The Care Quality Commission
  • Care Home
  • Care home

Archived: The Evergreens

Overall: Inadequate read more about inspection ratings

Hemlington Village Road, Hemlington, Middlesbrough, Cleveland, TS8 9DE (01642) 599744

Provided and run by:
Salco Homes Limited

All Inspections

6, 12 and 18 August 2015

During a routine inspection

We inspected The Evergreens on 6, 12 and 18 August 2015. The first day of the inspection was unannounced which meant that the staff and registered provider did not know that we would be visiting. We informed the registered provider of our visit on 12 and 18 August 2015.

The Evergreens is a complex of purpose built properties on the outskirts of Hemlington. The service comprises of five self-sufficient bungalows, Aspen, Redwood, Pinewood, Maple and Juniper. Each accommodates between four and ten people who have physical and / or learning disabilities

The home has not had a registered manager in place since 4 June 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. At the time of the inspection the project manager for Executive Care was acting as manager. The project manager is to apply for registration with the Care Quality Commission.

At our last inspection of the service on 19 December 2014 and 15 January 2015 we found that staff were unclear about what action they needed to take to ensure the requirements of Mental Capacity Act (MCA) 2005 were followed. There weren’t any records in place to confirm that staff had completed capacity assessments where appropriate and made best interest decisions. Staff did not know if people who used the service were subject to a deprivation of liberty safeguards authorisation (DoLS). From our review of records we saw that assessments and support plans had been developed but these had not been updated when people’s needs had changed. Effective systems for monitoring the service were not in place. The registered provider sent us an action plan telling us they would be compliant by 30 April 2015. At this inspection in August 2015 we checked to make sure that the registered provider had followed their plan. Following examination of records and discussion with the acting manager we found that the registered provider had not followed their plan and legal requirements had not been met.

Staff did not understand and work within the requirements of the Mental Capacity Act 2005. Capacity assessments were inaccurate or they did not clearly outline what decisions they specifically related to or why they had been completed. Where people had been found to lack capacity staff had not taken steps to complete ‘best interest’ decisions within a multidisciplinary team framework.

We saw that people had been deemed to lack capacity and then asked to sign consent forms for sharing their information and having their pictures taken. This was contradictory and staff could not explain the rationale behind these decisions.

Relatives made decisions for people but the care records did not to show whether relatives had become Court of Protection approved deputies, or if they had enacted power of attorney for care and welfare or finance or if they were appointees for the person’s finance. Relatives cannot make decisions about care and welfare unless they have the legal authority to do so and the person lacks the capacity to make these decisions for themselves.

We found that some people had difficulty making decisions; were under constant supervision; and prevented from going anywhere on their own. Staff did not know whether people were subject to DoLS authorisations, which are needed if people lack capacity to make decisions and these types of restrictions are made. DoLS is part of the MCA and aims to ensure people in care homes and hospitals are looked after in a way that does not inappropriately restrict their freedom unless it is in their best interests.

Care and support plans had been developed but these had not been updated when people’s needs changed. Information was recorded in the daily records but staff did not appear to use this to assist them to evaluate whether the support plans remained appropriate.

The arrangements in place for quality assurance and governance were not effective. Quality assurance and governance processes are systems that help providers to assess the safety and quality of their services, ensuring they provide people with a good service and meet appropriate quality standards and legal obligations.

The service’s procedures for recruitment did not protect people. Not all staff had completed an application form and proof of identity was not available for all staff employed. Gaps in employment were not always explored and one staff member had been recruited without a Disclosure and Barring Service check (DBS). The Disclosure and Barring Service carry out a criminal record and barring check on individuals who intend to work with children and vulnerable adults. This helps employers make safer recruiting decisions and also to prevent unsuitable people from working with children and vulnerable adults.

At times people who used the service showed behaviour that challenged to the point that staff needed to physically intervene. We found that staff had not received any training around the appropriate use of physical interventions such as physical restraint and breakaway techniques.

Examination of rotas and discussion with the acting manager identified that on some occasions the service had worked short because staff had not turned up for shift and alternative cover had not been found. It was agreed that staffing levels at times had not been sufficient and this had led to people not being able to go out. At times the service had needed to cover some shifts with agency staff. Agency staff at times had been the only staff in some of the bungalows.

We had concerns in relation to the management of medicines. Medicine storage was untidy and medicines were not stored appropriately. Medicines were not always administered as prescribed and appropriate records were not always kept.

We found that the registered provider did not provide adequate supervision and training to staff to enable them to fulfil the requirements of their role. Supervision is a process, usually a meeting, by which an organisation provide guidance and support to staff. We looked at seven staff files and found that five of the seven people had not received supervision.

