Care Home: The Green Home for Older People

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What the care home does well What has improved since the last inspection? There has been a significant improvement in the amount of detail written in care records. These now show people`s likes and dislikes and give staff valuable information about each person`s care needs. People moving into the home have an up to date statement of the terms and conditions of their stay. This means that they know the rights and responsibilities of all concerned. What the care home could do better: Although care records have improved more work is needed to make sure that people`s needs are reviewed and recorded. This will make sure that staff have accurate information and that people`s needs are not overlooked. People admitted for regular respite care should have their care needs re-assessed at each admission so that staff have up to date information about their care and the home is sure that it can still meet the person`s needs. When people are admitted staff should carry out a nutritional and falls assessment. This will make sure that people at risk are properly identified. Staff whose job includes giving out medication should have proper training. This will give them more information about good practice and reduce the riskof errors. Staff should have training updates in areas such as moving and handling, food hygiene and first aid within the correct timescales. This will make sure that they are working to the correct standards. To prevent the risk of cross infection water-soluble bags must be provided, and be available, at all times when laundering soiled linen. A full list of the requirements and recommendations made as a result of this visit can be found at the end of this report. CARE HOMES FOR OLDER PEOPLE The Green Home for Older People Seacroft Green Leeds LS14 6JL Lead Inspector Ann Stoner Key Unannounced Inspection 2nd January 2008 09:30 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 Home for Older People DS0000033270.V357386.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 Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service The Green Home for Older People Address Seacroft Green Leeds LS14 6JL 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) 0113 2144166 michaela.conoby@gov.co.uk Leeds City Council Department of Social Services Miss Michaela Jayne Conoby Care Home 37 Category(ies) of Dementia (21), Old age, not falling within any registration, with number other category (37) of places The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: None Date of last inspection 2.1.07 Brief Description of the Service: The Green provides personal care without nursing, for 37 people of both sexes over the age of 65, in a purpose built two storey building in the heart of Seacroft, a suburb of Leeds. There is an adjoining day centre, which is independent of the home and is not regulated, therefore is not included in the inspection process. The home has recently changed its registration category so that it can provide care for up to 21 people who have a dementia. A shortterm respite care and an intermediate care service for people who will eventually return to their own home in the community is also provided. Accommodation for people staying at the home is in single rooms on two floors. There is a lift for those unable to climb stairs. Bedrooms and bathrooms are arranged in small units with communal open-plan sitting and dining areas on both floors. There is level access to attractive gardens and a car parking area. Local facilities including shops, pubs and public transport are within easy reach of the home. The fees range from £10.56 per night to £473.60 per week. There are additional charges for hairdressing and newspapers. This information was provided by the service in January 2008. More up to date information may be obtained from the home. Copies of previous inspection reports are available in the home. The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. The quality rating for this service is 2 star. This means the people who use this service experience good quality outcomes This was an unannounced visit by one inspector who was at the home from 09.30 until 17.30 on the 2nd January 2008. The purpose of the inspection was to make sure the home was operating and being managed for the benefit and well being of the people who live there and in accordance with requirements. Before the inspection accumulated evidence about the home was reviewed. This included looking at any reported incidents, accidents and complaints. This information was used to plan the inspection visit. A number of documents were looked at during the visit and all areas of the home used by the people who lived there were visited. A good proportion of time was spent looking at how the home provides care for people with dementia, observing staff working with people and talking to people at the home as well as with members of the management team and the care and catering team. The manager was not on duty on the day of the visit. An Annual Quality Assurance Assessment (AQAA) had been completed by the home before the visit to provide additional information. This is a selfassessment of the service provided. Survey forms were sent out to the home before the inspection providing the opportunity for people at the home; visitors and healthcare professionals who visit the home to comment, if they wish. Information provided in this way may be shared with the provider but the source will not be identified. A small number of surveys were returned and comments are included in the body of the report. What the service does well: One of the good things about this home is that staff not only know what they are doing they also know why they are doing it. Since the last inspection the home can now admit people with dementia. Staff were well prepared for this change and received a rigorous training programme about ‘understanding the needs of people with dementia’. They can see the benefits of this training and say that it has helped them to understand the special needs of people who have dementia. When working with people they are patient, sensitive, and discreet. They spend time making people comfortable with a choice of where The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 6 to sit and what to do. They are also very good at recognising when people are distressed and take immediate action if needed. Staff have a good understanding of the importance of people remaining in control of their lives and being as