this care home. We believe high quality care should • • • • • Be safe Have the right outcomes, including clinical outcomes Be a good experience for the people that use it Help prevent illness, and promote healthy, independent living Be available to those who need it when they need it. The first part of the review gives the overall quality rating for the care home: • • • • 3 2 1 0 stars - excellent stars - good star - adequate star - poor There is also a bar chart that gives a quick way of seeing the quality of care that the home provides under key areas that matter to people. There is a summary of what we think this service does well, what they have improved on and, where it applies, what they need to do better. We use the national minimum standards to describe the outcomes that people should experience. National minimum standards are written by the Department of Health for each type of care service. After the summary there is more detail about our findings. The following table explains what you will see under each outcome area. Outcome area (for example Choice of home) These are the outcomes that people staying in care homes should experience. that people have said are important to them: They reflect the things This box tells you the outcomes that we will always inspect against when we do a key inspection. This box tells you any additional outcomes that we may inspect against when we do a key inspection. This is what people staying in this care home experience: Judgement: This box tells you our opinion of what we have looked at in this outcome area. We will say whether it is excellent, good, adequate or poor. Evidence: This box describes the information we used to come to our judgement. Care Homes for Older People Page 2 of 30 We review the quality of the service against outcomes from the National Minimum Standards (NMS). Those standards are written by the Department of Health for each type of care service. Copies of the National Minimum Standards – Care Homes for Older People can be found at www.dh.gov.uk or bought from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering from the Stationery Office is also available: www.tso.co.uk/bookshop The mission of the Care Quality Commission is to make care better for people by: • Regulating health and adult social care services to ensure quality and safety standards, drive improvement and stamp out bad practice • Protecting the rights of people who use services, particularly the most vulnerable and those detained under the Mental Health Act 1983 • Providing accessible, trustworthy information on the quality of care and services so people can make better decisions about their care and so that commissioners and providers of services can improve services. • Providing independent public accountability on how commissioners and providers of services are improving the quality of care and providing value for money. Reader Information Document Purpose Author Audience Further copies from Copyright Inspection report Care Quality Commission General public 0870 240 7535 (telephone order line) © Care Quality Commission 2010 This publication may be reproduced in whole or in part in any format or medium for non-commercial purposes, provided that it is reproduced accurately and not used in a derogatory manner or in a misleading context. The source should be acknowledged, by showing the publication title and © Care Quality Commission 2010. www.cqc.org.uk Internet address Care Homes for Older People Page 3 of 30 Information about the care home Name of care home: Address: Greenways 720 Preston Road Bamber Bridge Preston Lancashire PR5 8JP 01772339083 01772334633 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Ark Care Services Limited Name of registered manager (if applicable) Mrs Jill Loftus Type of registration: Number of places registered: care home 30 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 dementia old age, not falling within any other category Additional conditions: 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. The maximum number of service users who can be accommodated is: 30 Date of last inspection Brief description of the care home Greenways is a residential care home providing 24-hour personal care and accommodation for 30 older people or people who have dementia related care needs. The home is owned by Mr and Mrs Ajisebutu, who also own a second home in the South of England. The home is located in a residential area on the outskirts of Care Homes for Older People Page 4 of 30 Over 65 0 30 30 0 1 3 0 1 2 0 0 9 Brief description of the care home Bamber Bridge, close to all local amenities and the motorway network. The home is a two-story building. Accommodation is provided in single bedrooms, the majority of which have en-suite facilities, comprising of a wash hand basin and WC. Although the rooms are pleasantly furnished, service users are also able to take personal possessions with them when they come to live at the home. Bedrooms are located on both the ground and first floor. There is a passenger lift. Accessible toilets and bathrooms are located on both floors near to bedrooms and living rooms. There are three dining areas; two of these are a combined lounge with a dining area. A separate conservatory is also available. The home is a no smoking home. The fees at the home range from £360 - £410 per week. There are additional charges for hairdressing and newspapers. All the above information and more can be obtained from the Service User Guide which is available on request from the home. Care Homes for Older People Page 5 of 30 Summary This is an overview of what we found during the inspection. The quality rating for this care home is: Our judgement for each outcome: two star good service Choice of home Health and personal care Daily life and social activities Complaints and protection Environment Staffing Management and administration peterchart Poor Adequate Good Excellent How we did our inspection: The inspection of this home included a site visit which was carried out on an unannounced basis. This meant that the manager and staff did not know the visit was to take place until we arrived. During the visit we spent time with residents, talking to them and observing their daily routines. We also held discussions with staff at the home and the acting manager. We carried out a tour of the home looking at communal areas and a selection of residents private accommodation. We also viewed a variety of