Care Home: The Evergreens

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What the care home does well The Evergreens provides a homely and friendly place for people to live. Staff interviewed clearly enjoyed working at the home. They know the people who use the service well and are committed to providing the best care that they can. The staff work together as a team and are well supported by the manager. Good interaction was observed between the staff and people living at the home. What has improved since the last inspection? Since the previous inspection new care planning documentation had been introduced and staff were in the process of gathering and completing information. The plans are person centered and each area is looked at with the person, what they can do, what they would like to do and what they need help with. The providers had extended the service and two new spacious bungalows had been built. Major refurbishment had also been carried out in the existing bungalows. There were two conservatories linking bungalows together and they also provided a quiet place for people to sit. Some of the people living in the home are also involved in the recruitment process for staff, two on the interview panel with a member of staff to support. A person who takes part in the interviews said `I like to choose the best one`. What the care home could do better: To continue with the new care planning documentation and maintain the level of care and service provided to the people who live in the home Key inspection report Care homes for adults (18-65 years) Name: Address: The Evergreens Hemlington Village Road Middlesbrough TS8 9DE     The quality rating for this care home is:   three star excellent 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: Valerie Daly     Date: 0 2 1 2 2 0 0 9 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 Adults (18-65 years) Page 2 of 23 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 Adults (18-65 years) 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) Copyright © (2009) Care Quality Commission (CQC). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. www.cqc.org.uk Internet address Care Homes for Adults (18-65 years) Page 3 of 23 Information about the care home Name of care home: Address: The Evergreens Hemlington Village Road Middlesbrough TS8 9DE 01642599744 01642595744 Telephone number: Fax number: Email address: Provider web address: Name of registered provider(s): Type of registration: Number of places registered: Salco Homes Limited care home 29 Conditions of registration: Category(ies) : Number of places (if applicable): Under 65 learning disability physical disability Additional conditions: The maximum number of service users who can be accommodated is :29 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: Physical Disability, Code PD Learning Disability - Code LD Date of last inspection Brief description of the care home The Evergreens is registered with the Commission for Social Care Inspection under the Care Standards Act 2000 as a care home to provide care and accommodation for eighteen adults who have a learning disability. The home is compromised of three single storey dwellings, Juniper having nine places, Redwood having three places and Aspen having six places. The care home is situated in a secluded site set back from a main link road and close to a popular public house and has views over undeveloped grassland. 29 29 Over 65 0 0 Care Homes for Adults (18-65 years) Page 4 of 23 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: three star excellent service Choice of home Individual needs and choices Lifestyle Personal and healthcare support Concerns, complaints and protection Environment Staffing Conduct and management of the home peterchart Poor Adequate Good Excellent How we did our inspection: The quality rating for this service is three star. This means people who use this service experience excellent quality outcomes. This Key Inspection was to check that the home meets the standards that the Care Quality Commission say are the most important for the people who use the service, and that it does what the Care Standards regulations say it must. The inspection was conducted by a regulatory inspector in one inspection day. During the inspection a number of records were looked at, including records of people who use the service, along with staff recruitment and training records and maintenance. There was also discussion with the manager, deputy manager and care staff who work at The Evergreens. Care Homes for Adults (18-65 years) Page 5 of 23 The manager had completed the Annual Quality Assurance Assessment (AQAA), the services self-assessment of how well they think they are meeting the standards. We have reviewed our practice when making requirements to improve national consistency. Some regulations from previous reports may have been deleted or carried forward into this report as recommendations, but only when it is considered that people who use the service are not being put at risk or harm. In future if a requirement is repeated it is likely that enforcement action will be taken. Care Homes for Adults (18-65 years) Page 6 of 23 What the care home does well: What has improved since the last inspection? What they could do better: 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 Adults (18-65 years) Page 7 of 23 Details of our findings Contents Choice of home (standards 1 - 5) Individual needs and choices (standards 6-10) Lifestyle (standards 11 - 17) Personal and healthcare support (standards 18 - 21) Concerns, complaints and protection (standards 22 - 23) Environment (standards 24 - 30) Staffing (standards 31 - 36) Conduct and management of the home (standards 37 - 43) Outstanding statutory requirements Requirements and recommendations from this inspection Care Homes for Adults (18-65 years) Page 8 of 23 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, what they hope for and want to achieve, and the support they need. People can decide whether the care home can meet their support and accommodation needs. This is because they, and people close to them, can visit the home and get full, clear, accurate and up to date information. 