independent as possible. They encourage people to use tureens at meal times, but are always there to give support and assistance if needed. Well thought out changes have been made to the décor of the home so that it does not confuse people and named corridors help people to find their way about without getting lost. When people are disorientated staff offer reassurance and support. Staff recognise the importance of people keeping in touch with their friends and relatives and make sure that visitors are always welcome. There is a private sitting room so that visitors can have a chat in private with their friend or relative and overnight accommodation is available if needed. The home has extended the care service it offers to people. This has resulted in more visits to the home from other health care professionals. As a result the home has a wider network of professionals to call upon for support and advice, which in turn benefits everyone living at the home. The home is well managed and there is a real sense that people work well as part of a team. What has improved since the last inspection? What they could do better: Although care records have improved more work is needed to make sure that people’s needs are reviewed and recorded. This will make sure that staff have accurate information and that people’s needs are not overlooked. People admitted for regular respite care should have their care needs re-assessed at each admission so that staff have up to date information about their care and the home is sure that it can still meet the person’s needs. When people are admitted staff should carry out a nutritional and falls assessment. This will make sure that people at risk are properly identified. Staff whose job includes giving out medication should have proper training. This will give them more information about good practice and reduce the risk The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 7 of errors. Staff should have training updates in areas such as moving and handling, food hygiene and first aid within the correct timescales. This will make sure that they are working to the correct standards. To prevent the risk of cross infection water-soluble bags must be provided, and be available, at all times when laundering soiled linen. A full list of the requirements and recommendations made as a result of this visit can be found at the end of this report. 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 Home for Older People DS0000033270.V357386.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 The Green Home for Older People DS0000033270.V357386.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): Standards 1, 2, 3, 4, 5 & 6. People who use the service experience good quality outcomes in this area. People have the information needed to choose a home that will meet their needs. We have made this judgment using available evidence including a visit to this service. EVIDENCE: Information provided in the AQAA states that anyone thinking about moving into the home is encouraged to spend some time there and have an introductory period so that he/she, and the home, can be sure that needs can be met. On admission people are given a tenancy agreement, which is updated every six months. During the visit these were seen in people’s care records. They were up to date and signed by all concerned. Surveys completed by people living at the home and their relatives show that they had enough information about the home before moving in. A range of different leaflets and information is displayed in the entrance of the home, The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 10 including the statement of purpose, which gives detailed information about what the home offers. One of the ways that the home makes sure that it can meet people’s needs is by carrying out a pre-admission assessment. The pre-admission assessment information that was seen in people’s records had some good information for staff. However, these could be improved by including information such as where the assessment took place, who was involved in the process, any special arrangements needed for and before admission and more information about the what the person can do for him/herself. People admitted for regular respite have their needs re-assessed at some time during their stay. To make sure that the home is still in a position to meet their needs, some form of reassessment should take place before each respite stay. A discussion took place with a care officer about the best way to do this. The home has recently changed its registration category so that it can admit people with dementia and people who need an intermediate care service. A care manager said the home has an excellent working relationship with other professionals from the intermediate care team and described how staff at the home are offered immediate support when someone is admitted for this type of care. Staff have received training and when spoken to were knowledgeable about dementia and intermediate care. One person was admitted for a respite stay during this inspection. Staff were sensitive to this person’s needs, introduced themselves to him, and tried to make him feel at ease by offering a hot drink. The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 11 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 7, 8, 9, & 10. People who use the service experience good quality outcomes in this area. The health and personal care, which each person receives, is based on his or her individual needs. People’s privacy and dignity are respected. We have made this judgment using available evidence including a visit to this service. EVIDENCE: The AQAA states that the care planning skills of staff has improved in the last 12 months and this was confirmed during the inspection. Each person has a plan of care in the form of a Lifestyle plan. The level of recording on the Lifestyle plan has improved significantly since the last inspection and in the plans seen there was good information about the person’s life history and good information for staff about each person’s likes and dislikes, the level of support required and when and how assistance should be given. A care manager said that work is now on-going to bring the standard of reviewing care plans, on a monthly basis, to a level that clearly demonstrates how the Lifestyle plan is still meeting people’s needs. The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 12 This improvement must continue to make sure that the Lifestyle plan accurately reflects the person’s current needs. One