paperwork including residents care plans and staff personnel files. Prior to our visit we wrote to the manager and asked her to complete a very comprehensive self assessment. This gave us a lot of information about how the home is managed. In addition, we wrote to a selection of residents and staff and asked them Care Homes for Older People Page 6 of 30 to take part in a written survey about their opinions of the service provided. Care Homes for Older People Page 7 of 30 What the care home does well: The majority of people we consulted both in writing and during our visit, expressed satisfaction with the home and made some very positive comments. These included; All the staff are very friendly and do their utmost to help. Even the smallest task is always done at the time of asking. The home gives the best care possible to residents and tries to meet their needs. I think the home does well in all aspects of the care and well being of residents. The home is small and friendly, staff are caring. Throughout our visit we observed carers going about their duties in a cheerful and pleasant manner. There was a relaxed, friendly atmosphere in the home and residents and carers appeared to get along very well. We noted that carers addressed residents in a courteous and respectful manner. We found care needs assessments had been carried out for all residents prior to their admission. This is important because it helps ensure that the prospective residents needs can be met at the home and that it is the right place for them. Robust assessment procedures also help ensure that carers have a good understanding of peoples needs and can plan their care effectively. In general, peoples care plans provided comprehensive information about their preferred daily routines and other things that were important to them. In all cases we found that peoples health care needs were very clearly stated and clear guidance was in place for staff in relation to how to meet those needs. We found improvement in arrangements for activities and noted that the home now try to provide activities that meet peoples individual needs. This means that there are now activities provided on a one to one basis as well as group activities that may not suit everyone. The majority of people we consulted expressed satisfaction with the quality and variety of meals provided at the home. Menus showed that people are provided with a varied diet and residents individual needs and preferences in relation to food were recorded in their care plans. People are enabled to raise concerns and if they do so, the home take them seriously and respond appropriately. People who live at the home told us they knew how to raise any issues and that they would be comfortable in approaching the manager or the owner of the home. The home follows careful procedures when recruiting new staff members. This ensures that all the necessary background checks are carried out prior to any new person being appointed which helps protect the safety and wellbeing of residents. The home has a good approach to training and the manager carefully monitors this Care Homes for Older People Page 8 of 30 area. All carers are provided with training in the key health and safety areas such as moving and handling at the start of their employment and other areas such as caring for people with dementia are covered as part of each carers personal development plan. Over half the carers employed at the home hold National Vocational Qualifications in care at level 2 or above. What has improved since the last inspection? What they could do better: Whilst we found some improvements in assessment and care planning processes we noted that some peoples care plans still lacked detail in certain areas, for example support some people required in relation to more complex behavioural needs. It is important that carers have detailed guidance in relation to individual residents so that they can approach situations consistently and confidently. Residents and their relatives who responded to our written survey told us that they were able to get involved with their care planning and contribute towards the development of their care plans. However, there was no documentary evidence of such involvement in the home. We advised the manager to ensure that evidence is maintained so that the home can demonstrate that people are provided with this opportunity. Care Homes for Older People Page 9 of 30 We found significant improvements in the way residents medicines were managed resulting in safer practice and better protection for residents. We made two recommendations to further support development in this area. We found some examples of missing information in relation to as and when required medication. This information is very important to ensure that people receive their medicines when they need them and as such we made a recommendation that details guidance be included in the care plans of all residents prescribed medication on this basis. We also made recommendation regarding the recording of medicines belonging to people staying at the home on a short term basis. The person centred approach now adopted by the home when arranging activities should continue. Records of peoples engagement in activities should be regularly analysed to ensure that their individual needs and preferences are being met. We found that the home follow careful procedures when recruiting new staff and suitable background checks including a Criminal Records Bureau check are carried out for all prospective staff members. However, some of these disclosures are now several years old and in discussion we found that there is no policy for updating such checks. We have made a recommendation that this be addressed and procedures introduced to ensure that these checks are updated within specified timescales. The manager needs to ensure that the Commission is made aware of any incident which occurs in the home and is notifiable under regulation 37 of the Care Homes Regulations, 2001. A requirement has been made in relation to this matter. 