Care Home: Lower Greenfoot - Settle Elderly Persons Home - NYCC

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What the care home does well There is a very pleasant atmosphere in the home, generally people move into the home from the nearby local villages and are looked after by staff that live in the same villages.There is a well-established staff team who know the people living at Lower Greenfoot well. Positive comments were made by about the staff for instance: -`kind and caring`, `patient` `good attitude and `marvellous staff.` People are given enough information about the home before they move in. Someone from the home visits them and they are offered the opportunity to visit the Lower Greenfoot for a look around and to ask questions about how the service is delivered. This enables them to make an informed decision as to whether the home is the right place for them to live. The home has a warm friendly atmosphere, where people are engaged and encouraged by staff to participate in social activities of their choice. This helps them maintain their social skills and independence. People are able to make choices in some areas of their lives. Examples given by people are rising and retiring times, food and activities. This ensures that people are able to maintain some control over their lives. A good choice of food and drinks are available. This ensures that people receive a varied and nutritious diet. One person spoken to said, `The food is very good`. Visitors are encouraged and made welcome. There is a clear and user-friendly complaints procedure and complaints are taken seriously. Arrangements are in place to measure the quality of the service, which includes feedback from people. This ensures that the staff continues to deliver care in the best interests of people who use the service. There is a robust procedure in place to direct staff in their practice and protect people from financial abuse. What has improved since the last inspection? Following a recommendation all bedrooms have or were being fitted with thermostats on the radiators whilst the inspection was being carried out, so that people can regulate the temperature of their own living environment. What the care home could do better: The management of the home is not recording or updating or organising information fully this has caused most of the requirements made at this inspection. This paper work included the care plans, risk assessment, training and recruitment records. A good standard of record keeping helps to provide people with a consistent and safe service. Nutritional risk assessments should be included in the initial assessments. This will seek to ensure that people will receive proper and appropriate nourishment and identify if any medical interventions are needed. The recording of the application of prescribed creams and the record of medicines issued must be kept up to date. This ensures a proper record is maintained and prevents the risk of errors.Health and safety checks need to be carried out these help to make sure people are living in a safe environment. CARE HOMES FOR OLDER PEOPLE Lower Greenfoot - Settle Elderly Persons Home - NYCC 30 Lower Greenfoot Settle North Yorkshire BD24 9RB Lead Inspector Caroline Long Key Unannounced Inspection 09:30 27th November 2007 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Lower Greenfoot - Settle Elderly Persons Home NYCC 30 Lower Greenfoot Settle North Yorkshire BD24 9RB Address 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) 01729 822 973 01729 825336 www.northyorks.gov.uk North Yorkshire County Council Mr Robin Keir Hargreave Care Home 30 Category(ies) of Dementia (30), Old age, not falling within any registration, with number other category (30) of places Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The registered person may provide the following category of service only: Care home only - Code PC to service users of the following gender: Either, whose primary care needs on admission to the home are within the following categories: Old age, not falling within any other category - code OP, Dementia - Code DE. The maximum number of service users who can be accommodated is: 30 15th November 2006 2. Date of last inspection Brief Description of the Service: 30 Lower Greenfoot is a care home run by North Yorkshire County Council and registered to provide a service for thirty-one older people of either gender. The home was purpose built approximately twenty-one years ago and the accommodation is arranged around four flats. Three of the flats have a lounge/dining area, and eight bedrooms. One of the flats has a lounge/dining area, a quiet lounge and seven bedrooms. All bedrooms are intended for single occupancy. All the accommodation is on the ground floor and there is level access to the main entrance. The home is set in large landscaped gardens. There is a day centre attached to the home and a separate team also provides meals for the community. On the 27th November 2007 the weekly charge was from £94.45 to £368.90, this amount is dependent upon income and savings. The Commission for Social Care inspection reports are displayed in the home for anyone to read. Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The inspection focused on the key standards and also matters, which were raised at the last inspection. This is what was used to write this report. • • • Information about the home kept by the Commission for Social Care Inspection. Information asked for before the inspection, this is called an annual quality assessment questionnaire. Information from surveys that were sent to people who live at the home, their relatives, health professionals and the staff. Six surveys were returned from people who live at Lower Greenfoot and two were received from relatives and three from staff. An unannounced visit to the home. This was carried out by one inspectors and lasted over seven hours and included talking to staff and the registered manager about their work and the training they have completed. And checking some of the records, policies and procedures the home has to keep. Some time was spent observing staff supporting people and talking with the people who live at Lower Greenfoot. Four peoples care records were looked at in detail. An expert by experience was asked to accompany the inspector during the visit to the home. An ‘expert by experience’ is a person who because of there shared experience of using services and /or ways of communicating. Visits a service with and inspector to help them get a picture of what it is like to live in or use the service. During this visit they were asked to look at peoples daily life and social activities, their observations have been used in this outcome area. • • • • What the service does well: There is a very pleasant atmosphere in the home, generally people move into the home from the nearby local villages and are looked after by staff that live in the same villages. Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 6 There is a well-established staff team who know the people living at Lower Greenfoot well. Positive comments were made by about the staff for instance: -‘kind and caring’, ’patient’ ‘good attitude and ‘marvellous staff.’ People are given enough information about the home before they move in. Someone from the home visits them and they are offered the opportunity to visit the Lower Greenfoot for a look around and to ask questions about how the service is delivered. This enables them to make an informed decision as to whether the home is the right place for them to live. The home has a warm friendly atmosphere, where people are engaged and encouraged by staff to participate in social activities of their choice. This helps them maintain their social skills and independence. People are able to make choices in some areas of their lives. Examples given by people are rising and retiring times, food and activities. This ensures that people are able to maintain some control over their lives. A good choice of food and drinks are available. This ensures that people receive a varied and nutritious diet. One person spoken to said, ‘The food is very good’. Visitors are encouraged and made welcome. There is a clear and user-friendly complaints procedure and complaints are taken seriously. Arrangements are in place to measure the quality of the service, which includes feedback from people. This ensures that the staff continues to deliver care in the best interests of people who use the service. There is a robust procedure in place to direct staff in their practice and protect people from financial abuse. What has improved since the last inspection? What they could do better: The management of the home is not recording or updating or organising information fully this has caused most of the requirements made at this inspection. This paper work included the care plans, risk assessment, training and recruitment records. A good standard of record keeping helps to provide people with a consistent and safe service. Nutritional risk assessments should be included in the initial assessments. This will seek to ensure that people will receive proper and appropriate nourishment and identify if any medical interventions are needed. The recording of the application of prescribed creams and the record of medicines issued must be kept up to date. This ensures a proper record is maintained and prevents the risk of errors. Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 7 Health and safety checks need to be carried out these help to make sure people are living in a safe environment. Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.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 Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 9 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 3 only Standard 6 does not apply to this service. People who use the service experience excellent quality outcomes in this area. To be confident that the service can meet people’s needs fully, staff complete comprehensive assessments before a person moves into the home. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Examination of three peoples records showed that comprehensive assessments are completed before anyone is offered a place in the home. A community care manager employed by North Yorkshire County Council (NYCC) does the initial assessment. The assessment is then discussed at a weekly meeting, which is held by North Yorkshire Social Service where the NYCC services are allocated. If it is agreed at the meeting, the home is appropriate all the assessment records are given to Lower Greenfoot and a manager from Lower Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 10 Greenfoot then visits people in their own homes or in hospital to complete the Lower Greenfoot’s own assessment. The three records looked at had assessments by the care manager, the hospital staff, community psychiatric nurses and by the registered manager of Lower Greenfoot. These reflected people’s personal preferences, this shows that people were actively involved in their assessment process. Together these assessments would have enabled the registered manager to assess whether the home has the equipment and staff skills necessary to care for the person properly. During the inspectors visit to the home the registered manager was arranging to carry out an assessment at a person’s home. Everyone is offered the opportunity to visit Lower Greenfoot before moving in. This provides another chance for people and their families to assess whether or not they want to go ahead with the admission. All admissions are subject to a trial period. After six weeks a review is held to decide whether they want to live in the home permanently and whether the home is able to meet the persons needs fully. If the person feels they need longer to make a decision this is accommodated. On admission a key worker is allocated to each new person. The key worker role is to take a special interest in the person. On the day of admission a member of staff is allocated to help them settle in and find their way around. During the inspectors visit staff were aware of how frightening it could be moving into the home and explained how they greet people, show them their rooms and help them to settle in. A person who had recently moved into the home and their relative were able to confirm this. They explained they were provided with information, visited by the registered manager in hospital and shown around the home. On arrival they had been allocated a key worker who had provided them with further information about daily life at Lower Greenfoot. They both talked about how welcoming all the staff had been when they first arrived. A second relative said how the staff had been ‘wonderful’ when their relative moved into the home. They described how the staff had made special effort to make sure the move into Lower Greenfoot was as relaxed and welcoming as possible. They also confirmed they had received information about the home and felt fully informed before moving in. All of the six surveys received confirmed that they were given enough information about the home before they moved in which helped them to make a decision as to whether or not Lower Greenfoot would be the right place for them to live. Comments included ‘Invited to look round and see the room which I would occupy also detailed leaflet received.’ Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 11 During the inspectors visit and from the surveys people confirmed their needs were always or usually met. One relative commented’ My relatives needs have been attended to carefully and with good humour.’ The home does not provide intermediate care. Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 12 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9 and 10. People who use the service experience good quality outcomes in this area. People receive care that is delivered in a manner that respects their wishes and meets their needs. However this could be compromised if people’s care records are not improved upon. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Feedback from people who lived in the home and on the surveys returned when asked if they received the care and support they need, three said they always did and three people usually did. Examples of comments made were: ‘Generally home is above average.’ ‘Marvellous place.’ ‘Alright, difficult to fault it.’ Two surveys received from relatives and those spoken with during the inspectors visit to the home indicated that Lower Greenfoot always provides people the support needed. Examples of comments made were: Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 13 ‘I am extremely pleased with Greenfoot. It is the best care available in the area. It is perfect for my family. I don’t think it could be improved much.’ and ‘Its wonderful, marvellous, all their needs are met by considerate, kind and caring staff.’ People living in the home said staff respected their privacy and dignity. They were able to give examples as to how staff did this. Staff were observed providing support in a kind and helpful manner and people were clean and dressed in co-ordinating clothes. A relatives confirmed this was always the case. On the dementia unit the atmosphere was calm and comfortable, people looked happy and content. A member of staff was able to explain how they use divisional methods to keep people calm. A relative described how staff had found out about specific possessions and tasks that calmed people and how staff helped them to carry them out. Four peoples’ case records were looked at in order to check that a plan had been formulated which helped staff provide support to people according to their needs and wishes. A requirement was made at the last inspection for everyone to have a care plan, which should include clear guidance to staff about the support that they have to provide to meet people needs. The care plans consisted of assessments of personal and health care, which are carried out following moving into the home, these are person centred and provided good information on which to base a plan of care for people. However one of the outcome based care plans was not completed and the others did not fully reflect the person’s mental health needs or had not been updated following any changes to the person’s health. Where the staff had identified people needs had changed these were reflected in different places such as the daily task sheet or the daily contact sheets. This made the records difficult to navigate and for a member of staff new to the home could have prevented them from providing people with the care they need. Also people’s records did not always contain the relevant risk assessments, for nutrition, falls and medication. Examples were a person who had nutritional needs did not have a risk assessment in place; and a second person that had recently fallen did not have a falls risk assessment in place. Risk assessments help identify potential risks to people, this helps the staff to put into place arrangements which may minimise the risks. However talking with the registered manager, a team manager and the staff evidenced they are fully aware of peoples care needs and personal preferences and are proactive about identifying any changes and consulting with health Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 14 professionals. The care staff also explained they have very good handovers at the beginning of a shift where they are updated about peoples needs. Also when questioned staff were able to confirm they were assessing any risks to people and regularly making sure that the person was safe. Examples of the staffs actions are, where a person had been identified as not eating a full diet, the staff had commenced weighing them regularly and started to record their fluid intake and were providing them with alternative ways of maintaining their diets such as milk shakes and finger foods. For another they had followed up their incontinence and referred them to the in house incontinence adviser. Staff promotes the rights of people to access the health care professionals that they need both within the home and in the community. The surveys, people spoken with during the inspectors visit to the home and the three records looked at all showed people do have access to the GP, the community psychiatric nurse and the dietician. The team manager explained the home has a member of staff on site that is trained to provide advice on incontinence Although there are medication procedures to guide staffs’ practice and training is provided on the safe storage, administration and disposal of medicine and all the staff who dispense medication have received training. The application of prescribed skin creams are not recorded on the Medication Administration Record in the same way as tablets are. Creams applied are recorded in the peoples daily log as part of the personal care delivered on each shift. Also for people who were self-medicating risk assessments were not in place or could not be found. These points were discussed with the team manager who agreed to make sure these were put into place immediately. The home has now introduced a system for monitoring the number of drugs brought into the home when people come into the home for temporary care. These systems help to prevent any medication mistakes being made. Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 15 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 and 15. People who use the service experience excellent quality outcomes in this area. People are provided with the opportunity to have a stimulating daily life by staff. People are given a choice of nutritious drinks and meals when they request them. This judgement has been made using available evidence including a visit to this service. EVIDENCE: There is a very pleasant atmosphere in the home, generally people move into the home from the nearby local villages and are looked after by staff that live in the same villages. There is a domino group, which people can go and join in, this happens most afternoons. There are also outings organised to Coniston Court for mince pies and to see Settle lights. Residents meeting minutes, are on display in each of the flats, these showed a Communion Service is held once a month. During the inspectors visit to the home the staff were arranging the Christmas outdoor lights in preparation for a switch on event. Other entertainment for people is mainly in the attached day centre where there are a variety of things to do. On the day of the inspectors visit to home Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 16 the day centre was holding a Christmas coffee morning, people who lived in the home and their relatives were able to join in. In the dementia unit there are budgies and if peoples relatives bring a dog with them they are allowed to take it into the home when they visit. One relative explained their relative had been taken into Settle to the Market. They also described how they had previously enjoyed a task at home and the staff made sure that this task could be continued in the home. Everyone in the home particularly in the dementia unit are encouraged to maintain their daily living skills, such as making a drink, setting tables or washing up. Talking with two relatives and the two relatives surveys received, confirmed that visitors are made welcome. One explained how they were always made to feel welcome and offered a cup of tea. People living in the home when asked in the surveys, are there activities arranged by the home that you can take part in four said always, and one said usually. However one or two did ask for further trips out to the shops so they could buy their own toiletries etc. People spoken with during the inspector’s visit all said the staff support them to live the life they choose, this was also confirmed in the relatives surveys who state that the care service always supports their relatives to live the life they choose. People living at Lower Greenfoot confirmed that they could rise and retire at when they want. There is a five-week cycle for the meals and there is a good choice of menu for each mealtime; tables are set with tablecloths and matching crockery and cutlery. People can choose whether they sit in the dining area or their rooms to eat. In the dining room staff eat with people encouraging them to talk to each other during their meal. Food is checked with a temperature probe to make sure it is hot before serving. People have a choice of drinks throughout the day. However, some people would benefit from specialised cutlery to help with picking up the food from the plate easily. Staff working on the dementia unit are aware of peoples specific appetites and tried to cater for each persons individual needs, such as a little and often and finger food and milky drinks. The registered manger explained people do go out to a local lunch club organised by age concern. During the inspectors visit people commented upon the food saying it was excellent and they are given a choice of what they wanted to eat. When asked in the surveys do you like the meals at the home four stated always, and two stated usually. One commented: ‘I have diet problems some food I cannot eat but I am always offered a suitable alternative.’ Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 16 and 18. People who use this service experience good quality outcomes in this area. People who live in the home and their families can be sure that complaints are taken seriously and staff are alert to any signs of abuse. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The home has a clear complaints procedure that highlights the importance of complaining if people are not happy with the service. The procedure is given to everyone as part of the information provided to them at the time of moving in. Records examined showed that complaints are dealt with speedily. People spoken to know how to complain and feedback from surveys confirmed that they are aware of the complaints procedure and know who to talk to if they are dissatisfied with the service. During the inspectors visit people said they would tell the manager. The operations manager investigates any major complaints made about the home, the registered manager deals with any other concerns. The registered manager explained the complaints are reviewed regularly and used to inform and develop a plan for the service. There have been two concerns made to the home about being disturbed by noise at night both had been resolved. The Commission has not received any complaints or concerns. Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 18 Staff surveys confirmed that they know what to do if anyone has concerns about the home. The policies and procedures regarding the protection of people in the home are in line with best practice. Management know the course of actions to take in relation to protecting the rights of people. Staff are aware of the need to report any allegations or suspicions of abuse to their manager. Staff have received safeguarding adults training as part of their National Vocational Qualification or induction but some were waiting for further a update to their training about the procedure in North Yorkshire. The registered manager gave an example of when the local advocacy service had been contacted to help to support a person to uphold their rights. Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 19 and 26. People who use this service experience good quality outcomes in this area. People live in a clean, comfortable and safe home. We have made this judgement using a range of evidence, including a visit to this service. EVIDENCE: The accommodation is arranged in four separate units, each with up to eight bedrooms and a small kitchenette, lounge and dining area, a toilet and bathroom. The bedrooms do not have en suite facilities, however they have a wash hand basin and all the toilets are near to peoples rooms. There are additional sitting areas around the home where people can get away from others without having to go to their bedrooms. Flat four has a quiet lounge, to enable people to be more comfortable when their relatives visit. People can also use the day centre during the day and at weekends. Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 20 The premises are easily accessible and provide a safe and well-maintained environment for the people who live there. Aids and adaptations are provided and regularly serviced. The home employs a handyman who is responsible for some maintenance and the monitoring of some health and safety aspects of the premises. Over the last year the areas of the home have been redecorated and refurbishment such as the bathrooms and kitchen. The corridor and several of the bedrooms have had new carpets. The residents meeting minutes showed they have been involved in deciding about the redecoration. The staff meeting minutes showed staff were planning to carry out more refurbishments in the future. The home has a number of courtyards for people to sit out in during the inspectors visit these were being dressed with christmas lights in prepartion for the Settle christmas light switch on, one of the courtyards is used for people who want to smoke. There is also a enclosed sensory garden area for people with dementia to use. All bedrooms are individual, with different decorations and furnishings, people are encouraged to bring their own pieces of furniture and personal possessions; there is a homely feel to the home. All rooms have views either over the garden or the Yorkshire Dales. Following a recommendation made at the previous inspection all bedrooms have been fitted with thermostats on the radiators, so that people can regulate the temperature of their own living environment. For the duration of the inspectors visit the home was clean and fresh, there were no unpleasant odours. People in the home and their relatives said this was always the case. There is a policy on the prevention of infection and the management of infection control. The guidance is followed and systems are in place to prevent the spread of infection. Gloves and aprons were available throughout the home. However, the annual assessment questionnaire shows only five members of staff have received infection control training. To prevent the spread of infection all staff need to have infection control training. Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.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. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 27, 28, 29 and 30. People who use this service experience good outcomes in this area. People receive the care they need from an experienced and skilled workforce. This judgement has been made using available evidence including a visit to this service. EVIDENCE: Everyone spoken with during the inspectors visit made complementary comments about the staff, for instance: -‘kind and caring’, ’patient’ ‘good attitude and ‘marvellous staff.’ Two people who lived in the home said there were enough staff available. one said that there call bell was answered quickly. Two relatives also said there seemed to be enough staff to meet people’s needs. The registered manager and staff said when there were no vacancies and no one on leave there were enough staff to meet people’s needs. However comments made on the surveys returned were: ‘Due to staff shortages sometimes there is a delay but I have every confidence in them getting staff here as soon as possible.’ And ‘I think Greenfoot is an excellent care home. The staff work really hard to keep their residents happy whatever their needs and seem to me to be on the Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 22 look out for these needs. They are sometimes short staffed but I have never seen any of them other than pleasant with the residents and visitors.’ The home follows North Yorkshire County Councils well developed recruitment procedure that seeks to ensure that only suitable people are employed. The personnel department of North Yorkshire County Council carries out all the recruitment checks and forwards the information to the registered manager. Four staff files were checked, and found some of the paper work had not been transferred to the home, such as applications forms and references. So it was not possible to evidence at this inspection whether people had been recruited safely. However the registered manager explained he sees the application form, receives confirmation from the personnel department of satisfactory references. Also a member of staff who had been appointed since the last inspection confirmed all the appropriate checks were carried out before they started work. People in the home generally said they felt safe and the care staff did have the knowledge and skills to look after them properly. Staff also said they were provided with enough training to make sure they could meet peoples needs. The registered manager explained induction is carried out initially by the home and staff work alongside another experienced member of the staff team for a few days. Following this they are sent on the official induction course carried out by North Yorkshire County Care. Unfortunately for some this can mean waiting up to four months before they complete the North Yorkshire course and North Yorkshire induction training is not generally offered to relief staff. For other training although there was a comprehensive programme offered by North Yorkshire and staff talked about the training they had carried out such as dementia, back care, challenging behaviour, abuse, managing diversity and National Vocational Qualifications in care. Also the annual quality assessment questionnaire shows a large percentage of staff have competed their National Vocation qualification in care at level two or above. However it was difficult to confirm if these were up to date or had occurred, due to the records. Although the manager did say that training was discussed at annual apprasials and was aware that food hygiene training was necessary. Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 23 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 31,33, 35 and 38. People who use this service experience good outcomes in this area. Although the home is well managed in a manner that promotes peoples best interest, better record keeping is needed to ensure this continues. This judgement has been made using available evidence including a visit to this service. EVIDENCE: The registered manager is experienced and has managed the home for a number of years. He is suitably qualified. The staff spoke positively about the home’s management team and said that they are approachable and very supportive. People in living in the home knew who the registered manager was and said they felt comfortable approaching him if they had any concerns. People spoken to say they receive a reliable service from staff that are courteous, respectful, and the services are delivered in a responsible and professional manner. One survey commented that ‘I am extremely pleased Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 24 with Greenfoot. It is the best care available in the area. It is perfect for my family. I don’t think it could be improved much.’ Accident records are kept in line with data protection; the registered manager and the operational manager identify any patterns by reviewing the number and type of accidents monthly. The operational manager visits the home monthly to carry out a review of the quality of care. This review involves looking at accidents and complaints, minutes of staff and residents meetings and talking to staff and people living in the home. The home also follows North Yorkshire County Council selfassessment of qualitative performance. Where they carry out regular selfassessments of there performance and once a year a manager of another North Yorkshire homes carries out the further checks. This all ensure that the home continues to provide people with a good standard of care. The most recent residents meeting held in November shows the home is seeking residents’ views about the decorations and the food. Staff said supervision and meetings were carried out. The manager was able to show how the home is now tracking the number of supervisions people have carried out on the computer. However the records show whilst some have had four, some have only had one supervision in the last year. People are encouraged to manage their own financial affairs and spend their money as they wish. Staff provides support for people who require help in managing their finances. The inspection evidenced that although people receive a good service the standard of record keeping needs to be improved upon. Good record keeping helps to promote peoples rights and protect their best interests. A sample of health and safety records were checked and found not be up to date. At the last inspection the home was asked to check water temperature at risk assessed intervals and record this. The registered manager explained this had not been carried out. Also the fire alarm had not been checked since 2/11/07. These health and safety checks are necessary to make sure people are living in a safe environment. Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.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 3CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 X X 4 X X N/A HEALTH AND PERSONAL CARE Standard No Score 7 2 8 4 9 2 10 4 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 4 14 4 15 4 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 2 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X 1 1 Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? Yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1. Standard OP7 Regulation 15 Requirement Timescale for action 01/01/08 2. OP9 13(2) The registered manager must make sure: • Staff record people’s needs in a consistent way in the care plans. • Peoples mental health needs are part of the care plan. • The registered manager needs to make sure where a risk is identified the appropriate risk assessment is carried out and recorded. This helps to make sure people are provided with the care they need safely. The application of prescribed 10/12/07 skin creams must be recorded on the Medication Administration Record. This helps to prevent medication errors. To help to maintain a safe environment. Water temperature must be checked at risk assessed intervals and records kept. Previous requirement 01/01/06 &15/11/07 not DS0000034564.V351590.R01.S.doc 3 OP38 13 27/11/07 Lower Greenfoot - Settle Elderly Persons Home - NYCC Version 5.2 Page 27 met. RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 2 Refer to Standard OP3 OP7 OP29 Good Practice Recommendations Nutritional risk assessments should be completed. An initial assessment will help to identify anyone who may be at risk of not eating a nourishing diet. The Registered Manager must approve and retain an evidence of all recruitment documentation. This makes sure the manager is involved with and responsible for the recruitment of staff in the home. To make sure all staff are properly trained they should all complete training in food hygiene, safeguarding adults and infection control. All staff working at Lower Greenfoot should be offered induction training by North Yorkshire County Care. All records including health and safety records should be kept up to date. This is to make sure people live in a safe environment. 3 4 4 OP27 OP30 OP37 Lower Greenfoot - Settle Elderly Persons Home - NYCC DS0000034564.V351590.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection York Area Office Unit 4 Triune Court Monks Cross York YO32 9GZ National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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