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 the person 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. Peoples care needs are appropriately assessed prior to moving into the home and at regular periods of time thereafter. Evidence: Two peoples assessment documentation were read these showed that the home had obtained good information about the person, their likes and dislikes. The assessment looks at all aspects of daily life, eating/drinking, personal hygiene, continence, dressing, sleeping, mobility, religion, medical/physical needs, communication, personal finances, work, leisure and education. Additional assessments are also carried out; psychological, dependency, waterlow, service limitations and a nutritional screening tool is used. A relative spoken to said I had the opportunity to visit the home prior to the admission and the home had provided them with good information about the homes services and facilities. Information provided in the AQQA showed that people referred for admission were given the opportunity to visit the home several times and a person had in the past had an overnight stay, before accepting a placement there. Care Homes for Adults (18-65 years) Page 9 of 23 Individual needs and choices 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 needs and goals are met. The home has a plan of care that the person, or someone close to them, has been involved in making. People are able to make decisions about their life, including their finances, with support if they need it. This is because the staff promote their rights and choices. People are supported to take risks to enable them to stay independent. This is because the staff have appropriate information on which to base decisions. People are asked about, and are involved in, all aspects of life in the home. This is because the manager and staff offer them opportunities to participate in the day to day running of the home and enable them to influence key decisions. People are confident that the home handles information about them appropriately. This is because the home has clear policies and procedures that staff follow. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. People have care plans, which explain what they can do and what they need help with. People can make choices in their daily lives. They are encouraged to lead as full lives, as they can. Evidence: Since the previous inspection new care planning documentation had been introduced and staff were in the process of transferring information. Two peoples care records were looked at. They both contained a pen picture, which was very detailed and comprehensive. It gave information about the person such as their history, likes and dislikes and health problems. One person was said to be cheerfull, liked having fun and also had an interest in gardening. The care plans were completed with the person and their key worker over a period of time as they are very in depth. They are person centered and each area is looked at with the person, what they can do, what they would like to do and what they need help with. Areas covered in the care plans were; self advocacy, eating/drinking, washing/bathing/personal hygiene, toileting/continence, dressing/care of clothes, Care Homes for Adults (18-65 years) Page 10 of 23 Evidence: sleeping pattern, mobility, religion/culture/spiritual needs, relationships, medical/physical, communication, accommodation, domestic skills, personal finance, leisure, work, education and sport. The key worker carries out regular reviews with the person and plans are updated accordingly. Risk assessments are completed depending on peoples needs and any activities the individual carries out, assessments were found to be very detailed and are being regularly reviewed. A relative spoken to said I am fully involved and aware of the persons care needs and I attend reviews of care when held. Staff spoken to were knowledgeable of the care records and the importance of keeping them upto date in line with meeting the persons needs. Daily journal, on going records showed evidence of being linked to the care plans. Care Homes for Adults (18-65 years) Page 11 of 23 Lifestyle 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 can take part in activities that are appropriate to their age and culture and 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 and the home supports them to have appropriate personal, family and sexual relationships. People are as independent as they can be, lead their chosen lifestyle and have the opportunity to make the most of their abilities. Their dignity and rights are respected in their daily life. People have healthy, well-presented meals and snacks, at a time and place to suit them. People have opportunities to develop their social, emotional, communication and independent living skills. This is because the staff support their personal development. People choose and participate in suitable leisure activities. 