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. Care Homes for Older People Page 10 of 30 Details of our findings Contents Choice of home (standards 1 - 6) Health and personal care (standards 7 - 11) Daily life and social activities (standards 12 - 15) Complaints and protection (standards 16 - 18) Environment (standards 19 - 26) Staffing (standards 27 - 30) Management and administration (standards 31 - 38) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Older People Page 11 of 30 Choice of home These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People are confident that the care home can support them. This is because there is an accurate assessment of their needs that they, or people close to them, have been involved in. This tells the home all about them and the support they need. People who stay at the home only for intermediate care, have a clear assessment that includes a plan on what they hope for and want to achieve when they return home. People can decide whether the care home can meet their support and accommodation needs. This is because they, or people close to them, have been able to visit the home and have got full, clear, accurate and up to date information about the home. If they decide to stay in the home they know about their rights and responsibilities because there is an easy to understand contract or statement of terms and conditions between them and the care home that includes how much they will pay and what the home provides for the money. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The homes thorough assessment process means that carers have a good understanding of peoples needs from the point that they are admitted to the home. Evidence: A Service User Guide is available for people who are considering a move to the home. This document includes various information such as the facilities available and the service provided. It also gives a picture of daily routines in areas like mealtimes and activities. Since the last inspection the manager has carried out some work to ensure the Service User Guide is available in a variety of formats to meet peoples individual needs. We confirmed that the guide can now be made available in large print and work is currently ongoing to have it converted to an audio format. Unless people have to move into the home very quickly because of an emergency Care Homes for Older People Page 12 of 30 Evidence: situation, an assessment of their needs is carried out before their admission. This means that the manager can be sure that a persons needs can be met at the home and that the home is the right one for them. It also means that staff have a good understanding of the persons care needs and can provide the right level of care straight away. We viewed a number of residents pre admission assessments and found that in general, they were well detailed in terms of medical and personal care needs. There was also an improvement in the amount of information included about social aspects of peoples lives such as life history, relationships, hobbies and preferred daily routines. These are important areas that need to be explored so that peoples care can be planned in a person centred way. Person centred planning means recognising and valuing peoples individuality and providing their care accordingly. Some people who responded to our written survey told us that they were not sure if they had ever been given a contract by the home. We advised the manager to review each residents file to ensure that contracts had been provided in all cases, as soon as possible. Care Homes for Older People Page 13 of 30 Health and personal care These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People’s health, personal and social care needs are met. The home has a plan of care that the person, or someone close to them, has been involved in making. If they take medicine, they manage it themselves if they can. If they cannot manage their medicine, the care home supports them with it, in a safe way. People’s right to privacy is respected and the support they get from staff is given in a way that maintains their dignity. If people are approaching the end of their life, the care home will respect their choices and help them feel comfortable and secure. They, and people close to them, are reassured that their death will be handled with sensitivity, dignity and respect, and take account of their spiritual and cultural wishes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home receive care that is in line with their individual needs and wishes. Evidence: We received a good response to our written survey from people who live and work at the home. People who live at the home told us that they were happy with the way their personal care was provided. Carers who responded told us that they felt they were provided with a good level of information about peoples individual needs so that they could provide the right sort of care. As part of our case tracking exercise we viewed a number of residents care plans. We found that care plans were generally very comprehensive in terms of peoples physical and health care needs. Some examples were particularly good and provided a good deal of information about peoples preferences in relation to their daily routines and how they would like their care to be provided. We noted that efforts had been made to make care plans more person centred and in Care Homes for Older People Page 14 of 30 Evidence: most cases, peoples care plans addressed areas such as social activities, relationships and emotional wellbeing. However, we did view some examples where this sort of information could have been developed further, particularly in relation to residents who may require support due to more complex behavioural needs. There are very good procedures in place to assess the risk people face in areas such as developing pressure sores or falling, for example. We looked at some examples and found that where people had been assessed as being at risk, detailed guidance was in place for staff to ensure that the correct measures were taken to keep people safe. The sample of daily care records viewed demonstrated that carers monitor residents health carefully and are quick to ensure that people receive support from relevant health care professionals. We found evidence of effective joint working with a variety of health care professionals including district nurses, doctors and specialists. The home have good systems in place for the safe receipt, storage, administration and disposal of peoples medication. We viewed a number of records relating to medication and found these to be in good order and well maintained. We also noted that medicines were stored, safely and securely. We found that the manager regularly audits medication stock and records to help ensure that people receive their medication as prescribed. In