We last inspected Evergreen Residential Home (referred to as 'the home') on 6 October 2013. We raised concerns about certain aspects of how the home was looking after people living there. We asked the provider how they were going to address those concerns and by which date. They told us they would have achieved this by the end of April 2014. We returned this time to review the areas we were concerned with in October 2013 and in addition we looked at how the home was training and supporting its staff.There were 16 people living in the home at the time of our inspection. We spoke with people living in the home, relatives and staff. We also used our observation, to see how care was being provided, and read records kept by the home. We spoke with one professional who visited a person in the home.
A single inspector carried out this inspection. We spoke with eight people who lived in the home, read four care plans (these are the records that tell us how care should be delivered), spoke with two family members and two staff. We also spoke with two of the managers, of which there were three, during the day.
When we inspect we gather evidence to answer the questions below:
Is the service safe?
Is the service effective?
Is the service caring?
Is the service responsive?
Is the service well led?
Below is a summary of the inspection and what we found.
Is the home safe?
People told us they felt the staff were suitably trained to carry out their tasks. They stated 'I'm looked after very well' adding staff were competent in how they looked after them. We were also told 'They're alright; you are bound to get one or two who are not good.'
People's privacy, dignity and independence were respected. People told us that staff were polite and respectful when speaking and interacting with them. We observed that staff treated people with respect and used a balance of caring, kindly tones and humour when interacting with people.
Few staff had completed safeguarding adults training, but we were shown that the home was seeking to place staff on the training that the local authority was providing.
We found that people's care plans and records kept by the home did not address people's current needs. We also found the records lacked risk assessments to ensure that the person's individual needs had been assessed and their care planned accordingly.
There was a system in place to check the safety of the building on a weekly basis. We raised concerns about the fire exits to the rear of the building. People told us they could not always use the light above their sink as it was difficult to grasp. The emergency alarms in the en-suite and toilet facilities were either broken or short. These would be difficult to reach in the event of a fall.
CQC is required by law to monitor the operation of the Mental Capacity Act 2005 (MCA) and Deprivation of Liberty Safeguards (DoLS), and to report what we find. The DoLS apply to care homes and hospitals. We found that people's records included an assessment of their mental capacity and referenced whether the DoLS were relevant. Staff had been trained in the requisites of both the MCA and DoLS so reducing the possibility of people being deprived of their liberty illegally.
Is the home effective?
We found people who used the service were not being given appropriate information and support regarding their care or treatment. The eight people we spoke with told us that they had not seen their care plan or been involved with its design and development.
People told us the care they were being provided with was how they expected. For example, one person told us they had to have a special diet and this was catered for. We were told: 'The staff respect that I need time to do things; I'm slow and they rarely rush me'; 'They wash and dress me. I can't do that now'; 'The staff help me with washing. I can dress and do most things myself. The staff help with what I can't reach' and 'I am able to do most things myself; the home orders my dressing packs'.
People were supported in promoting their independence and community involvement. All of the eight people we spoke with told us they were encouraged to remain as independent as possible.
Is the home caring?
The majority of people told us their experience of living in the home was positive. People told us: 'I am looked after very well; generally I am happy'; 'My care is very good'; 'I'm alright; quite satisfied'; 'The staff are very good' and 'There's no better place in Plymouth; we're well looked after.'
One person when asked how they felt they were cared for, however, told us 'You pretty much look after yourself; they tell you off every now and then'.
Relatives told us: 'The home has been fantastic; they've been absolutely brilliant. My mum's come on leaps and bounds since being here. They spent time with her to settle her in' and 'I think my mum's content there.'
People told us there were a few activities in the week where they could complete jigsaws and quizzes but if the staff were too busy there was less interaction. Some people who were in their rooms stated that staff would drop in to see if they were alright, but we were also told 'Staff don't pop in to talk to me; not very often anyway. I'm usually on my own' and 'When staff bring a cup of tea they will have a few cheerful words.' We did not see staff providing activities and interaction beyond completing tasks while we were at the home.
Is the home responsive?
The home had been found to be noncompliant in several outcomes when last inspected in October 2013. They had provided us with an action plan and stated they would have the areas addressed by the end of April 2013. During this inspection we found areas of those action plans had not been fully addressed. We continued to have concerns about how the home was meeting people's needs. This raised concerns about the home responding appropriately to the concerns raised and ensuring these were addressed.
People told us they were always asked what food they would like to eat and were offered alternatives.
We found people's personal choices were not used as a foundation to their care plans and people who used the service did not always understand the choices available to them in respect of their care and treatment. For example, one person told us that they had a catheter in place and did not understand why this was.
Is the home well led?
There was not a Registered Manager in place. We were told that there were three managers responsible for running the home. Manager (1) was seeking to be registered as the Registered Manager and was the owner of the home. Manager (2) carried out duties similar to Manager (1). Manager (3) was responsible for the maintenance of the building, health and safety, repairs and was one of the Fire Wardens. Manager (1) and (3) were on duty on the day we carried out our inspection.
We were told that all three managers had recently reviewed their roles. Manager (1) and (2) had sought to ensure that they took on different responsibilities for different parts of running the home. They had recognised that there was duplication of roles and this was not supporting the home to progress.
People told us they knew Manager (1) was the owner of the home and had ultimate responsibility. People gave us a mixed picture of how they felt the home was run. People told us they 'rarely saw' Manager (1) but we were also told 'The person who runs it is a caring person; the home is really caring.'
The home had systems in place to ensure the maintenance of the building was up to date. The quality assurance system in place, however, had not identified the concerns raised by our most recent inspection.
We found the systems in place had not ensured people were protected from the likelihood of inappropriate and unsafe care.