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. Peoples rights are respected and people take part in a wide range of activities in line with their individual needs and lifestyles. People are in regular contact with their families and friends and they enjoy healthy diets and a good variety of food. Evidence: People living in the home enjoy a good range of activities, the home has a good selection of board games, snooker, pool and carpet bowls. Bingo and film nights are also popular. There are often pool competitions held and whilst the majority of people either join in or watch, some dont like the noise this creates so they go to another bungalow to visit others where it is quiet. People go out regularly to shops and for meals out also trips to the cinema and theatre, a number of people go out to day centres each day. Holidays are arranged each year some have day trips others go away for a few days. This year people had been to Blackpool, Brighton and Torquay. The home has its own Care Homes for Adults (18-65 years) Page 12 of 23 Evidence: mini-bus and regular trips out are arranged. The home has an open visiting policy and two relatives spoken to confirmed that We can visit at any time. Mealtimes in the home are very flexible and menus show a good choice and variety of food is being offered in the individual bungalows. People decide with staff on the weekly menus and one person goes out shopping with a member of staff. Individual food likes and dislikes are being identified and met. On occasion someone may not like what is on the menu in their bungalow, they may then go to visit in another bungalow and stay there for a meal. On Saturday evening people have a choice of take aways and a kareoke is held in the largest bungalow for those who wish to participate. Care Homes for Adults (18-65 years) Page 13 of 23 Personal and healthcare support 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 receive personal support from staff in the way they prefer and want. Their physical and emotional health needs are met because the home has procedures in place that staff follow. If people 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. If people are approaching the end of their life, the care home will respect their choices and help them to 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. Peoples personal and health care needs are explained in care plans and individuals have a say in how their care is provided. People who use the service are protected by the homes procedures for managing medication. Evidence: People in the home have their own General Practitioner and seven GP surgeries are used and people attend appointments with either a member of staff or a relative. A health care plan is completed for each person in their care records, those seen were detailed and comprehensive. The home operates a key worker system and named staff are responsible for developing the health care plans. Staff spoken to were knowledgeable of their care plans. The systems for the management of medicines was looked at. Evidence of good practice in medication ordering systems, medication administration process and disposal of unwanted medication was found. None of the people in the home are self medicating. There were records of training and competency assessments of staff administering medicines. Care Homes for Adults (18-65 years) Page 14 of 23 Concerns, 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. Their concern is looked into and action taken to put things right. The care home safeguards people from abuse, neglect and self-harm and takes action to follow up any allegations. 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 are encouraged to express their views about the service and they are confident that they will be taken seriously. The homes policies and procedures protect people from abuse and harm. Evidence: The homes complaints policy and procedure were seen and were well written and detailed. People living in the home each have a copy of the procedure. No complaints have been received since the last inspection. Relatives spoken to said if they had any concerns or problems they would speak to the manager and said they would be confident they would be dealt with. Information about making a complaint and safeguarding people is made available to people in picture format. The policy and procedure for safeguarding people was seen and is good. Staff had received training and had recently completed a safeguarding booklet as a refresher. This was confirmed in the staff training files. Care Homes for Adults (18-65 years) Page 15 of 23 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, comfortable, 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. People have enough privacy when using toilets and bathrooms. 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 live in an environment that is safe, homely, comfortable and well maintained. This judgment has been made using available evidence including a visit to this service. Evidence: All areas of the home seen were clean, homely and well maintained. Since the previous inspection the providers had extended the service and two new spacious bungalows had been built. Major refurbishment had also been carried out in the existing bungalows. There were two conservatories linking bungalows together and they also provided a quiet place for people to sit. New furniture had been purchased for the lounges and dining areas, which provided a homely and comfortable environment. Peoples bedrooms were highly individualised with different decoration in each room, each persons room was full of personal effects, televisions and music players their own furniture in some. One persons room had a large collection of film tapes and dvds he told me I love watching my filmsanother had a collection of cuddly toys. A relative spoken to said His bedroom is very homely. The gardens, lawns and courtyard area to the rear of the home were tidy and well maintained, and there was garden furniture for people to use in the better weather. Care Homes for Adults (18-65 years) Page 16 of 23 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, qualified 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. People’s needs are met and they are supported because staff get the right training, supervision and support they need from their managers. People are supported by an effective staff team who understand and do what is expected of them. 