addition, we found that there are good systems in place to ensure that all staff who administer peoples medicines are competent to do so, including regular competence assessments. We made two recommendations to support further improvements in this area. One was related to the recording of medication for people staying at the home on a short term (respite) basis. We also made a recommendation that more detailed guidance be included in the care plan of every resident prescribed a medication on an as and when required basis. Care Homes for Older People Page 15 of 30 Daily life and social activities These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: Each person is treated as an individual and the care home is responsive to his or her race, culture, religion, age, disability, gender and sexual orientation. They are part of their local community. The care home supports people to follow personal interests and activities. People are able to keep in touch with family, friends and representatives. They are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. People have nutritious and attractive meals and snacks, at a time and place to suit them. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are provided with regular opportunities to take part in things they enjoy doing. Evidence: People we consulted were generally positive about daily life at the home and told us they were satisfied with arrangements in areas such as mealtimes and activities. One resident said There is always something going on, we have good fun, and a carer told us We try and ensure that there is an activity every day for people to join in if they want to. We found when we viewed peoples care plans that attention had been paid to their individual needs and wishes in relation to activities and hobbies and that a good variety of activities were offered to try and help ensure that everyone had the chance to take part in pastimes that they enjoyed. We also noted that the home had moved towards a more person centred approach and attempt to provide activities on a one to one basis as well as group activities that may not suit everyone. As well as regular activities inside the home, attempts are made to provide people with the opportunity to take part in trips out to places such as the local garden centre Care Homes for Older People Page 16 of 30 Evidence: and other local amenities. During our visit we observed one resident saying that she felt like going out for a walk and we were pleased to see that this was immediately arranged. There is an activities coordinator employed at the home who oversees the area and attempts to ensure that every resident is provided with regular opportunity to take part in things they enjoy doing. To aid this, records are kept of whether residents have chosen to join in activities and if they have appeared to enjoy them. We made a recommendation that these records be regularly reviewed so that it can be identified when a resident is found to be refusing activities regularly, and their care plan can be reviewed to see what else can be offered. People told us that they were happy with the quality and variety of food provided at the home. During our visit we observed a lunch time and were pleased to see that people were being offered the choice of two main meals. In discussion, the manager explained that the home were in the process of developing pictorial menus to help people who may not be able to make use of written menus make and express their choices. We noted that the dining area used by residents was much improved since the last inspection and at the time of our visit, tables were nicely set up with condiments and serviettes available on each one. The food served looked nicely presented and people we observed appeared to enjoy their meals. Menus and records of meals served demonstrated that people are provided with a varied and appealing diet. In addition, residents care plans provided information about their dietary preferences and any specific needs in this area. Care Homes for Older People Page 17 of 30 Complaints and protection These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: If people have concerns with their care, they or people close to them know how to complain. Any concern is looked into and action taken to put things right. The care home safeguards people from abuse and neglect and takes action to follow up any allegations. People’s legal rights are protected, including being able to vote in elections. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home can be confident that any concerns raised will be taken seriously and dealt with effectively. Evidence: The home has a complaints procedure which is written in a clear and easy to understand manner. The manager confirmed that the complaints procedure is available in a number of formats including large print and at the time of our visit, the home was in the process of producing the procedure in an audio format. People we spoke with told us that they were aware of the complaints procedure and that they would be happy to raise any concerns they had. A number of residents commented on the approachability of the manager. In our written survey one relative commented the manager and care staff are very approachable and I feel that i could raise concerns at any time. Processes are in place to ensure that all complaints are recorded along with the outcome of any investigation and subsequent action taken. We viewed records which showed that all complaints raised since the last inspection had been dealt with appropriately. All homes are required to have written procedures in place that must be followed if it is alleged or suspected that a resident has been the victim of any kind of abuse. These Care Homes for Older People Page 18 of 30 Evidence: are generally referred to as safeguarding procedures. We found that the manager and the staff members we spoke to had a good understanding of the procedures. We were also able to confirm that the majority of staff members had received training in safeguarding and were aware of their responsibility to report abuse or bad practice in line with the homes whistle blowing procedures. In addition, staff members told us that they felt they would be supported by their manager in the event that they made any such report. Care Homes for Older People Page 19 of 30 Environment These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People stay in a safe and well-maintained home that is homely, clean, pleasant and hygienic. People stay in a home that has enough space and facilities for them to lead the life they choose and to meet their needs. The home makes sure they have the right specialist equipment that encourages and promotes their independence. Their room feels like their own, it is comfortable and they feel safe when they use it. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home are provided with comfortable, homely accommodation. Evidence: During our visit we carried out a tour of the home and viewed all the communal areas as well a selection of residents private accommodation. We found all areas of the home to be clean, warm and comfortable and noted a number of improvements that had been made since the homes last inspection. There are a number of communal areas for people to spend their time including two lounges and some safe outdoor space where the residents pet chickens live. Since the last inspection an additional quiet lounge/sensory room has been created for the residents use. We viewed several residents bedrooms and found that these were nicely personalised with items such as pictures and ornaments and in some cases, residents had pieces of their own furniture in their rooms to make them feel at home. The home employs a maintenance worker who works on a full time basis. This means that any issues requiring attention can be dealt with quickly. There are a number of showering facilities in the home and since the last inspection, a new assisted bathing facility has been installed for residents use. Care Homes for Older People Page 20 of 30 Evidence: There are procedures in place to protect people from infectious diseases and staff we consulted showed a good understanding of these. The manager confirmed that infection control training was provided to all staff as part of their induction training. Care Homes for Older People Page 21 of 30 Staffing These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have safe and appropriate support as there are enough competent staff on duty at all times. They have confidence in the staff at the home because checks have been done to make sure that they are suitable to care for them. Their needs are met and they are cared for by staff who get the relevant training and support from their managers. There are no additional outcomes. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People who live at the home received their care from carefully recruited, well trained staff. Evidence: We viewed a selection of staff personnel files which confirmed that the home follow careful processes to ensure that only suitable people are employed to work there. The manager advised us that all prospective staff members are required to complete a detailed application form which includes a full employment history. We were also able to confirm when viewing records that any gaps in a candidates employment history are fully investigated and a record kept of the explanation provided. Records viewed confirmed that appropriate background checks are carried out for people before they start work including references and a Criminal Records Bureau check. However, we did note that for some staff members, these checks had been made several years ago and we made a recommendation that a procedure for renewing these checks at specified timescales be introduced. During our visit we noted that staffing levels appeared to be appropriate to meet the needs of people living at the home. Carers were observed spending time with residents and providing care in a relaxed and unhurried manner. Care Homes for Older People Page 22 of 30 Evidence: People we consulted told us that they felt staffing levels were adequate. One resident wrote There is always someone there when you need them, even the smallest task is carried out at the time of asking. Records viewed confirmed that all new starters are provided with an in depth induction which is in line with Skills for Care standards. In addition, the home have a mentoring system so that new staff members always have a point of contact that they can use if they need advice or guidance. Staff who responded to our written survey were very complimentary about the standard of training provided and all told us that they felt they were provided with appropriate training to carry out their roles well. This was also confirmed by training records which showed that carers are provided with training in a number of areas relevant to their role including key health and safety areas such as moving and handling and infection control. It was pleasing to note that all staff members at the home including domestic staff were in the process of completing training in the area of caring for people with dementia. In addition, we were able to confirm that just over half of the carers at employed at the home hold National Vocational Qualifications in care at level 2 or above with several other staff members due to complete the course soon. Care Homes for Older People Page 23 of 30 Management and administration These are the outcomes that people staying in care homes should experience. They reflect the things that people have said are important to them: People have confidence in the care home because it is led and managed appropriately. People control their own money and choose how they spend it. If they or someone close to them cannot manage their money, it is managed by the care home in their best interests. The environment is safe for people and staff because appropriate health and safety practices are carried out. People get the right support from the care home because the manager runs it appropriately with an open approach that makes them feel valued and respected. The people staying at the home are safeguarded because it follows clear financial and accounting procedures, keeps records appropriately and ensures their staff understand the way things should be done. They get the right care because the staff are supervised and supported by their managers. This is what people staying in this care home experience: Judgement: People using this service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Greenways is a well managed home which is run in the best interests of people who live there. Evidence: Since the last inspection the homes manager has been through the process of registration with the commission during which she demonstrated that she was suitably skilled and experienced to run the home. Throughout