person’s needs had changed significantly. A care manager said that a review meeting was being held within the next week to discuss whether the home was still in a position to provide the level of care this person now requires. The changes in this person’s care needs was not accurately reflected in her Lifestyle plan or risk assessments. This person had a risk assessment for the use of bed rails that said these were only to be used at certain times. From the care records is appeared that they were used on a regular basis and a recent entry said that the person had tried to get out of bed even though the bed rails were in place. To make sure that staff have accurate and up to date information, and that people receive the correct level of care required all care records must be updated and reviewed as needs change. Nutritional and falls assessments are not always completed on admission. This means that potentially some people at risk may not be accurately identified. However, in practice the cook described how the home makes sure people have nutritious snacks to increase their calorie intake and a care manager gave an example of how a falls analysis has identified that epilepsy may be responsible for the number of falls sustained by one person. There was evidence in care records of people having chiropody, optical and dental appointments and of visits by GPs (General Practitioners) and community nursing staff. A care manager said that input from the intermediate care team was also benefiting people living at the home on a permanent basis because nurses from the team are always willing to offer advice and support. This team have made referrals to other professionals such as occupational therapists not only for people receiving an intermediate care service but also for people living permanently at the home. Two surveys completed by visitors to the home show that they felt the home meets the needs of their relative and gives the support expected or agreed. Both felt that they were always kept up to date with important issues affecting their relative such as hospital admissions or accidents. Surveys completed by staff show that they feel there are good communication systems in the home, which gives them information about each person’s care needs. However, when speaking to staff during the visit they felt that care records for people admitted for intermediate care were confusing and information was difficult to find. This was found to be the case when looking at these records. A care manager said that this was an area that needed further development and was being addressed with the intermediate care team. From discussions with staff it was clear that they have a good understanding of people’s needs, and were able to describe how they recognise changes in people’s needs, particularly those people with a dementia who find it difficult to communicate. During the inspection they noticed that one person was limping and from her facial expressions seemed to show pain. Staff reacted The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 13 immediately; they were patient, gave reassurance and spent time with this person and asked her to ‘put her hand on where it hurt.’ This is good practice. Medication is managed properly, but some staff that administer medication have only received basic training from a local pharmacist and other staff at the home. A care manager said that these staff were still completing dementia training and then would start a distance training course on medication. A care manager explained how a recent medication error has resulted in changes to the way that medication is administered. Staff described the different ways that they respect each person’s privacy and dignity, and during the visit were sensitive and discreet when prompting and assisting people to the toilet. Everyone living at the home was smartly dressed, some had manicured nails and some were wearing jewellery. The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 14 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): Standards 12, 13, 14 & 15. People who use the service experience excellent quality outcomes in this area. People are able to make choices about their lifestyle and are encouraged to be as independent as possible. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The AQAA shows that the manager has a good understanding of equality and diversity and that the home provides flexible facilities that are varied and responsive to the unique needs of all individuals. Staff training on cultural and religious awareness is planned to take place during the next 12 months. During the inspection staff described the flexible ways that they work with people who have dementia. One care worker said that it was important to know the individual and deliver care that was right for him or her. She went on to explain how recent dementia training had helped her see the person as an individual first and their dementia second. Staff had a very good understanding of how behaviour can be a means of communication for some people. One care worker was very quick to see that one person appeared lost and gave immediate reassurance saying, “Would you like me to show you your The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 15 bedroom.” Another care worker said, “It is getting into a different mindset and working at a different pace with people.” When speaking about the different choices available to people this person said, “12 months ago people living here were able to tell you about their choices, now it is much harder to understand what people want.” She went on to describe how she shows people different options and sometimes reinforces this in writing. The AQAA states that the home is to introduce a ‘picture’ menu in the next 12 months. During the visit staff were patient with people and explained different choices, for example when serving afternoon tea, one carer took time to explain to people the difference between ginger and custard cream biscuits and asked if people preferred a cup and saucer or a larger sized beaker. Surveys completed by people living at the home show that they are able to make decisions about what they do each day. One person said, “On Tuesday I am going to town.” They all indicated that they can do what they want during the day, evening and weekend. One person, who was going home after her first respite stay, was upset at having to leave the home and the new friends she had made there. Her relatives said that she had settled very quickly and had ‘loved’ being there. Surveys