There were systems and processes in place to protect people from the risk of harm. Staff were able to tell us about different types of abuse and were aware of action they should take if abuse was suspected. Staff we spoke with were able to describe how they ensured the welfare of vulnerable people was protected through the organisation’s whistle blowing and safeguarding procedures.

Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety.

There were positive interactions between people and staff. We saw that staff treated people with dignity and respect. Staff were attentive, respectful, patient and interacted well with people. People told us that they were happy and felt very well cared for.

We saw that people were provided with a choice of healthy food and drinks which helped to ensure that their nutritional needs were met. Nutritional screening had been undertaken and people were weighed on a regular basis.

People were supported to maintain good health and had access to healthcare professionals and services. People were supported and encouraged to have regular health checks and were accompanied by staff to hospital appointments.

People’s independence was encouraged and their hobbies and leisure interests were individually assessed. We saw that activities and outings were arranged and that people who used the service went on holidays. Staff encouraged and supported people to access activities within the community.

The registered provider had a system in place for responding to people’s concerns and complaints. People said that they would talk to staff and the acting manager.

The overall rating for this service is ‘Inadequate’ and the service is therefore in 'Special measures'. The service will be kept under review and, if we have not taken immediate action to propose to cancel the provider’s registration of the service, will be inspected again within six months. The expectation is that providers found to have been providing inadequate care should have made significant improvements within this timeframe."

We found multiple breaches of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2014. You can see what action we took at the back of the full version of this report.

12 March 2015

During a routine inspection

We carried out an unannounced comprehensive inspection of this service on 19 December 2014 and 15 January 2015. After that inspection we received concerns in relation to the food that people who used the service received. We had received concerns that food provided for people to take to day services was inadequate (mouldy bread and black bananas and on some occasions out of date.) We were told that people were losing weight. We were told that vegetables were rarely served with meals provided at the service. These safeguarding concerns have been reported to the local authority. The local authority will manage safeguarding concerns raised in line with their lead role and safeguarding procedures. We undertook a focused inspection to look into concerns raised. This report only covers our findings in relation to this topic. You can read the report from our last comprehensive inspection, by selecting the 'all reports' link for (The Evergreens) on our website at www.cqc.org.uk.

The Evergreens is a complex of purpose built properties on the outskirts of Hemlington. The service comprises five self-sufficient bungalows, Aspen, Redwood, Pinewood, Maple and Juniper. Each accommodates between four and ten people who have physical and / or learning disabilities.

The home had a manager who started working at the service in January 2015. The manager was in the process of completing their application to apply to be registered manager. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run.

We spent time in each of the five bungalows and spoke with staff and people who used the service. We also looked in kitchen cupboards, fridges and freezers. Staff told us how they and people who used the service did their own shopping and cooking. Staff told us that the food budget had been increased and that this enabled them to buy all the food that was needed.

In four of the five bungalows we visited, staff and people who used the service had been for their weekly shop. Staff in one of the bungalows told us that they did their weekly shop each Friday. We looked in fridges and saw cooked and uncooked meats, cheese, yoghurts, vegetables and other snacks. Food was found to be fresh and in date. There was a plentiful supply of dried and tinned products. In each of the bungalows we saw a large bowl of fresh fruit. We saw people who used the service eating fruit during the day.

Staff we spoke with during the inspection told us that new menus that had been introduced by the manager and included fresh and / or frozen vegetables at least four times during the week.

We observed the lunch time of people on Aspen unit. The meal time was relaxed. People and staff ate their food and chatted together. We saw that one person who used the service needed encouragement to eat and staff provided this.

Staff told us that for some people at risk of weight loss they provided fortified food for people who needed extra nourishment. Fortified food is when meals and snacks are made more nourishing and have more calories by adding ingredients such as butter, double cream, cheese and sugar. This meant that people were supported to maintain their nutrition.

We saw that people who used the service had undergone nutritional screening to identify if they were malnourished, at risk of malnutrition or obesity. The manager told us that they were aware that up until recently people who used the service were not always weighed on a monthly basis. We saw some gaps in the taking and recording of weights, however all people had been weighed in February / and / or March. On Redwood we saw some fluctuations in people’s weights; however this was thought to be due to faulty scales. People were to be weighed again and the scales calibrated to ensure that they were accurate. We found people’s weights to be stable.

During the inspection we spoke with the regional support manager who told us that menus were to change again in the very near future. Menus were to be analysed for their nutritional content, discussed with people who used the service and introduced over the coming weeks.

We spoke with the relatives of eight people after the inspection. We asked for their opinion on the quality and quantity of food served. Relatives did not raise any concerns in relation to the food served. One relative thought that staff needed to be more aware of ensuring a healthy diet by offering more fruit rather than biscuits.

We spoke with representatives from day centres that people attended. We found that some people had chosen to have their meals at the day centre and some people had chosen to take a packed lunch. Representatives from two of the seven day centres told us that previously there had been some concerns with the food that people who used the service had brought, however improvements had now been made.