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. Staff recruitment procedures and training is good, people are supported by competent and qualified staff.protected by the homes recruitment procedures. Evidence: The homes staff numbers were checked and the home is fully established for all grades of staff. Other than care staff the home also employs a handyman 25 hours each week, a mini-bus driver 25 hours each week and a domestic 16 hours weekly. Duty rosters showed that staffing levels were being maintained. Two of the most recently recruited staff files read showed that all of the required documentation and checks had been completed. Some of the people living in the home are also involved in the recruitment process, two on the interview panel with a member of staff to support. This is to be commended and is good practice. A person who takes part in the interviews said I like to choose the best one. Staff training files were examined, which showed training had been carried out for Food Hygiene, Infection Control, Safeguarding, Nutrition/Well Being, Safe Handling of Medication and Fire Training. NVQ training has been ongoing since the last inspection with 27 out of 33 care staff having achieved NVQ level 2 or above. This is well above the level required and is very good. The organisation has a Training Manager and he either delivers training or organises an outside agency to come to the home. Formal supervision of staff is in place and records showed that this is occurring, also three Care Homes for Adults (18-65 years) Page 17 of 23 Evidence: members of staff spoken to confirmed they were receiving supervision at the specified levels of frequency. Care Homes for Adults (18-65 years) Page 18 of 23 Conduct and management of the 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 have confidence in the care home because it is run and managed appropriately. People’s opinions are central to how the home develops and reviews their practice, as the home has appropriate ways of making sure they continue to get things right. The environment is safe for people and staff because 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. They are safeguarded because the home follows clear financial and accounting procedures, keeps records appropriately and makes sure staff understand the way things should be done. This is what people staying in this care home experience: Judgement: People using this service experience excellent quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Quality in this outcome area is good. People benefit from a well run home, peoples health, safety and welfare is promoted and protected. Evidence: The manager of the home is an experienced practitioner and has been manager of the home since August 2004. Both himself and the deputy manager have completed the managers award training. The home undertakes annual audits of the service they provide people, relatives and staff are involved and action plans are carried out. Meetings are held monthly for staff, people who use the service and an additional one for Health and Safety. Minutes are kept of the meetings, people who use the service are encouraged to discuss any new activities or outings they would like. The manager also offers a meeting for relatives each month, however they are not attended. Regulation 26 visits by a senior company manager occur monthly and minutes of these visits were read and are appropriate. A selection of maintenance reports were looked at; PAT tests, Gas Certificate, Fire testing and Drills and all information was up to date. Care Homes for Adults (18-65 years) Page 19 of 23 Evidence: The system for the management of peoples personal monies was checked evidence was seen of regular transactions, money balances checked were found to be correct. People were observed interacting with the homes manager and it was clear that there was good rapport between both parties. Three members of staff were spoken to all three said the manager was very approachable and supportive to them in their job roles. Staff training files showed that staff had received Health and Safety training. The manager encourages people who use the service to be involved in the running of the home. One person takes part in the walk around of the buildings for the weekly quality audit, and another assists with the safety on the minibus. Care Homes for Adults (18-65 years) Page 20 of 23 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 Adults (18-65 years) Page 21 of 23 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 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 Care Homes for Adults (18-65 years) Page 22 of 23 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). This publication may be reproduced in whole or in part, free of charge, in any format or medium provided that it is not used for commercial gain. This consent is subject to the material being reproduced accurately and on proviso that it is not used in a derogatory manner or misleading context. The material should be acknowledged as CQC copyright, with the title and date of publication of the document specified. Care Homes for Adults (18-65 years) Page 23 of 23 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. Re-publishing this information is in breach of the terms of use of that website. Discrete codes and changes have been inserted throughout the textual data shown on the site that will provide incontrovertable proof of copying in the event this information is re-published on other websites. The policy of www.bestcarehome.co.uk is to use all legal avenues to pursue such offenders, including recovery of costs. You have been warned!