completed by staff show that there is an ethos in the home of promoting independence. When asked what the home does well the following comments were made: • • • Helps maintain independence as far as possible Provides quality care offering support and promoting independence Promotes rights, choice and encourages independence. During the inspection one care worker encouraged and involved one person to fold tablecloths and napkins. The care worker told me that it was important to this person’s self-esteem to be actively involved in tasks. The lunchtime meal was relaxed and people were encouraged to help themselves to potatoes and vegetables from tureens, which is good practice. A member of staff said that just because someone has dementia it doesn’t mean they cannot serve themselves from a tureen. The cook described how he speaks to people living at the home before making any changes to the menu and said that the catering staff are willing to make a meal at any time. One person’s care records showed that she was offered food and drink during the night. The home recognises the importance of people keeping in touch with their family and friends and tries to make visitors feel welcome by offering refreshments and juice and biscuits to children. Two surveys completed by relatives of people living at the home show that they felt the home helps their relative keep in touch with them. Visitors can use a visiting room, which is decorated and furnished to give a ‘homely’ feel, for private conversations with The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 16 their relative. The AQAA states that overnight accommodation is provided for any visitor who has a sick or dying relative. This is good practice. The Green Home for Older People DS0000033270.V357386.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 & 18. People who use the service experience good quality outcomes in this area. People are able to express their concerns and have access to a robust and effective complaints procedure. There are robust safeguarding procedures in place to protect people from abuse. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: Information provided in the AQAA states that over the last 12 months there has been a low level of complaints and a high level of compliments. There is a robust complaints procedure in place and people are made aware of how to make a complaint. The home has received two complaints during the last 12 months; both were investigated by them properly and resolved. During the inspection information, in large print, about how to make a complaint was displayed in the entrance of the home. A discussion took place with a care manager about having an alternative format with pictures that might be more suited for people with dementia. Surveys completed by people living at the home show that they know how to make a complaint and that carers listen and act upon what they have to say. Surveys completed by visitors to the home show that they feel that the home responds properly if concerns are raised. The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 18 Care staff described the different types of abuse and were clear about reporting safeguarding (abuse) issues. A care manager was clear about the procedures she should follow if a safeguarding issue was suspected or reported. The Green Home for Older People DS0000033270.V357386.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 & 26. People who use the service experience good quality outcomes in this area. The design and layout of the home is suited to the needs of the people living there. Some practices increase the risk of cross infection. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The AQAA states that the environment is maintained to a high standard with an annual décor programme in place where priorities are scheduled. Facilities are adapted for older people and people with disabilities and communal space is to be increased in the next 12 months by building a conservatory. Returned surveys completed by people living at the home show that they are happy with the cleanliness. During the inspection visit the home was clean and tidy. There are good facilities for people who use a wheelchair and aids and adaptations for people who have a disability. The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 20 The home has made good use of signs and colour, which is good practice in dementia care. Corridors have been re-named and numbered. For example one corridor has a street sign saying, ‘Whitby Gardens’ and another ‘Bridlington Close.” A care worker said that this is important because it helps people to find their way about. Another care worker spoke about the importance of people ‘associating’ with where they live, hence the importance of having an address. A care manager said that the home is learning from experience and described how the walls have been redecorated with plain colours because one person was trying to pick the pattern off the wallpaper. She went on to say that the home is now thinking about changing patterned carpets to plain ones. Adapting the home, furnishings and fittings to the unique needs of people living there is good practice. A care manager said, that if not in use, the visitor’s room is used for meetings because it has a ‘homely’ feel and helps to put visitors at ease when speaking in a group. Staff had a good understanding of infection control but described a system of hand sluicing when dealing with soiled linen. A care manager said that the home has difficulty in obtaining water-soluble bags for laundering soiled linen, so they are not always available. This increases the risk of cross infection and is something that the home must address. The Green Home for Older People DS0000033270.V357386.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 & 30. People who use the service experience adequate quality outcomes in this area. Staff in the home are skilled and in sufficient numbers to support the people living at the home. The organisation’s central training programme does not always meet the needs of the home, which means that some staff do not have training updates as often as they should. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: Information in the AQAA shows that there is a good mix of full time and part time staff and a varied age range. Staff said that staffing levels had improved in the last 12 months and that they have time to spend with people. Surveys returned from staff also confirmed that that they feel that staffing levels are right for the needs of people living at the home. During the inspection there seemed to be sufficient numbers of people on duty and they were spending time with people. A member of staff saw that one person with dementia was distressed and immediately suggested that they go somewhere private for a chat. Two surveys returned from people living at the home show that they both felt that staff have the right skills and experience to look after people. The AQAA shows that there is a high emphasis placed on training and that staff The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 22 appraisals and supervision feeds into the annual training plan. During the inspection a care manager explained how this works in practice, but because of availability of courses swift access to them is not always possible, which means that some people are waiting several months for a place on a course. This has resulted in first aid, food hygiene and infection control updates being long overdue for some staff. This is outside of the home’s remit and something that the organisation should address. Over 50 of staff have an NVQ (National Vocational Qualification) in Care and a further 6 are currently being assessed. In surveys all staff felt that induction training covers the things initially needed to work with people living at the home. During the inspection visit a new care worker confirmed that she was completing an induction programme and was shadowing a more experienced member of staff. Recruitment records were sampled during the inspection visit. All the necessary pre-employment checks had taken place. The Green Home for Older People DS0000033270.V357386.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 & 38. People who use the service experience good quality outcomes in this area. The management of the home is based on openness and respect and is led by a qualified and competent manager. We have made this judgment using a range of evidence, including a visit to the service. EVIDENCE: The AQAA shows that the manager has a good understanding of equality and diversity and from discussions with staff and observation during this visit it is clear she is supporting staff to adopt a person-centred approach to care. The manager has NVQ level 4 qualifications in both Care and Management. Two care managers support her and all are highly regarded by staff. Care staff said that the management team are accessible and are willing to listen to their views and opinions. They said that they felt there was a good team working The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 24 relationship throughout the home, which benefited the people living there. A care manager said one of strengths of the management team was their consistent approach to dealing with issues. Meetings are held regularly for people living at the home and the recent introduction of a newsletter keeps people informed of any new developments. A care manager said that quality assurance questionnaires are distributed regularly, the latest were sent out in November 2007. Information from these has yet to be analysed. Feedback from the analysis is made available to people through meetings, visitors’ coffee mornings and in the home’s newsletter. A care manager described the systems in place to make sure any money handed in for safekeeping is managed properly. Clear records are kept of all transactions and the home is subject to external audit along with a system of frequent in-house ‘spot checks’. Health & safety is well managed. The AQAA states that the manager and senior staff have completed health & safety training and make sure that there are policies and procedures in place to protect the well being of staff and people living at the home. The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 25 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 3 3 3 3 3 3 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 4 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 2 STAFFING Standard No Score 27 3 28 3 29 3 30 2 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 X 3 X 3 X X 3 The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 26 Are there any outstanding requirements from the last inspection? No STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP26 Regulation 13 (3) Requirement The practice of hand sluicing must cease. Water-soluble bags must be provided and available at all times for laundering soiled linen. Timescale for action 28/02/08 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 1 Refer to Standard OP3 Good Practice Recommendations Pre-admission assessments should be more detailed. This will make sure that from looking at this document it is clear where the assessment took place, who was involved in the process, what, if any, special arrangements for admission are required, and the precise level of tasks the person can do for him/herself. People admitted for respite care should have their needs re-assessed before each respite stay. This will make sure that the home is still in a position to meet his/her needs. Development work on care plans should continue to make sure that they are reviewed and accurately reflect any changes in the person’s condition. This will reduce the risk DS0000033270.V357386.R01.S.doc Version 5.2 Page 27 2 OP7 The Green Home for Older People 3 4 OP8 OP9 5 OP16 6 OP30 of needs being overlooked. Nutritional and falls assessments should be carried out on admission and updated as required. This will make sure that those people at risk are properly identified. Additional training that reflects best practice guidelines should be provided to all staff involved in the administration of medication. Having well trained staff helps to reduce the risk of medication errors. The home should consider revising information about how to make a complaint so that it is in a format that is suitable for people with dementia. This will make sure that this information is suitable for everyone living at the home. Mandatory training updates should be provided within the required timescales. This will make sure that staff practices are up to date. The Green Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 28 Commission for Social Care Inspection Aire House Town Street Rodley Leeds LS13 1HP 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 Home for Older People DS0000033270.V357386.R01.S.doc Version 5.2 Page 29 - Please note that this information is included on www.bestcarehome.co.uk under license from the regulator. 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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