19 December 2014 and 15 January 2015

During a routine inspection

We inspected The Evergreens on 19 December 2014 and 15 January 2015. This was an unannounced inspection which meant that the staff and provider did not know that we would be visiting. At the last inspection in September 2013 we found the home met the regulations that were reviewed. During this inspection we found that the provider had appointed a new manager but they did not come into post until January 2015 and we met this new manager on 15 January 2015.

The Evergreens is a complex of purpose built properties on the outskirts of Hemlington. The service comprises five self-sufficient bungalows. Each bungalow accommodates between four and ten people who have learning and physical disabilities. In total 29 people can be accommodated at the home.

The home has not had a registered manager in place since June 2014. A registered manager is a person who has registered with the Care Quality Commission to manage the service. Like registered providers, they are ‘registered persons’. Registered persons have legal responsibility for meeting the requirements in the Health and Social Care Act 2008 and associated Regulations about how the service is run. A manager was appointed to replace the registered manager but ceased working for the provider in September 2014. From September 2014 to January 2015 the regional manager and a deputy manager from a sister home ran the service.

During August and September 2014 the local authority and provider were made aware of concerns with the service. Since then the provider has reviewed the operation of the home and noted it was not running in the manner they expected. The provider has therefore increased staffing levels; employed cleaners; reviewed the competency of staff; improved managerial oversight; taken action to develop more appropriate care records; and is in the process of upgrading the bungalows

Staff had received Mental Capacity Act (2005) and the Deprivation of Liberty Safeguards training but were unclear about the requirements of the Act. We found that there were no records in place to show that staff completed capacity assessments where appropriate and made ‘best interest’ decisions. Relatives made decisions for people but the care records did not to show whether relatives had become Court of Protection approved deputies, or if they had enacted power of attorney for care and welfare or finance or if they were appointees for the person’s finance. Relatives cannot make decisions about care and welfare unless they have the legal authority to do so and the person lacks the capacity to make these decisions for themselves.

We found that people we spoke with were able to discuss a range of decisions they made. Some people required support to understand complex information and think through consequences of their actions. Other people had difficulty making decisions; were under constant supervision; and prevented from going anywhere on their own. Staff did not know whether people were subject to DoLS authorisations, which are needed if people lack capacity to make decisions and these types of restrictions are made. DoLS authorisations allow staff to deprive people of their liberty and can only be used if the person lacks capacity to make decisions and the choices they wish to make would put them at risk of harm. We found that the provider and manager recognised that further action was needed to ensure the staff understood how to apply the requirements of the MCA.

We saw that assessments were completed, which identified people’s health and support needs as well as any risks to people who used the service and others. These assessments were used to create plans to support plans for people to follow whilst they used the service. We found that staff needed to ensure these were updated and altered as people’s needs changed. At times staff were not recording the review of people’s needs that they had completed. Staff were able to discuss in-depth the support each person needed and how they worked with people.

Albeit the provider had systems for monitoring and assessing the service these had not supported them to identify concerns in the operation of the service during the summer. The provider had reviewed their existing processes and taken action to improve the quality of systems for monitoring the service. However, it was too early to determine if these would be effective long-term.

We spent time with people in each of the bungalows. We found that people required varying levels of support. We saw that staff provided people with support to manage their day-to-day care needs; learn independent living skills as well as to manage their behaviour and reactions to their emotional experiences. We found that the staff had taken appropriate steps to ensure people received care and support, which was tailored to their needs.

The people we met were very able to tell us their experiences of the service. They were complementary about the staff and found that home met their needs. One person told us about concerns that they had with a staff member. We explored this with the operational director and found that the staff no longer worked at the home and appropriate action had been taken, at the time, to investigate the concerns. Other people told us that they felt the staff had their best interests at heart and if they ever had a problem staff helped them to sort this out. People told us that they made their own choices and decisions, which were respected by staff but they found staff provided really helpful advice.

The other people we met had difficulty discussing abstract ideas, such as their views on whether the support provided at the home was appropriate but were able to share their views about day-to-day life at the home. People told us they liked living at the home and that the staff were kind and helped them a lot. We saw there were systems and processes in place to protect people from the risk of harm.

We observed that staff had developed very positive relationships with the people who used the service. We saw that staff were kind and respectful; we saw that they were aware of how to respect people’s privacy and dignity. Interactions between people and staff that were jovial.

People told us they were offered plenty to eat and assisted to select healthy food and drinks which helped to ensure that their nutritional needs were met. We saw that each individual’s preference was catered for and people were supported to manage their weight and nutritional needs. We saw that people living were supported to maintain good health.

Effective recruitment and selection procedures were in place and we saw that appropriate checks had been undertaken before staff began work. The checks included obtaining references from previous employers to show staff employed were safe to work with vulnerable people.