our visit the manager demonstrated a good understanding of her role and was able to provide a number of examples of improvements that had been made since the last inspection to help improve outcomes for people living at the home. The manager returned the Annual Quality Assurance Assessment (AQAA) to us within agreed timescales. This document was completed to a very good standard and showed that the manager is aware of the importance of constantly monitoring and developing all aspects of the service. Care Homes for Older People Page 24 of 30 Evidence: Some people who live at the home need assistance to manage their day to day finances. We viewed samples of records relating to residents finances and found these to be well maintained and in good order. During our visit we became aware of some incidents that had occurred in the home since the last inspection which we should have been notified about but were not. We discussed this with the manager and have made a requirement in relation to the matter. The home has a comprehensive health and safety policy in place which is supported by a number of separate procedures in areas such as fire safety and COSHH (control of substances hazardous to health). We also viewed a number of certificates during our visit confirming regular inspection and maintenance of equipment and utilities within home. Training records viewed confirmed that all staff members had been provided with training in the key health and safety areas such as moving and handling. The manager advised us that attempts are always made to provide this training as part of a new staff members induction. The manager now has a training matrix in place which enables her to monitor all staff training quickly and efficiently and easily identify when staff are due to undertake refresher training in the relevant health and safety areas. Care Homes for Older People Page 25 of 30 Are there any outstanding requirements from the last inspection? Yes £ No R Outstanding statutory requirements These are requirements that were set at the previous inspection, but have still not been met. They say what the registered person had to do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. No. Standard Regulation Requirement Timescale for action Care Homes for Older People Page 26 of 30 Requirements and recommendations from this inspection: Immediate requirements: These are immediate requirements that were set on the day we visited this care home. The registered person had to meet these within 48 hours. No. Standard Regulation Requirement Timescale for action Statutory requirements These requirements set out what the registered person must do to meet the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The registered person(s) must do this within the timescales we have set. No. Standard Regulation Requirement Timescale for action 1 31 37 The manager must ensure 14/02/2010 that the Commission is made aware of any incidents that are classed as notifiable under regulation 37 of The Care Homes Regulations 2001. This is to help ensure that the Commission are aware of significant incidents that adversely effect the safety or wellbeing of people using the service. Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 1 2 The home should ensure that written confirmation is received and retained from a resident or their representative that a contract or statement of terms and conditions has been provided. Residents care plans should be further developed to provide more detailed guidance for staff, particularly in areas such as positive behaviour support. Page 27 of 30 2 7 Care Homes for Older People Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations 3 7 A clearer record should be maintained of the involvement of residents and their representatives in their care planning. This is so that the home can demonstrate that people are provided with opportunities for such involvement. Detailed guidance should be in place for all residents who are prescribed a medicine on an as and when required basis. This is to help ensure that people receive their medicines when they need them . Clear records should be maintained in respect of medication being returned with residents who have stayed in the home on a short term basis. This is so that the home can keep an accurate record of stocks of medicines at all times. The development of pictorial menus should continue to help ensure that people who are unable to access written information are assisted to make and express choices about what they eat. Records of peoples engagement in activities should be included as part of their care planning reviews to help ensure that their individual needs and wishes are being met in this area. A contemporaneous record of complaints should be maintained within the home so that an overview of all issues that have been raised is available at all times. The home should establish procedures for renewing Criminal Records Bureau checks for staff, to help ensure that these checks are updated within appropriate timescales. Consideration should be given to holding regular meetings for residents and their representatives. This is to help ensure that the involvement of residents and their relatives in the running of the home and the homes quality assurance processes is developed further. Receipts obtained on behalf of residents for daily living items should be numbered and recorded. This is to help the manager audit records made in respect of residents personal finances. Formal staff supervision should include opportunity for one to one meetings as well as the current observed practice 4 9 5 9 6 12 7 12 8 16 9 29 10 33 11 35 12 36 Care Homes for Older People Page 28 of 30 Recommendations These recommendations are taken from the best practice described in the National Minimum Standards and the registered person(s) should consider them as a way of improving their service. No Refer to Standard Good Practice Recommendations format. This is so that staff have the opportunity to discuss areas of daily practice and raise any concerns they may have. Care Homes for Older People Page 29 of 30 Helpline: Telephone: 03000 616161 Email: enquiries@cqc.org.uk Web: www.cqc.org.uk We want people to be able to access this information. If you would like a summary in a different format or language please contact our helpline or go to our website. Copyright © (2009) Care Quality Commission (CQC). 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