Care Home: The Green

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What the care home does well Residents and their representatives generally stated that The Green provides good quality care and accommodation. Residents all commented positively about the quality and choice in the daily menus. Staff were felt to be `kind`, and `caring`. Residents and their representatives were positive about staff skills and attitudes. All residents have individual care plans are drawn up with their relatives` involvement where this is appropriate. Residents and their representatives commented that they have access to health care and felt that their health needs were met to a `good` standard. The home and local community provides a varied programme of activities. Visitors commented upon the pleasant atmosphere in the home. Cornwall Care Ltd is committed to staff training and is keen to continue to develop staff skills. Staff were complimentary about the training they receive. What has improved since the last inspection? The last report listed a number of statutory requirements and recommendations. We note that all of these have been complied with. In particular the content of care plans and assessment records has improved, as have general recording practices. Medication procedures have been tightened up and improvements made. Communication with Community Nurses has also improved and discourse occurs on a regular basis. Improvements to the environment have been made and more is planned. Areas of the home have been redecorated, new carpets laid and, improvements by way of privacy in toilets is noted. CARE HOMES FOR OLDER PEOPLE The Green Drump Road Redruth Cornwall TR15 1LU Lead Inspector Mike Dennis Unannounced Inspection 10:00 15 November 2007 th 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 The Green DS0000009107.V344391.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. The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Green Address Drump Road Redruth Cornwall TR15 1LU 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) 01209 215250 01209 313375 Cornwall Care Limited Mrs Susan Jacqueline Cain Care Home 45 Category(ies) of Dementia - over 65 years of age (45), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (45) The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. 2. 3. 4. Service users to include up to 45 adults aged over 65 with Dementia [DE E] Service users to include up to 45 adults aged over 65 with a mental illness (MD E] To accommodate up to 4 service users outside the registered age category of the Home Total number of service users not to exceed a maximum of 45 Date of last inspection 18th.May 2006 Brief Description of the Service: The Green is one of eighteen care homes owned by the Registered Provider, Cornwall Care Ltd. It is registered to accommodate forty-five older people with dementia or mental disorder. The Green is situated in a residential area of Redruth close to local amenities and a short distance from the town. The home also provides respite care and day care. The Green is a purpose-built home on two floors in its own grounds. There are seven individually named wings, which comprise residents’ bedrooms, toilet and bathing facilities, a lounge/dining room, and a kitchen area. There are three double bedrooms; the remaining rooms are for single occupancy. The three double bedrooms are currently being modified to provide for single, ensuite, accommodation. The main entrance to the home provides level entry and lifts provide access to both floors. There is a large lounge on the ground floor which is used for day care but is also available to residents and their visitors. A safe courtyard area is accessible to residents. Cornwall Care Ltd provides information about their services and the home in the statement of purpose and service users guide. The range of fees is currently from £383 to £620 weekly at November 2007. The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This was an unannounced key inspection. The purpose of the inspection was to follow up the provider’s compliance with the requirements and recommendations set in the last inspection report dated 18th.May 2006, and two subsequent random inspections completed on the 14th.July 2006, and the 8th. March 2007, and to focus on the key national minimum standards as identified by the commission. We were on the premises from 09:15 to 16:30. The methods used were discussion with the manager, staff, and residents, their relatives and visitors, inspection of records and documents, observation of the daily life of the home and inspection of the premises. We were also in receipt of a completed Annual Quality Assurance Assessment completed by the home which provided useful information. We are grateful to the providers, staff and residents for their assistance in completing the inspection. What the service does well: Residents and their representatives generally stated that The Green provides good quality care and accommodation. Residents all commented positively about the quality and choice in the daily menus. Staff were felt to be ‘kind’, and ‘caring’. Residents and their representatives were positive about staff skills and attitudes. All residents have individual care plans are drawn up with their relatives’ involvement where this is appropriate. Residents and their representatives commented that they have access to health care and felt that their health needs were met to a ‘good’ standard. The home and local community provides a varied programme of activities. Visitors commented upon the pleasant atmosphere in the home. Cornwall Care Ltd is committed to staff training and is keen to continue to develop staff skills. Staff were complimentary about the training they receive. The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 6 What has improved since the last inspection? What they could do better: 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. The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 7 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 The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1, 2, 3, 5, 6. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Prospective residents receive the information they require in order to make an informed choice about residing at The Green and their needs are assessed so that they can be assured that the home can provide the care required. EVIDENCE: A comprehensive Statement of Purpose and Service User Guide is available and is kept under review. The pre-admission assessments form the basis of the initial care plan. Training is supplied to support this programme. The assessment process is undertaken by the managers and care staff of the home. The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 9 Assessments are undertaken with the residents family or representatives, health professionals, and a copy of the social services assessment is obtained where applicable. The assessment includes a scoring system for calculation of dependency. Residents files contained signed contracts/ terms and conditions of the home. The contracts clearly stated that fees are reviewed annually in line with inflation/DSS increases. Relatives and residents confirmed the above processes. The Green does not provide Intermediate Treatment. The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7, 8, 9, 10. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents health, personal and social care needs are set out in individual plans of care which are regularly reviewed and amended. Medication procedures were appropriately followed EVIDENCE: All the residents case tracked had written care plans. Cornwall Care Ltd has a standard single format for assessment and care planning. At The Green staff were also using a ‘Care Profile’. This is a summary of the care plan used as a working document on each wing. The quality and content of the care plans has improved to include more information on the residents’ social and emotional needs. The plans clearly indicate actions and goals to be achieved. They do not specifically record the The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 11 result of such actions/goals, which is recommended. We did however find that the continuity records did in fact record improvements achieved. Comments in daily records have also improved and are now seen as being more explicit in terms of describing a persons’ lifestyle within the home. Staff retain separate daily records in respect of bathing, and, for some residents, food eaten and bowel activity and urine output etc. Information relating to residents was recorded and held in a various number of places and separate files. A recommendation was made during the course of the inspection that all information on each individual person, to include accident reports, was brought together and held in that persons individual master file. By the end of the day this task had been completed. Residents case tracked were all registered with local GP practices. Residents and their representatives felt that their health care needs were well-monitored and appropriate attention obtained. Staff maintain a record of medical contacts for each resident. The community nurses visit the home regularly. In the past there has been a significant number of recorded falls. Falls risk assessments have now been put in place and are appropriately analysed. As a result the number of falls occurring at this home has substantially reduced. Medicines are stored in locked cabinets in a locked room. The room and cabinets were tidy and well organised. A monitored dosage system is in use. No residents are currently assessed as being safe to administer their own medication. Residents sign a medicines agreement, and there were copies of these on file for all residents case-tracked. Cornwall Care has a corporate policy and procedure on the handling of medicines. Identified staff, who have completed training, have responsibility for the administration of medicines. The administration records were complete and well maintained. Where a hand written administration record is used, for example for recently admitted residents, a second person should check and countersign the record. A sample of controlled drugs was checked against the record and found to be accurate. The controlled drugs are stored in a small controlled drugs cabinet, which is appropriately secured within the main locked drugs cupboard. There is a record of medicines returned to the pharmacist. We observed staff providing care in a sensitive manner – for example in support with eating, and supporting people throughout the day with their needs and demands. The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12, 13,14, 15 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Residents are supported to follow a lifestyle, which accords as far as possible with their own choices and preferences. The diet provided is varied and nutritious with attention to individual preferences. EVIDENCE: The residents individual care plan has a detailed section regarding their interests and choice, and activities are planned to encompass these interests. The home arranges and facilitates visiting entertainment and in-house activities. Planned activities are displayed on a notice board. Flexibility is achieved throughout all aspects of daily living. Social Profiling or Active Care is promoted at this home. This in turn allows staff to target individual service users with activities most likely to provide The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 13 stimulation. Staff were observed to be sitting with individual residents at different times of the day, thus providing one to one stimulation. Various organised activities were taking place throughout the day of inspection. Morning activities included the breakfast club, reading, knitting and card making. In the afternoon flower arranging, a quiz and film hour were on offer. We observed visitors in the home and the visitors book indicated that relatives and friends frequently visit the home. Contact with the community is maintained in various ways. Residents are supported to venture into the community by way of group outings or as an individual. Various organised groups also visit the home from time to time. The midday meal was observed and appeared appetising. Service users received sensitive help with feeding as required. A varied menu is displayed each day giving choice. Mealtimes are unhurried and flexible The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): 16, 18. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home has a satisfactory complaints procedure that would ensure that complaints are listened to and acted upon. There are arrangements to protect service users from abuse. EVIDENCE: A comprehensive complaints policy and procedure is kept within the home. This procedure includes timescales and who will deal with the complaint. The home also keeps a complaints log for ease of reference. Residents indicated that they were aware of the procedures. The home has a comprehensive policy and procedure in place to protect residents from abuse. Policies are also available in regard to physical and / or verbal aggression from residents. Staff are made aware of these procedures during the induction period. The registered manager is also aware of the local social services procedure within “No Secrets” to investigate any complaints regarding the suspected abuse of any resident. CRB and POVA checks are undertaken, with Cornwall Care being the umbrella body to obtain these checks. The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 15 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19 and 26 People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The home is generally well maintained and provides a safe environment. The premises are clean and hygienic providing a pleasant environment and reducing risks to residents. EVIDENCE: The Green is a large building divided into seven separate wings on two floors, with a large communal