Staff had received a range of training, which covered mandatory courses such as fire safety, infection control, food hygiene as well as condition specific training such as working with people who experienced epilepsy. We found that the staff had the skills and knowledge to provide support to the people who used the service. People and the staff we spoke with told us that there were enough staff on duty to meet people’s needs. We saw that during the day at least two care staff and a waking night staff covered each bungalow. Throughout the week day there was the registered manager, an administrator and the domestic staff.

We reviewed the systems for the management of medicines and found that people received their medicines safely.

We saw that the provider had a system in place for dealing with people’s concerns and complaints. People we spoke with told us that they knew how to complain and felt confident that staff would respond and take action to support them.

We found that the building was very clean and well-maintained. Appropriate checks of the building and maintenance systems were undertaken to ensure health and safety. We found that all relevant infection control procedures were followed by the staff at the home. We saw that audits of infection control practices were completed.

We found the provider was breaching three of the Health and Social Care Act 2008 (Regulated Activities) Regulations 2010. These related to adhering to the requirements of the MCA, maintenance of the records and assessing the performance of the home. You can see what action we took at the back of the full version of this report.

9 September 2013

During a routine inspection

During the visit, we spoke with seven people who used the service and staff who were on duty in the houses. The people we spoke with told us that they liked the home and thought the staff did a good job. They said, 'I like it here', 'The staff are lovely,' They also said, 'The staff treat me well.'

Some of the people who lived at the home used non-verbal communication such as picture boards and Makaton (sign language). We saw that staff were adept at understanding these communication methods and determining what people wanted. From our observations, we found that the care staff supported people in a sensitive and empathetic manner. We found that staff were extremely committed to ensuring people received good care.

From our observations and what the people told us we found that the staff consulted them about their preferences and actively engaged them in making decisions about all of the activities going on in their houses.

We checked whether the staff applied the requirements of the Mental Capacity Act 2005. We found that the staff had a good understanding of the Act, how to apply it, and completed the appropriate records.

We found people's needs were assessed and care was planned in line with their needs. At the time of this visit there were enough qualified, skilled and experienced staff available to meet people's needs. Also an effective system was in place to ensure the on-going quality of the service was maintained.

13 March 2013

During an inspection looking at part of the service

We inspected The Evergreens in September and November 2012 and found that the service met three of the five outcomes we reviewed. We found that the staff needed to improve their record-keeping. Also, although the staff understood the Mental Capacity Act 2005 action was needed to ensure the service adhered to the requirements of this legislation.

At this visit we spent time observing care practices and met with 15 people who used the service. Some people at The Evergreens found it difficult to talk with us about their experiences but staff used various communication techniques such as sign language. We saw that these people challenged staff if they did not quite correctly relate their views.

People told us that they were extremely happy living at the home and found that the staff supported them to meet their needs. They told us about their planned holidays, which included cruises around the Mediterranean and kayaking activities. People said, 'The staff are brilliant', 'Staff help me do everything I want to,' and 'It is great here.' One person used a picture board to sign to us that they audited the home's finances on a weekly basis.

We found that staff had completed in-depth work around how to use and apply the Mental Capacity Act 2005 and staff now ensured all their actions met these legal requirements. Also we found that staff had improved their record keeping; introduced new care plan documentation and made sure this was kept up to date.

7 November 2012

During an inspection in response to concerns

We inspected The Evergreens in September 2012 and found the service met four of the five outcomes we reviewed. Currently the manager and staff are improving record-keeping in order to meet the compliance action we set. Following that inspection we were contacted by a person raising concerns around how the staff worked with people who lacked capacity and dealt with complaints. Therefore at this visit we concentrated on how the staff and provider adhered to their complaints procedures and staff understanding of the requirements of the Mental Capacity Act 2005.

At the visit we spent time observing care practices; talked with visiting relatives and the people who used the service as well as the staff. We found that staff ensured people had a range of interesting activities to participate in; actively ensured each person made choices about what they wanted to do; and dealt with complaints in an appropriate manner. We spoke with four people and one relative they were very positive about the service being provided at the home. The relative told us that they found that the staff were good at their job and 'Really went out of their way to champion people's rights'.

We found that although the staff understood the Mental Capacity Act 2005 action was needed to ensure the service adhered to all of the requirements of this legislation.

5 September 2012

During a routine inspection

Due to the nature of the illnesses and conditions of people who lived at The Evergreens, most of whom had learning disabilities, broad spectrum autism and other complex needs, we were only able to speak with two people who used the service and one relative. People told us that staff were nice and very friendly. They said that staff were never bad tempered and were always patient and helpful. The relative we spoke with was very happy with the support their family member received, visited frequently and had never seen any behaviour by staff which caused them any concerns.