lounge, and coffee bar and dining areas on the ground floor. Each wing has its own lounge, dining area and kitchen. Wings do not provide accommodation to residents with similar identified needs – for example there is no wing for people with more complex needs. The main entrance The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 16 provides a level entry and lifts provide access to the first floor. There used to be a contrast between the newer wings, which are bright, modern and in good repair, and the original wings, which appeared less appealing. Refurbishment and redecoration programs have greatly improved the appearance of the older part of the home. Bedrooms were personalised according to the wishes of the occupant. The original wings still provide three shared rooms. These rooms are currently being converted for single occupancy only. They will be provided with en-suite facilities. All the wings have an assisted bath. The home was clean and hygienic. We were impressed with the hygiene control at this home. There was no hint of any unwanted odours. There is a courtyard accessible to residents from the ground floor lounge. The laundry is separate from food preparation areas, well equipped with industrial standard washing machines and dryers, and complies with the standard. Good laundry practice information was on display and hand wash and paper towels provided. There are a number of sluices sited throughout the building. Most bathrooms provided hand wash and paper towels. Some remedial work is needed in the kitchen. We were informed that this is planned for and should commence shortly. The Green presents as being well cared for, comfortable and homely. The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 17 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27, 28, 29, 30. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. Recruitment procedures support and protect the service users. Staff are trained and competent to meet the needs of residents. The staffing levels are generally satisfactory. EVIDENCE: The roster details a minimum of eight sometimes nine, care staff during the morning and seven later in the day in addition to domestic staff (general assistants) and management. This allows one staff for each wing with a ‘floating’ worker. There is a full time cook, another cook for four days weekly and a kitchen porter. Three staff and a manager on call cover nights. Staff are recruited through the Job Centre and local press. Cornwall Care Ltd has standard corporate recruitment procedures. Two managers interview using set questions and keep a record of the interview. Records of recent recruitment contained application forms with health declarations, two references, and Criminal Records Bureau Disclosures. Staff records complied with the regulations. The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 18 The manager stated that at least 70 of the staff team currently hold an NVQ award at level 2 or above. New staff are enrolled on these courses. Training records showed that staff were up to date with required training in moving and handling, dementia care, food hygiene and health and safety. Newly appointed staff were beginning their inductions. The staff spoken with seemed generally content with their job roles. The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 19 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31, 33, 35, 36, 38. People who use the service experience good quality outcomes in this area. We have made this judgement using a range of evidence, including a visit to this service. The provider has appointed an experienced and qualified manager who has improved the care delivery to meet the homes stated purpose and objectives. The health and safety of residents and staff is promoted. EVIDENCE: Mrs Sue Cain has been in post for approximately 2 years and is the registered manager of the home. She has a management qualification and extensive experience of the care of older people. Mrs Cain had a clear view of what needed to be done to improve the quality of service provided at the home, and The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 20 has succeeded in making good progress and improvements in all areas which were listed as requirements in the last report. The management team also includes an experienced deputy manager and four assistant managers. This structure is under review and may be changed in the near future. A full independent quality assurance review has not been carried out this year but we understand that one is being planned for. There was however a review of staff opinions and comments. Cornwall Care provides safe keeping facilities for small amounts of personal spending money. We examined a sample of the records, which detail all payments in and out, and a running balance. The bulk of this money is held in a combined bank account for security and not as cash for each individual. Staff were satisfied with the level of support and supervision that they received. They were positive about the training provided by Cornwall Care Ltd. Records showed that some improvement has been made to ensure that staff are regularly supervised. Recorded evidence did not substantiate that all staff receive the required number of supervisions per year. (ie six). Staff training in health and safety is up to date. There were no obvious health and safety risks noted in the premises during the inspection. Hoists for transferring residents had records for recent services. Cornwall Care Ltd has a corporate policy on fire training and safety checks. These were all found to be in order. . The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 21 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 X 3 N/A HEALTH AND PERSONAL CARE Standard No Score 7 3 8 3 9 3 10 3 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 3 15 3 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 X X X X X X 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 3 X 3 The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 22 Are there any outstanding requirements from the last inspection? None STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. Standard Regulation Requirement Timescale for action RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1. 2 Refer to Standard OP9 OP36 Good Practice Recommendations When medicine administration records are handwritten, a second person should check them and sign to confirm this. Supervision of staff should occur more frequently in order to comply with the required 6 sessions per year. The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 23 Commission for Social Care Inspection Ashburton Office Unit D1 Linhay Business Park Ashburton TQ13 7UP 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. Extracts may not be used or reproduced without the express permission of CSCI The Green DS0000009107.V344391.R01.S.doc Version 5.2 Page 24 - 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. 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